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Simple strategies for acute back pain

Back pain is so common that we know that 8 out of 10 people in the developed world will have an episode of back pain sometime in life. Despite the complexity of the spine, the vast majority of back pain gets better with minimal fuss. Knowing how to address symptoms yourself or when to consult the health professionals is actually quite straightforward.

When in pain, the body’s natural instinct is to become rigid. Spasm occurs to protect the area from further hurt. Damage limitation signals sent to the brain say ‘don’t move…’ While okay in the short term, in the case of simple muscle or ligament strain staying rigid for a period of even a couple of hours may actually slow down recovery. Mild or moderate pain should respond to self help. The message is to try to move through the pain. If movement reduces your pain, it is safe to adopt the following approach.

The things to consider is you experience sudden or gradual pain are:
Where the pain is
How severe the pain is
What happen to the pain when you move?

First listen to your body. Note exactly where you feel the pain in your back. Commonly it is centred in the low back around or either side of the waist, sometimes spreading into the upper buttocks. This usually denotes a simple muscle or ligament strain, likely to resolve with appropriate self help. If the initial pain is more than a diffuse ache, but instead is perhaps sharper, in a small area and feels deep, this may implicate a movement dysfunction of one or two of the small intervertebral joints in the back, which again can often ease out with simple strategies.

Next rate the severity of the pain: mild / moderate/ strong. Or use a scale of 0 -10; 0 being no pain, while 10 is the worst pain imaginable. Pain rated as between 1 and 6 will often recover fully with simple advice. Strong pain, rated as over 6, perhaps spreading right down along one leg is considered severe and may ring alarm bells.

Stuck joints or muscles in spasm respond well to rocking movements. Rocking works as a natural pain reliever and can be performed standing, sitting or lying down. In order to loosen the spasm, start gently rocking through your waistline area. Sometimes it is useful to count out loud as you rock, distracting yourself from the pain by counting. Begin with small movements, nudging gently INTO the pain. Spend as long as 2-3 minutes at a time rocking. Try to stretch out cramping muscles.

Ice, heat or over-the-counter medications are valuable for pain relief too. Being careful to protect the skin of the back, either place an icepack for 10 minutes over the worst area or a hot water bottle for 20 minutes, no longer. You can reapply heat or ice every hour if you find it helps. This on/off method is safer and more effective than prolonged use. If the heat or cold does help, use the window of opportunity of pain relief to get moving and assist the rest of the spine to unblock the joint. Take over-the-counter anti-inflammatory medication for a 24-48 hour period as prescribed on the package.

Later if you must sit, choose your chair carefully. Ideally sit only on an upright kitchen type chair. Avoid the soft squashy low sofa: it may be comfortable when you are sitting on it but you may find it impossible to rise out of.

That night in bed, try lying on the less sore side, with knees bent and a pillow between them. This supported position is helpful for easing out strain. When you wake, turn onto your back and rock your knees side to side for a full minute before you stand out.

Whatever else don’t go to bed and stay there longer than 24 hours. Research has demonstrated conclusively that this strategy is not helpful for most back pain. Bedrest is now proven to prolong symptoms and can leave muscles in a weakened state that may persist for weeks and months.

These self-help strategies should reduce ‘simple’ back pain to below 3 within 24 hours. For the following couple of days do not overload the back muscles. Don’t lift anything heavy. Choose not to mow the lawn in the following 48 hours. Leave off the gym for 2-3 days.

If your pain is so severe that you rate it between 6 and10 on scale and it doesn’t respond to self treatment techniques within 24 hours, is worsening or extending down one or both legs, you are advised to make an urgent appointment to attend your GP or local chartered physiotherapist.
Mairead O’Riordan, MSc, MISCP is a senior Chartered Physiotherapist & CEO of TherapyXperts, an allied health network dedicated to clinical excellence.
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