Managing Acute Lower Back Pain
In the U.S., about 80% of individuals will experience lower back pain (LBP) at some point in their lives. A 2019 study found that 39% of individuals had experienced LBP in the past 3 months (Back, Lower Limb, and Upper Limb Pain Among U.S. Adults, 2019). The U.S. spends billions of dollars each year on treating LBP, and costs for the consumer also add up to cover medical visits and procedures. Many individuals have to take time off work, leading to reduced productivity and income.
But even more than the financial cost of lower back pain, we must consider the functional cost. The cost of missing out on activities in our lives because of pain. The cost of not being able to fulfill the roles we wish to - mother, wife, friend, worker, runner, etc. because pain is keeping us from lifting, getting on the floor, standing for more than a few minutes, bending over to help our children get dressed.
So what do we do? Practicing as a physical therapist for nine years, I can tell you that LBP is complex. Any pain in our body is for that matter. It can be helpful to classify LBP in two broad categories - acute (recent onset) with a known mechanism of injury (what started the pain), vs. chronic (lasting >3 months) and maybe not knowing a specific event that started the pain. A different approach must be taken to each of these categories to successfully resolve the pain. This post will focus on treatment of the first category.
When we can point to an event that started our pain (i.e., I bent down to lift my child and felt a sharp pain in my right lower back, which I had not experienced before), that typically implies that there is a tissue (muscle, ligament, nerve) that has been injured or damaged. This causes an inflammatory reaction. While inflammation is typically seen as a negative thing, acute inflammation is actually the body’s way of facilitating tissue repair and restoration of normal function. Inflammation acts as a protective response by the body, aiming to isolate the damaged area, remove debris and dead cells, and initiate the healing process by recruiting immune cells to the site of injury (Pain Regulation by Non-neuronal Cells and Inflammation - PMC) . It’s a necessary step to begin the body’s healing mechanism after trauma or infection. It does typically lead to pain due to activation of pain receptors in the process. Though none of us like to experience pain, it serves a purpose to prevent us from performing activities that will result in further tissue damage. The bottom line is, pain and inflammation are a necessary step in the acute stage of injury.
Phase 1: Rest, Pain Modulation, and Gentle Movement
Rest and pain modulation are recommended for the first 1-3 days following injury as your body begins the repair process. However, resting beyond this time frame may contribute to prolonged and/or more intense experience of pain. Begin with gentle movement. Movement aids in improved circulation, which allows the vascular system to bring nutrients to the injured area and clear away dead or damaged cells. Movement also helps to “glide” your nerves. While this is especially important for anyone experiencing radicular symptoms (i.e., pain down your leg or what is often referenced as “sciatica”), it also aids in pain modulation of centralized low back pain. Additionally, movement prevents your muscles and joints from becoming overly stiff, which can also contribute to delayed healing times.
As you begin moving, you should notice that you are able to do a little more each day. Remember to listen to your body and do not try to force yourself to do a movement or activity that causes increased pain. Depending on the tissue that is damaged, there may be certain movements that cannot be performed for a longer period of time as the tissue is healing. Each day, try to do a little more than the day before.
Phase II: Aerobic Exercise
Once you are tolerating gentle movement, begin incorporating aerobic exercise. This can include walking, riding a stationary bike, elliptical, or even an upper body bike. Aerobic exercise will further improve circulation and nerve mobility. It can also help relieve stress associated with dealing with an injury.
Phase III: Strength Training
Next, you must work on strengthening muscles around the affected area. Inflammation can cause inhibition of muscles around the affected joint(s) as a protection mechanism to reduce further damage. However, after the first few days we must actively work to facilitate these muscles to begin working again; otherwise, it can lead to abnormal movement patterns that can keep us in pain now, or cause an issue later on down the road.
Some exercises that help facilitate these muscles include:
Abdominal Brace
Bridges
Clamshell
Quadruped arm and/or leg raises
Supine marching
Hip adductor squeeze
Phase IV: Functional Training
Finally, after working these muscles in isolation, you must then begin to challenge the muscles functionally. For example, learning how to activate your core muscles while lifting, pushing, pulling, etc. The goal is to be able to return to these activities without pain and without compensation. Our bodies our extremely smart, and when something hurts, they often find a new way to accomplish the task (think of some one picking something up off the floor without bending forward and instead performing a deep squat). While this may work temporarily, if we do this long term, we are likely to end up with another injury or pain developing.
Of course, always talk to your health care provider after an injury as they can guide your treatment program. If you are struggling to recover from your injury within 1-2 weeks, working with a physical therapist or online coach is a great way to receive specific recommendations to address your unique pain with your unique life demands. There is not a one size fits all when it comes to managing back pain, and what works for someone else may not work for you. Please reach out by sending me a message if you have any questions about your back pain or how I may be able to help.
