Managing Acute Back Pain

If acute back pain has occurred recently (within the past 2 weeks), the following are tips to minimize and hopefully abolish this pain:

Keep bed rest to a minimum. If pain is excruciating, a couple days of bedrest may be beneficial, but various studies have shown that prolonged bed rest will actually slow recovery time.
Avoid aggravating activities. If an activity hurts, then it is best to stop instead of trying to “work through the pain.” Frequently, low back pain is aggravated with forward bending, lifting, or twisting, so efforts to avoid or minimize these motions are generally advised. Other examples of aggravating activities include prolonged sitting (studying in one position too long), doing laundry, cleaning the apartment, or even simple activities such as leaning forward to wash dishes or to brush teeth. Car rides should be avoided, since vibrations from the road, the inability to change positions frequently, and the flexed trunk position can increase the pain. If an aggravating activity cannot be avoided, it should be modified to decrease the amount of pain felt, often by keeping your spine erect as much as possible.
Use good posture. Using supportive chairs and/or lumbar rolls or pillows will provide low back support, promoting improved posture. Good posture places less strain on the discs and irritated soft tissues in the low back.
Change positions more frequently. While one is recovering, more frequent positional changes or rest breaks are helpful. Sitting for too long may result in stiffened low back muscles, which may be aggravated when one first stands or picks up a backpack from the floor.
Return to normal activities as soon as tolerated. When returning to previous activities, one initially should resume the activity less strenuously and for a shorter duration, since symptoms may not be felt until the next day, when it is too late. If your back pain is worse on a particular day, think back to the previous day for a possibly aggravating activity. If it hurts more the day after the activity, then it was likely too much too soon.
Use ice or heat. Ice packs initially are quite helpful to reduce inflammation and pain. Then heat may be beneficial after 2-3 days to relieve stiffness. But if ice continues to give relief, then continue using it as needed. Use heat or ice for 20 minutes at a time.
For sleeping,
- consider your mattress. A poor mattress, either too hard or too soft, may cause or aggravate back pain. If possible, sleep on a different surface to see if it decreases discomfort.
- sleep in a different position. Sleep on your side with a pillow between your knees, or on your back with a pillow under your knees.
Lighten up the backpack or shoulder bag. Heavy backpacks or shoulder bags may aggravate back pain. The weight of the backpack may not be the only problem. Bending over, twisting, and lifting may re-injure your back. In general, backpacks should not weigh more than 10% of one’s body weight. Also, a good backpack generally is better than a shoulder bag since the backpack distributes the weight more evenly.
Wear appropriate footwear. Shoes with well cushioned soles will provide shock absorption and will minimize jarring forces to the spine. Avoid high heels since they tend to arch one’s back.
Address stress levels.Relaxation techniques, breathing exercises, meditation, and guided imagery may help relax tensed muscles and relieve pain.
See a doctor if the pain is severe, has not improved after 1-2 weeks, or symptoms are felt into the lower extremities. The doctor can determine the appropriate course of action, e.g. diagnostic tests, medication, or referral to another health care professional such as a physical therapist. Take prescribed medications as instructed.

When Symptoms are Felt Below the Spine

Sometimes when one’s back is injured, symptoms may include numbness, tingling, or pain running down to the buttocks, thigh, or even all the way to the foot and toes. Such symptoms may be temporary, or they may be persistent. These cases tend to be more serious since a nerve running from the spine down the leg may be irritated. Pain radiating farther down the leg over time can be a sign that the condition is worsening. If this happens, one should avoid activities which cause this. Most of the time these aggravating activities involve flexed positions, twisting, and bending forward. The goal should be to have the area where the pain is felt farthest down the leg move up toward the spine, or centralize, over time. If leg symptoms are severe, persistent, and radiating farther down the leg, it is best to consult with a McKinley provider for the appropriate course of action.

Exercises

If the injury is aggravated by bending forward, prolonged sitting, or lifting, then the following exercises or positions may be helpful. If pain increases after performing these exercises, then stop and consult your health care provider.

Figure lying flat on stomach with hands next to shoulders, palms on flat on the floor, then pressing up through arms while keeping pelvis down.

Press-Up

Start by lying flat on your stomach. Press up through your arms while keeping your pelvis down. Perform 10-20 reps at a time periodically during the day. If this helps to decrease pain, this can be done up to every 2 hours during the day. Stop if pain increases or moves toward the buttocks or down the leg(s).

Student seated at desk in an office chair with lumbar support. She is sitting with her back against the lumbar support of the chair close enought so that her elbows are close to her body and bent at roughly 90 degrees.The top of the monitor is at her eye level.

Proper Posture

Keep the low back supported by the chair or a lumbar pillow, move close to the desk so that your elbows are close to your body and at roughly 90 degrees, keep the feet on the floor or if necessary on a small support. The top of the monitor should be at approximately eye level.

Student staning with both feet together with each hand on the back of each hip. Back is arched so the hips are slightly forward of the feet and the sholders are slightly behind the feet. The head is rotated back so the face is looking up and behind.

Standing Back Extension

While supporting your hands on hips, bend backwards 5-10 times, holding it for 2-3 seconds each time. This exercise may be especially beneficial after prolonged sitting.

References

"Low Back Pain: Treatment and Prevention." Harvard Men’s Health Watch. Dec 2006: 4-6.
Brennan, G., et al. "Lower Back Pain in Physically Demanding College Academic Programs: A Questionnaire Based Study." BMC Musculoskeletal Disorders 8 (2007): 67.
Kofotolis, N. and Sambanis, M. "The influence of exercise on musculoskeletal disorders of the lumbar spine." Journal of Sports Medicine and Physical Fitness 45.1 (2005): 84-92.
Becker, M., et al. "Postural changes while sitting may trigger back pain." BioMechanics 10.8 (2003): 52-54.
Devroey, C., et al. "Evaluation of the effect of backpack load and position during standing and walking using biomechanical, physiological and subjective measures." Ergonomics 50.5 (2007): 728 – 742.