Acute Back Pain Treatment

Acute back is a recent, short-term injury, with possibly sharp pain, restricted movement or inflammation within about the last 6 weeks. You probably have three main objectives:

1. Get out of pain
2. Get moving again
3. Return to work and being active

Possibly, and especially if this has happened before:

4. How can I prevent having another acute episode

Treating acute back pain is about getting you back on your feet, back to work and generally feeling normal again. Once the pain has settled and movement in the back has returned, the focus can shift towards prevention and avoiding the stresses that caused the pain in the first instance. Often back pain comes on for no apparent reason and acute back pain is a short-term injury (see Acute vs Chronic Back Pain).

Protective or guarding muscle spasm

When an injury occurs the body’s reaction is to protect the injured area by tightening the surrounding muscles to prevent further strain. As with many auto-immune conditions, the body does not help itself by over-doing this muscle guarding. In acute back pain, it is the muscle spasm that causes much of the pain and immobility, which actually slows down the healing process and puts us out of action for longer.

How is Acute Back Pain Treated?

Understanding the cause of the acute pain

The first step is to figure out, if possible, how the pain came on, and to rule out anything more serious called ‘Red Flags’. If it’s a fall, accident or trauma then we at least understand why it’s happened and it is important to gauge whether X-rays or MRI scans are required, or whether it was only a mild trauma where scans are not indicated. Most acute back pain (around 85%) is mechanical or musculoskeletal (MSK) in nature but Chiropractors are trained at spotting any indication of any medical causes of back pain which, whilst rare, may require referral for medical investigation.

Since most back pain settles within 12 weeks, GPs and consultants are unlikely to consider referring for X-rays, MRI scans, or to a spinal specialist or further investigation during this time, unless there are ‘red-flags’ present that indicated more urgent attention is required. This can often leave you in an unhappy state of feeling simply brushed-off or neglected by your doctor and frustrated that the painkillers aren’t helping greatly, or you may be in a waiting list to see the physiotherapist. Perhaps this leaves you not only in considerable pain, but also frustrated and worried, especially if you are unable to work. Provided the condition is musculoskeletal in origin, it can be treated in the following way:

Chiropractic Treatment in the early stages of acute back pain

Chiropractic Research has shown early treatment to be excellent at achieving a faster recovery and helping prevent recurrence.

Main Goals of initial treatment:

• Reduce muscle spasm and tightness that causes much of the pain

• Reduce inflammation and swelling

• Restore joint mobility and flexibility

• Achieve an early return to work and normal life

• Breaking the pain cycle and restoring muscle-joint movement and balance

• Help prevent the muscles and joints from becoming chronically locked or fixed long-term

• As with many medical conditions, treatment is best done early.

• Prevent long-term withdrawal from normal activities, or long-term absence from work.

The RCGP guidelines for management of acute lower back pain are, in summary:

• Manipulation provides better short-term improvement in pain and activity

• Avoid bed rest – it can lead to debilitation, disability and difficult rehabilitation

• Stay as active as possible and continue normal daily activities

• Stay at work or return to work as soon as possible
• Back exercises don’t help acute back pain, so avoid trying to ‘strengthen’ the spine at this stage.

Common Signs of Acute Back Pain

Locking whilst being ‘static’

• You may sit down without pain, but when you go to get up you extremely stiff and may feel locked forward. It usually eases after a short time, and as the back pain settles it takes less and less time for the back to loosen as you move about.

• Standing still is quite often very painful and to be avoided. For example, you go shopping and are fine moving around the store, but as you stand in line waiting at the checkout your back muscles spasm and you simply can’t wait to get out of the store.

Prolonged bed rest

• You wake in the night in pain as you go to turn, when the muscles have been static lying on one side

• It’s painful to get up in the morning and can take some time before you can move easily, sometimes the first few steps are excruciating.

Action Plan if you’re in Acute Pain

• Help the muscles to relax!
• Stop if you’re playing sport or in the middle of cleaning, or DIY.
• Perhaps lying down to rest the spine may be helpful – but not for too long.
• If you can walk or move gently this is often very helpful.
• You can take some painkillers, provided you are not allergic
• Ice treatment (usually not heat) immediately may be helpful to reduce inflammation.
• Don’t just sit, or stay static in one position too long
• Rest your back which means varying your activity, some lying, some gentle movement
• Seek treatment if you can.

Stay active gently to help acute back pain!

Muscles can be helped to relaxed by moving gently, but don’t overdo it. Do what is comfortable, listen to your body and try to relax. There is a fine line between exercise and strain, and this fine line becomes extra fine when we have an injury. It can be tricky at best sometimes to not over-do it and cause some relapse with some reactive muscle spasm. Just listen to your body and do whichever movement you can comfortably:

Perfect gentle exercises that can be done whilst the back pain is acute:

• Walking is the simplest, see below

• If walking is too painful, standing bending forward arms on a table or supported, just walking on the spot gently.

• Cycling gently, even on a static bike if you are in too much pain or do not feel safe to ride

Whilst it can be a hassle to get into a swimming pool, once you are there it can help tremendously:

• I’m a huge fan of Swimming and this is one of my own favourite activities when my back has spasmed. I’m fortunate (well, not really, I’ve worked hard to develop a good technique) to have a very relaxed swimming style, so when my back has locked up I swim very gently. The worst part is just turning at each end, which I simply do very gingerly.

• Aqua-aerobics or simply walking and relaxing in water. If you can’t swim, then just perhaps walk up and down, or use a spaghetti float and lie and relax gently, perhaps moving the legs. This can be amazing to help the muscles relax.

• Lying on your back gently rocking your knees from side to side, pulling one knee up to the opposite shoulder, then swapping and then pulling both knees to your chest.

• Roll over into crawling position and rocking ‘cat-arch’ exercises.

Don’t stay static too long

The danger of sitting too long cannot be stressed strongly enough. Sitting is the activity that puts most pressure on the spine and surrounding muscles, so only sit for short periods of time when it is absolutely necessary. Injured muscles can tend to cramp and lock in ANY position, so gentle variety of comfortable movements is the best solution.

Walking to help Back Pain is one of the best exercises.

• Walk at your OWN comfortable pace.

• Relax the arms and shoulders.

• Please, no handbags!

• Try to go out and walk in a straight line.

• Walk on an even surface if possible.

• If pain comes on, stop, but go for regular short walks.

• If you feel comfortable, then go further, but build it up as it’s important you don’t overdo it to find yourself in more pain later.

It is very common for people with back pain to find slow or stop-start walking or standing worsens the pain, i.e. when shopping for too long, but that walking more quickly at a relaxed comfortable pace helps much more to loosen the muscles. At other times, waking too quickly can be a struggle. Once again this is very personal, so listen to your body.

Lying down can be very helpful in the day for short periods, to break up the sitting and standing. You can either lie on your back with the hips and knees flexed (See Resting your back Lying down) or simply lie on your sides in the recovery position. Avoid prolonged bed rest. You may feel that you need to protect yourself and avoid movement, but this can make matters worse and slow the recovery.

Ice usually, not heat

When there is swelling or inflammation, it is usually correct to use ice. It helps reduce pain and greatly speed up the recovery time and the sooner you can apply the ice (wrapped in damp towel) the better. Heat can often aggravate or worsen the swelling so usually should be avoided. I encourage clients to ring or ask prior to Chiropractic treatment to clarify whether to apply ice or heat. For more information, please read the full Ice Treatment article.

Pain-killers and anti-inflammatory treatments for the back

Whilst frequently prescribed by the medical profession, there is also clear indication that drug treatments are controversial and may not have much effect of helping the back pain; please Read GP Guidelines for Back Pain. There are clear side effects on the stomach with NSAIDs (Non-steroidal anti-inflammatory drugs), so please, short-term use only, NOT long term.

Herbal treatments that can help reduce inflammation

There are several herbal remedies for inflammation that can be used, and more natural treatments such as homeopathy. These can help although it’s difficult to guarantee their success. Provided you take them sensibly, and not excessively, they are generally safer with less harmful effects than some of the stronger prescription drugs.

Seek treatment soon!

Finally, seek treatment soon. Don’t leave it too long if you are in acute pain. Sometimes there is no substitute for treatment that can so often dramatically speed up the recovery process.

Preventing a Recurrence of Acute Back Pain

I’m sure you want to do everything you can to help prevent a recurring acute pain. This important question can be addressed, once the acute phase of the back pain has passed, and falls more under the Treatment of Chronic Back Pain. See also Acute vs Chronic Back Pain.

Please find below a downloadable PDF with advice for treating acute lower back pain.