Acute Low Back Pain

Acute Low Back Pain.
What is it? What can be done?

Daniel Sereni, France

1. What is the cause of acute Low Back Pain (Backache)?

Ninety percent of adults experience at least one episode of backache during their life. In most cases the lumbar pain is acute and resolves in less than one or two days. It may be provoked by an effort or an unusual and brisk movement; but it can also appear suddenly without evident reason. Pain can be intense with a sensation of burning aggravated by bending or walking. Acute Lumbar Pain is not the consequence of any anomaly of the vertebrae or of the vertebral disk. Pain is triggered by a sudden strain in the muscles and ligaments around the intervertebral disk. As the disk is richly innervated this situation results in an acute pain.

2. Is it necessary to visit a doctor? To have x-rays?

Low back Pain may be very painful, but it does not mean that it is dangerous. In an adult in general good health the backache will resolve in a few hours or days. There is no need to visit a doctor; x -rays will not show anything relevant and should not be performed.

 Yet there are some situations when a call to a doctor is justified:

  • People with a severe disease like a cancer or an infectious or inflammatory disease
  • Pain accompanied by fever.
  • Pain after a fall or a direct traumatism
  • In a context of involuntary weight loss or abnormal fatigue
  • In frail elderly persons
  • If there are symptoms of sciatica (pain along the leg down to the foot) or dumbness in the foot or difficulties with urination
  • If the pain aggravates after a few days.
3. What can be done?

Rest is often necessary due to the intensity of pain. But it must be as short as possible. It is better to rest on a rigid surface, for example lying on your back on the floor. While lying on the back flex your knees at 90 degrees and put your feet on a chair.

Pain killers like paracetamol (acetaminophen) or low doses of ibuprofen are effective . Heat or ice packs on your back may be helpful.  Muscles relaxants are not recommended. Local treatment with any kind of cream or pomade has no efficacy. Reducing the duration of pain permits to start doing some movements like gently stretching your back. After one or two days, when the pain is gone resume prudently normal activities avoiding efforts like lifting heavy charges or twisting your back. It has now clearly been proven that long-time rest (more than 3 days) prolongs the duration of pain and incapacity.

4. How to prevent relapses?

No medication is needed.

The principles of relapses prevention are to improve flexibility, reinforce strength of trunk muscles, particularly abdominals and correct any causal factor, for example by avoiding sitting too long or finding better positions for work or at home.

A regular physical therapy combining stretching and muscle reinforcement is the cornerstone of prevention. Sports are good for Low Back Pain. It is prudent to avoid sports necessitating jumps or brutal physical contacts. Practice a sport you like and do it on a regular basis. Swimming is excellent but some people do not like it and it is not always easy to find a good swimming pool in the vicinity. If tennis is the only sport you enjoy, then do not hesitate! Ask a professional sport teacher or a coach for advice. Practicing in average three physical activities of 45 minutes duration per week is a good objective. Do not stop when you feel better. There is no limit of age to start physical exercises; if you have doubt about your heart condition, visit your doctor.

Avoid sitting for a long time. Check if you are sitting in good position, particularly when using a computer.

Check if your driving position is correct. Make a stop after one hour when driving.

Maintaining a normal weight is important. Overweight is a proven cause of Low Back Pain; and there is absolute evidence that weight loss alleviates pain and reduces relapses.

 Physical activity remains the best if not the only proven treatment of low back pain. Many kinds of trainings are available including Yoga, Tai Chi, Pilates, etc.. The choice depends on personal preferences and practical issues. When available help and advice from a physical therapist are precious. Learn from the therapist how to improve posture, how to lift a charge or wear a bag and how to accomplish safely your daily and professional tasks.

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