As a spectator, I cringe a lot at football games. Not because my team is winning (Go Cowboys!) or losing, but because of the direct body impact these guys sustain during aggressive physical play. I also cringe a lot when I watch America’s Funniest Home Videos. Those pitiful scenes when someone gets hurt tend to upset me more than make me laugh. My kids blame my “doctorness” (that is not a real word), and tell me I am an over-actor when I cover my face during the “funny “ scenes. I just know those guys and gals hurt in the morning when they get out of bed (we won’t even get into Tony Romo….). I wonder how many of them experience back pain.
New onset low back pain is what brings many patients into our clinic and “acute” back pain episodes are defined as six to twelve weeks of pain. Low back pain is located between the mid to low back and when pain radiates down one or both legs it is called sciatica.
For many readers, this information seems repetitive, here are some facts released by the American Academy of Family Practice and some of this information is new to me. You will find interesting:
- First time back pain sufferers are usually between 20 and 40 years of age and for many it is the first time to seek medical attention as an adult.
- Approximately 31% of people with low back pain do not fully recover within 6 months, but most will improve
- Pain returns in 25-62% of patients within 1-2 years. (What more can I say…)
- Back pain could be a signal of a significant underlying medical condition which should be ruled out by your medical provider. Tumors, kidney stones, vascular disease, bladder infections, bone marrow disorders are just a few of many diseases that present as sudden low back pain.
- Bed rest is not helpful for acute back pain. Over time, bed rest can promote joint stiffness, blood clots, in addition to muscle and bone mineral loss. Bed rest is also less effective at reducing pain and improving mobility than staying active.
- For people with acute low back pain, spinal manipulation, massage and chiropractic therapy do not improve outcomes of low back pain; however, these methods may be beneficial for chronic back pain (yes, I said it and I will hear back from critics on this…).
- While regular exercises may not help initially for acute low back pain, certain forms of physical therapy may lessen the risk of its recurrence. ( Look up the McKenzie method and its spine stabilization program achieved thru physical therapy)
- Anti-inflammatory medicines are effective treatments for managing acute low back pain. Over the counter ibuprofen and naproxen sodium are good examples of effective anti-inflammatories. Acetaminophen is not helpful for acute back pain.
- Prescription muscle relaxants may be helpful for acute back pain. These medicines can comfort and relieve pain, but will not shorten the duration of recovery.
- In general, there is no need to order radiology imaging (X-rays, cat scans or MRI) for acute low back pain other “red flag” signs or symptoms of more significant underlying problems are present. For example, sudden back pain in a 70-year-old lady with thin bones (osteoporosis) could indicate a spinal compression fracture (bone collapse) and at minimum, she would need an X-ray.
- Heat works better than ice for acute low back pain. ***BONUS (I gave you 11 facts…sorry, but I got carried away) It has been ingrained in our memories to use ICE for early injury care, but in the case of the low spine, heat seems to work better. I should add that there is little evidence to suggest that supports the use of acupuncture, exercise, back support devices or traction to reduce acute back pain. But these are modalities that could be beneficial for chronic (on-going) back pain beyond the 3-month time marker.
Many times, staying at home and using heat and *anti-inflammatories and maintaining usual activities as tolerated is best care for acute back pain. However, if pain worsens or begins to extend down the leg or is accompanied by fever, you should seek help thru your medical provider. If you have a history of cancer, it is highly important you follow up to ensure there is no cancer recurrence in your bones. When in doubt, it does not hurt to seek medical advice.
*You should always discuss with your medical provider whether anti-inflammatories are safe in combination with your prescription medications or your ongoing medical problems.