Acute low back pain is usually first felt just after you lift something heavy, move suddenly, sit in one position for a long time or are hurt in an accident. It is most often caused by a sudden injury to the muscles and ligaments that support the back, and the pain may come from muscle spasms or from a strain or tear in them. Bed rest is not recommended for it, and if you have no sign of a serious cause, stay as active as possible. If yours started when you lifted the groceries out of the car four days ago, check the signs below before tomorrow's session of the twice-weekly training you began three weeks ago.
Signs that your back pain needs a doctor
Call your doctor's office right away if, at any point, any one of these applies to you:
- back pain after a severe blow or fall
- burning when you urinate, or blood in your urine
- a history of cancer
- loss of control over urine or stool
- pain traveling down your legs below the knee
- pain that is worse when you lie down, or that wakes you up at night
- redness or swelling on the back or spine
- severe pain that does not let you get comfortable
- a fever with back pain that nothing else explains
- weakness or numbness in your buttocks, thigh, leg or pelvis
- difficulty walking or keeping your balance
If the office is closed when you phone, a nurse or other provider on call for the clinic may answer instead: say what your symptoms are and ask what you should do. If a problem could kill you or leave you permanently disabled, it is an emergency, and you call 911 if you cannot wait.
These are not on the right-away list, but any one of them is still cause to phone your doctor's office:
- you have been losing weight without meaning to
- you use steroids or inject drugs
- you have had back pain before, but this episode is different and feels worse
- this episode has lasted longer than 4 weeks
- numbness and tingling with your back pain
- trouble urinating
- weakness, pain or numbness in your legs
- back pain after a fall or injury
- pain that has not gotten better after a few weeks
Where a sign here is also on the right-away list, such as numbness in a leg or pain after a severe fall, the right-away instruction applies. With none of these signs, stay as active as possible, and check with your doctor or a physical therapist before you start any exercise routine, tomorrow's session included.
How long ordinary back pain takes, and where four days sit
Acute back pain comes on suddenly and usually lasts a few days to a few weeks. Many people are better within a week, and most get better or recover within 4 to 6 weeks, often much sooner than that. Pain that lasts 4 to 12 weeks is called subacute, and pain that lasts longer than 12 weeks and occurs daily is called chronic, so at four days yours is still acute.
By day four the general cutting back is meant to be over: reduce your activity only for the first couple of days, then slowly start your usual activities again, still limiting what causes pain. For the pain itself, apply heat or ice to the painful area; one good method is ice for the first 48 to 72 hours and heat after that, so on day four that means heat. At night, try lying in a curled-up position with a pillow between your legs, or, if you usually sleep on your back, put a pillow or rolled towel under your knees to relieve pressure. If you can, avoid sleeping on your stomach.
Tomorrow's session, and training twice a week from here
You gradually start exercising again after 2 to 3 weeks, so a session five days in comes well before that. Counted from the day the pain began, here is what to do when:
- after the first couple of days, your usual activities, started slowly: limit the activities or exercise that cause pain, and increase physical activity gradually as you can tolerate it
- after 2 to 3 weeks, exercise again, beginning with light aerobic activity such as walking, riding a stationary bicycle or swimming
- until 6 weeks after the pain began, no heavy lifting and no twisting of your back
- later, stretching and strengthening exercises, since starting them too soon after an injury can make your pain worse: a physical therapist can tell you when to begin them and how to do them
The 6 weeks run from the day the pain began, so a back that stops hurting in the first week or two is still within those 6 weeks, and the heavy lifting in your training waits until they are over. When you do start again, build up slowly: back pain is more likely if you exercise too strenuously after being inactive for a while.
What happens if you see a doctor this week
A visit this week brings questions about the pain and a physical examination, and probably no X-ray or scan: a provider usually orders no tests of your spine at the first visit, or for 4 to 6 weeks, unless you have certain symptoms. Most people do not need additional testing, though doctors sometimes order tests to rule out a specific cause or to confirm one. Tests that might be ordered include blood tests such as a complete blood count, an X-ray, and a CT scan or MRI of the lower spine.
Your provider will ask where the pain is, how often it happens and how severe it is, and will try to work out its cause and whether it is likely to get better quickly with simple measures such as ice, mild painkillers, physical therapy and proper exercises. The physical exam may include looking at your spine and posture, asking you to bend or lift your legs to see how movement affects the pain, and testing your reflexes, muscle strength and sensation. Questions your doctor may ask include:
- Can you describe the pain, for example as sharp, aching or burning?
- Where exactly is it?
- When did it start, and how long has it lasted?
- What were you doing when you first felt it?
- How severe is it?
- What makes it worse or better?
- Does chronic pain, such as arthritis or back pain, run in your family?
When the doctor asks what you were doing, say you were lifting groceries out of the car, and mention the training you do twice a week as well: talk through with your doctor the types of exercise that are best for you, since there may be certain activities or exercises to avoid. A visit can also lead to a physical therapist: your provider will determine whether you need to see one and can refer you. If the pain lasts longer than 1 month, a referral from your primary provider to a physiatrist, who specializes in rehabilitation, or to an orthopedist, a bone specialist, may follow.
If NicoCares arranges your weight care, book any examination with your own doctor, and use Spruce to let the care team know you have hurt your back, since changes in your health and any new medications are things to tell them promptly. Spruce messages are answered on no stated timetable, so a sign on the right-away list goes to your doctor's office by phone, and one that cannot wait goes to 911.
Getting the groceries in from the car next time
Bring the groceries in over more trips, with less in your arms each time: limit the amount you carry, and make a few extra trips to avoid carrying too much weight. Tips for lifting and bending properly include:
- get help if an object is too heavy or awkward
- spread your feet apart for a wide base, and stand as close as you can to what you are lifting
- bend at your knees, not at your waist
- tighten your stomach muscles as you lift the object or lower it down
- hold it as close to your body as you can, and lift using your leg muscles
- keep from twisting while you bend down for it, lift it or carry it
Once you are training again, regular exercise that keeps your back muscles strong can help you have a healthy back, and so can a warm-up before exercise or other physical activities (see Strength work twice a week, and why it matters during weight loss).
