Acute Low Back Pain
The doctor has assessed your back pain as being due to either "mechanical" reasons (muscle and ligament injury) or due to a bulging, intervertebral disc which is pinching a nerve. Over 90% of people with either of these conditions recover fully by 6-8 weeks after onset. Less than 10% of people go on to have chronic back pain after this time. In fact, most people feel a lot better within 1-3 weeks. The initial treatment for both types of pain is identical. To have the best chance for a rapid and complete recovery, follow these simple rules:
Rest: For severe pain, the first 24-48 hours should be spent lying on your back on a firm mattress or on the floor. You should only get up to eat and go to the bathroom. Try one of the following positions for comfort:
Ice: For the first 1-2 days, apply an ice pack or bag of frozen vegetables wrapped in a damp towel to the painful area every 2-3 hours for no longer than 10-15 minutes at a time. If this fails to relieve the pain, try heat immediately after, or instead of the ice. After 48 hours, switch to heat.
Heat: Moist heat usually works better than dry heat. Put a moist towel against the skin of your back with a number of layers of dry towels over top. Apply a heating pad with a waterproof cover or a hot water bottle on top of this or soak in a hot bathtub or whirlpool for 15-20 minutes at a time, every 2-3 hours during the first 2 days. After the first 2 days, use heat once or twice per day especially before performing stretching exercises.
Medication: The doctor may have prescribed a muscle relaxant, pain killer or anti-inflammatory medication to try and give you some relief from your pain. You may experience temporary drowsiness as a result. If this occurs, avoid activities requiring you to be alert, such as driving a car. Avoid alcohol while taking this type of medication. Codeine products may upset your stomach and constipate you. You can relieve this by taking them after meals and by eating extra bran cereal, bran muffins, prunes, or by using a bulk laxative such as Metamucil. If no medication was prescribed, you may use acetaminophen (Tylenol) in a dose of 2 regular or extra strength tablets, taken every 4 hours.
Posture: As the pain decreases, you should begin moving as much as you can. Try to maintain a straight back when getting up from a bed, or when sitting or standing up for a long time. When sitting, use a firm chair, with your back held fairly straight, and a small stool for your feet. A small cushion or rolled towel in the small of your back, or an Obus Forme may also help. When standing for long periods, put one foot at a time on a small stool or bench to relieve strain on your back muscles. Change positions frequently.
Activity: Avoid lifting or repetititve bending in the first 2-3 days. During the first 48 hours, you should try to do some slow, gentle stretching while lying down, such as pelvic tilts, curls or extension stretches. Stop if you experience a lot of pain. To get into bed, sit on the edge, lower yourself sideways with your arms while you lift your feet up at the same time onto the bed. Then roll your shoulders and hips at the same time onto your back. To get out of bed, turn on your side facing the side of the bed, bend your knees up, then push yourself up sideways with your hands as you lower your feet to the floor.
If you are not feeling any better after 48 hours of rest, you should be seen by your own doctor to reassess your condition and to advise you when you can begin an active rehabilitation program. This may include some take home exercises or an early referral to physiotherapy.
The following are some simple stretches and exercises that you can do at home, within the first few days, as your pain allows:
Pelvic tilt - Lie on your back with knees bent and feet flat on the floor. Press the small of your back against the floor and tighten your stomach and buttock muscles. Pull your belly button towards your chin - do not push with your feet. This should cause the lower end of the pelvis to rotate forward and flatten your back against the floor. Hold for 6 seconds then relax for 6 seconds. Repeat six times per session every 3-4 hours. Remember to try and breathe normally without holding your breath while doing these exercises.
Knee-Chest - Lie on your back with knees bent and feet flat on the floor. While doing a pelvic tilt, slowly bring one knee to your chest. To begin with, you may have to pull your knee up gently with your hands. Hold for 6 seconds, then return to the starting position and relax. Repeat 6 times for each leg. If this does not cause a lot of pain, bring one knee to your chest and while holding it there, bring the other knee up also. Clasp your hands around both knees and pull gently until you feel a stretch. Hold for 6 seconds. Repeat 6 times.
Extension - This type of stretch is good for most types of back pain but especially good for pain caused by a prolapsed lumbar disc. Lie on your stomach with your arms at your side and head turned to one side. Now relax the muscles in your low back for a few minutes. Next put your elbows under your shoulders and support your upper body on your forearms, keeping pelvis and thighs on the floor. Keep buttocks relaxed and allow the lower back to sag. Try to hold for 3-5 minutes. If your pain increases then stop for now and try again in 1-2 days. Eventually you can progress this stretch by straightening your elbows and pushing the upper part of your body up as far as pain permits. Keep your pelvis, hips and legs relaxed and on the floor. Hold for 2-5 seconds. Repeat 10 times every 3-4 hours.
See a doctor urgently if: The pain continues to get worse in spite of rest; You begin to feel the onset of weakness, numbness or tingling in your legs or feet; You lose control of your bowels or bladder; You develop numbness in the sitting part of your buttocks (saddle anesthesia); You develop any other new symptoms such as fever, urinary difficulty, bloody urine, unusual vaginal discharge or bleeding, or stomach pains.
Copyright © The Credit Valley Hospital