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Acute Low Back Pain - what should you do?

Acute low back pain is a common experience that usually gets better with minimal or no intervention.  In our western world, it is a significant personal, social and economic burden.

Your lower back is made up of ligaments, joints, discs and muscles and it is VERY STRONG – it’s a beautiful design that allows us to do many weird and wonderful activities every day with no problems.

Sometimes, something happens and the result is acute low back pain with or without leg symptoms (pain, pins and needles or weakness).  For more information about back pain associated with leg symptoms click here.  Acute low back pain often arises from a simple back sprain secondary to increased mechanical loading and/or a ’pain flare’ associated with some form of lifestyle or psychological stress (For more information about how psychological and lifestyle stress interacts with pain click here).

Occasionally (in less than 1-2% of individuals with LBP) acute low back pain may mean something more serious — a healthcare professional can sort through information gathered during the initial interview and refer for further tests or assessment as appropriate.   It is important that you seek professional care if you have constant pain that has lasted for several weeks that seems worse at night, you feel unwell along with your back pain or you have a significant change in bowel or bladder habits.

The severity of back pain does not always reflect the seriousness of the problem.  This may mean that relatively minor back sprains can cause significant pain and spasms, however, bed rest is not recommended.  A physiotherapist can identify whether there is evidence of tissue strain or whether your back pain is a result of a pain flare.  Relaxed movement will help your back settle and it is helpful to remember “motion is lotion”.  Protecting your back and avoiding movement may make the pain worse. Try and keep to your normal routine as much as you can — it can be helpful to discuss what movement and exercise you should do whilst the acute pain is settling with a physiotherapist. For more information about exercise with low back pain click here.  Some over the counter medications may assist in reducing pain so you can keep moving. This needs to be discussed with your pharmacist or GP.

Manual therapy such as joint mobilisation / manipulation, massage and even dry needling (acupuncture) has been shown to be effective in some people with acute low back pain. We physiotherapists are still not entirely sure how this manual therapy works, but contemporary scientific evidence would suggest it induces a reduction in pain rather than a biomechanical effect (i.e. it does not move a stuck joint, put a joint back in place or lengthen a tight muscle).  Manual therapy is not uniformly effective for all people, therefore if manual therapy is not working for you -try something else.

Many people wonder if radiological imaging (x-ray, CT, MRI) is warranted, particularly if the pain is severe or if it seems to last longer than is anticipated.  However, imaging for acute low back pain in the absence of trauma (an accident), neurological changes (weakness or loss of reflexes) or other medical warning signs (known as red flags) is not recommended and in some cases, may be detrimental. For more information about imaging and low back pain click here.

Although acute low back pain often resolves spontaneously 30% of people will have a recurrence within 6 months and 40% within 12.  Physiotherapists can assist in addressing possible factors that may contribute to an increased risk of recurrence or the development of more persistent pain.

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