A bout of back pain can be extremely frustrating as well as worrysome. It is also very common with over 80% of people experiencing it in their lifetime.
What should you do if you have back pain?
Recent research and guidelines suggest education about back pain should form an integral part of treatment. Learning about back pain- what causes it and the expected recovery times, as well as knowing the right things to do (and what not to do) can be really effective in helping you recover more quickly.
This back pain educational guide has been developed by Grantham Chiropractor Mark Jessop. It has been developed using the recent Lancet series publication on low back pain (published March 2018) which summarises all the best research to date about the prevention and treatment of low back pain.
This 5 step recovery guide is specific to a new onset of back pain which has been present for less than 6 weeks. It is also known as acute low back pain.
1) Don’t panic
First of all don’t panic. It heals and gets better for most people. Remember more than 80% of people will get back pain at some point, it is normal to experience back pain and is usually drastically improved after 2-6 weeks.
Although I appreciate that can feel like a long time when you are in pain. It is important not to get too worked up and worry about it though as this has been shown to actually make it worse. Having said that most of the time back pain gets drastically better within 2-6 weeks (which is true) it is also highly likely to return and does so for 70% of people within the next year. We will cover how to help prevent this later on.
What causes back pain? Well in the vast majority of cases, over 90% no specific cause can be identified. Less than 1% is due to a serious pathology such as a fracture, cancer or an infection. Around 5-10% is due to nerve root pain – but this will also be accompanied with other symptoms such as pain into the leg along with pins and needles and/or numbness and/or weakness.
The rest of the time, so around 90% of the time no specific case can be identified and this is given the label “non-specific” low back pain. So non-specific low back pain makes up the vast majority of back pain we have.
This does not mean that there is no cause! It means that the causes are multifactorial and complex and not one specific structure can be identified as the single cause. It also means that in the absence of any indication of a serious or neurological cause any imaging such as MRI scans or x-rays will not tell you what is wrong.
In summary – Don’t panic. The vast majority of back pain is not serious and will be drastically improved within 2-6 weeks. In the section we will cover warning signs to monitor and when it may be important to seek further medical advice.
When to seek medical advice
As we said earlier that vast majority of back pain is not due to anything serious. But sometimes it can be so what are the indications that you may need to seek medical advice.
You should seek immediate medical advice by calling 111 or going to A&E if:
- You experience loss of your bowel or bladder control, altered sensation such as numbness or tingling in the saddle area (genitals or buttocks) or difficulty urinating.
- If your pain came on following a severe trauma such as an accident or fall.
You should seek advice from your GP if:
- Your back pain is accompanied by high fever or temperature or came on following a severe illness.
- Your pain wakes you up at night and you are unable to get back to sleep.
- If your pain is severe and constant and not eased by rest or related to physical activity .
- If you have or have previously had cancer such as prostrate, breast, kidney or liver cancer.
So if you have any of the above symptoms it is advisable to seek advice from your GP. The next few sections cover what you should do If your back pain is not accompanied by any of these symptoms.
2) Keep active
You might feel like all you want to do is rest however this can cause the back to cease up and the muscles to loose some of their strength, it is probably one of the worst things you can do. It is well established that keeping active will lead to a faster recovery. Listen to the pain though and do not over do it by doing anything that makes the pain feel a lot worse, but moderate activity such as walking and everyday tasks should ease your recovery.
Trying to continue with your daily activities as much as is possible is one of the best things you can do. This includes going to work. If you are able to work then continue to work. Taking time off has been shown to harm recovery and not help so despite it being painful you are best off working. You can either be at home in pain or at wrk in pain- but at least if you are at work you will be doing something and that might take your mind off it. Obviously if your work is of a very physical nature and aggravates the pain or if the pain is so severe you are unable to work then don’t, but, try to get back to work as quickly as you can, even if it means doing lighter duties.
You might also want to do some gentle mobility exercises. Good examples are the cat-camel, low back rotations, knee to chest and back extension exercises. These exercises can help the movement in your back and speed up recovery. They should not be painful to do though so if any of them are painful don’t force yourself to them and just do the others, although it doesn’t matter if they are slightly uncomfortable- you will not be causing more damage. If you find one of the exercises is especially beneficial then do this one more. Do the exercises little and often throughout the day- maybe even as often as every couple of hours if you are able.
In summary it is best to keep active and continue with life as best as you can, despite the pain. It will speed up your recovery. In the next section we will look at ways to help you do this by looking at strategies to decrease your pain.
3) Use ice/heat or painkillers to reduce pain
If there was no specific cause of your back pain (it just came on by itself) guidelines recommend using heat to help relieve the pain. However if your back pain came on as the result of an injury such as lifting something too heavy and/or twisting awkwardly then for the first 48hrs ish you might like to try ice instead. At the end of the day it is important to choose whatever works best for you- but unless you are in the early stages of an injury it is recommended to use heat. You might also like to try alternating between heat and ice.
If using heat- use a covered hot water bottle, wheat bag or heat wrap (they are much better than the heat creams which do not actually heat up any of the body tissue under the skin)
Put it on the area for around 20 mins and repeat this up to every hour or so. You can also have a hot bath or shower to help provide pain relief.
If using ice – use a cold pack or bag of frozen peas and cover it with a damp tea towl. Apply it to the back for 20mins and repeat every hour.
You can also try using both cold and heat. Try using ice first, followed by heat.
If you are not getting enough relief with this you might like to try some over the counter pain killers such as ibuprofen. Paracetamol is not recommended as studies have shown it to be ineffective for back pain. Ibuprofen has more risks associated to taking it and you should always read the label to be aware of these risks and speak to a pharmacist if you are unsure about taking them. Other stronger medications such as codeine (or co-codamol) or muscle relaxants such diazepam can be effective but due to the risks and side effects are not recommended for routine use with low back pain and should only be used in selected patients and with caution. It is best to discuss this with your GP and they should only be taken for as short a time as possible due to the side effects.
In summary- apply heat to the area for 20 mins at a time a few times per day or if it is a recent acute injury you can use ice for the first 48-72 hours. If this is not providing enough relief then try over the counter pain medications such as ibuprophen and if this still doesn’t provide enough relief you can speak to your GP about other options. In the next section we will look at seeking treatment for acute low back pain and what treatment is effective.
4) Seeking treatment
If you are worried about the pain, it is getting worse or has not started to subside after a couple of weeks you can seek advice or treatment. It is advisable to seek advice from a regulated health care professional that commonly treats back pain such as a Chiropractor, Physiotherapist or Osteopath as these professions are regulated. This means unless they are properly qualified will not be able to call themselves by that title and they must have a minimum of University degree education. They will commonly treat musculoskeletal problems such as back pain and are able to perform a proper examination and provide appropriate treatment to help you recover. Whoever you choose it is important that they listen to you and take your preferences into account when treating you and it is essential they give you advice as to what you can do to help yourself.
According to the recent Lancet papers effective treatment to compliment education and the advice to keep active are spinal manipulation, acupuncture and massage. They also state supervised exercise therapy can be of limited use in selected patients as can cognitive behavioral therapy. This is similar to the UK guidelines issued by NICE (national instate of clinical excellence) although the NICE guidelines do not include acupuncture.
5) Preventing a recurrence
As was said previously the vast majority of back pain will be significantly improved after 2-6 weeks. However unfortunately more commonly than not (70% of the time) it will recur in the next 12 months. So what can be done to help prevent this?
Exercise! Exercise alone or in combination with education is effective in the prevention of low back pain.
Education based on the science of why we feel pain has been shown to be superior to education based on anatomy and ergonomic advice on lifting.
It does not appear that any form of exercise is better than any other so what is important is that you do exercise you enjoy doing. This is because if you enjoy doing it you are more likely to continue doing it. Jogging, walking, swimming, cycling, pilates, yoga, Tai Chi, working out at the gym. All of these are examples of exercises that will help prevent back pain. A graded exercise programme to increase fitness levels is important. However it doesn’t necessarily have to be exercise or sporting activity. Increasing your general physical activeity levels through vigorous cleaning, gardening or walking- will also help guard and prevent a future recurrence of back pain.
Sometime though for some people back pain is a recurrent condition and like some people get cold sores some people get recurrent back pain. If you do get another bout of it- don’t get frustrated – easy for me to say I know but frustration will cause more tension in the back and make it worse. Be reassured that it is unlikely to be due to any damage- it doesn’t mean something is wrong with your back and it will subside- do the things you have found to be beneficial in previous episodes and wait for it to pass.