Acute low back pain can be a little scary, especially if it’s your first time experiencing it.
You bend over and feel a pop in your back and intense pain comes on over the next few hours. Or you help a friend with a move and overdo it and wake up the next day with extreme stiffness and pain in your low back. Or you stoop down to tie your shoes and suddenly can’t lift yourself back up.
Acute back pain can come on with heavy lifting or simply bending over to grab a celery stalk from the bottom drawer in the fridge. It can range from extreme tightness or stiffness in your low back to radiating symptoms down your buttock or even numbness trickling down your leg.
So, will your pain ever get better, and what do you do when this happens?
The scariest part of acute back pain is peering into a future of life long debilitating pain. It’s a terrifying vision, to say the least. Thankfully, most acute back injuries resolve over time even if you don’t have any clue what to do.
Typically the first two to three days is pretty tough, especially if you have to keep working every day. With the proper strategies, you can start feeling pretty good relief within four to six days, and complete relief within two to three weeks.
These timelines do vary depending on several variables, but a few, in particular, are most important.
Your physical activity level and overall health before the injury can play a big factor. The more active and healthy, the quicker the recovery will move.
Unfortunately, a factor that we have no say over is age. It’s crazy how fast teenagers with back pain get better when I work with them in the clinic. But again, even with older age, if you’re regularly active the healing will still move quicker than it would have otherwise.
The other key factor is the strategies you use to get out of pain. Let’s start by addressing advice you might see on youtube or hear from a friend that should actually be avoided.
What you should not do
Number one: don’t stretch your back or legs! (I can hear your audible gasp of disbelief from here).
Let’s talk about why this is. Acute back pain is very commonly sourced from a disc injury in your spine. Secondarily, you get pain and tightness in your muscles or pain radiating along a nerve in your leg.
When you stretch your legs and you have back pain, you’re likely just stretching your nerves, not your muscles. Discs and nerves do not like to be stretched or compressed. It might elicit a stretch reflex offering temporary relief of pain, but then it comes flying back.
Pretty often someone comes to me desperate for relief from acute back pain, and they’re a little surprised when I explain that I want them to stop stretching.
Typically they say, “but it’s the only thing that gives me any relief.” That’s the stretch reflex. Without question, they all admit that their pain returns very quickly, and they’re seeing me because their pain hasn’t improved at all. The stretching isn’t working.
I had a patient with acute low back pain who had residual pain down his leg for weeks that wouldn’t resolve. I was a little surprised until I asked some prying questions. That’s when I learned he had still been stretching his hamstrings and back every morning despite his earlier promises that he hadn’t been! Tricky, tricky.
I finally convinced him to not stretch for the next week. By the next scheduled appointment, he didn’t even need the visit because all of his pain had resolved.
And think about what you’re trying to accomplish with stretching anyway. Why would stretching your hamstrings or your piriformis make your acute back and nerve pain subside? Don’t try to stretch your pain away! It will only prolong your recovery.
What you should do
In the early stages, walk and lie down regularly. Walk for a few minutes and then lie down for 10–15 minutes to recover.
If you’re figuring this out on your own without a clinician to help, you’ll just need to experiment with different resting positions. These can vary from laying on your back with knees bent to laying on either side with pillows under your side, and several others. Just stick with the one that feels best.
Light massage can also be effective to take the edge off. Whether you have someone else do it or use a lacrosse ball against a wall, the key is to keep it VERY light.
Usually, my patients are tempted to try and smash their pain away. If you try to push hard against your muscles, they’re just going to push back and be tighter and more painful later.
Lastly, you have to keep your core tight and spine stable with all of your movements, especially when trying to get up and down from lying down. This is a critical part of your recovery.
I’m very picky about helping my patients do this properly because when done correctly, this drastically reduces how often you trigger your pain. Less triggering means more healing!
When to get help
Last question we’ll address here: How do I know if I need to go to a professional to help me?
If you already know and trust a clinician to get you out of pain, give them a call if your symptoms haven’t improved after a few days.
Otherwise, if your symptoms are worsening, for example, your pain is shooting further down your leg than it was, it’s time to get help. If it’s been 3–4 weeks and your pain is unchanged or worse, it’s again a good time to seek help.
There are a lot of other tools we can use to get you out of pain if needed. These are just the best strategies to use on your own, and in most cases should be all you need.
Have fun recovering and remember, no pain, more gains!