INFORMATION FOR YOU Lower Back Pain
WHAT IS ACUTE LOWER BACK PAIN? Acute lower back pain is defined as low back pain present for up to six weeks. It may be experienced as aching, burning, stabbing, sharp or dull, well defined, or vague. The intensity may range from mild to severe and may fluctuate. The pain may radiate into one or both buttocks or even into the thigh/hip area. Lower back pain may begin following a strenuous activity or jarring trauma, but often is seemingly unrelated to a specific activity. It may come on after a period of increased workload, particularly involving more than usual amounts of time sitting (for example at a computer), or a change in lifestyle or activity. The pain may begin suddenly or develop gradually. WHO EXPERIENCES ACUTE LOWER BACK PAIN? At least 80% of adults experience a significant episode of low back pain at some point in their lives. At any given time, at least 15% of individuals report that they are experiencing low back pain. Some consider the symptom of low back pain to be a relatively normal part of modern life. At least 80% of adults experience a significant episode of low back pain at some point in their lives WHAT CAUSES LOWER BACK PAIN? The exact source of acute lower back pain is often difficult to identify. In fact, many structures can be the source of pain including muscles, ligaments, joint capsules nerves and blood vessels. These tissues may be pulled, strained, stretched or sprained. Additionally, annular tears (small tears that occur in the outer layer of the intervertebral disc) can initiate severe pain. Even if the actual tissue damage is very minor and likely to repair quickly, the pain experienced may be quite severe. The level of pain experienced does not generally indicate that something is ʻdamaged. 2
No matter which tissue is initially irritated, a cascade of events occurs which contributes to the experience of pain. Numerous chemical substances are released in response to tissue irritation. These substances stimulate the surrounding pain sensitive nerve fibres, resulting in the sensation of pain. Some of these chemicals trigger the process of inflammation, which also contributes to pain. The inflammation attributable to this cycle of events may persist for days or sometimes weeks. HOW LONG WILL AN EPISODE OF LOWER BACK PAIN LAST? The good news is that even if the exact source of pain is not determined, usually the acute (immediate) episode of pain subsides spontaneously over a relatively short time. The originally irritated tissue heals. 50% of episodes nearly completely resolve within two weeks, and 80% by six weeks. Unfortunately, the duration and severity of a single episode cannot be predicted based on the onset, location of pain, or even the initial severity. Excruciating initial pain may resolve within several days, while moderate or mild symptoms may persist for weeks. However, up to 30% of people will experience recurrent pain or develop persistent pain in the future. 50% of episodes nearly completely resolve within two weeks, and 80% by six weeks. IS THIS PAIN DANGEROUS? In the vast majority of cases back pain is not at all dangerous. The symptoms of acute lower back pain do not usually signify any damage or disease at all and will clear up on its own. Even a ʻslipped discʼ (disc bulge or herniation) has a good chance of improving without much treatment. 3
Rarely, however, lower back pain is caused by more serious damage or disease. This is more common in people over the age of 60, those with a history of cancer, those with severe pain at rest, with associated fever, with underlying medical problems such as diabetes, heavy alcohol or drug use, long time corticosteroid use, or osteoporosis. For pain in the leg below the knee, weakness, pins and needles or numbness or feeling generally unwell and for all cases of pain lasting longer than six weeks, proper examination is advised. Difficulty with bowel or bladder control requires urgent medical assessment. HOW SHOULD ACUTE LOW BACK PAIN BE MANAGED? Some of the best advice for treatment of acute (recent or immediate onset) lower back pain is to continue to remain active without causing too much more pain. You may be anxious about performing everyday activities and the natural inclination may be to stay in bed or freeze, to guard and avoid activity. Yet activity keeps blood and nutrients flowing to the affected area, inhibiting inflammation and reducing muscular tension. Many individuals with lower back pain find that they can perform their usual activities, such as walking, in spite of the pain and often feel better after the activity. The outcome for those remaining as active as possible is nearly always better. More vigorous or uncontrolled activities such as running, weight training or competitive or contact sports are not advisable while pain is severe. There is no reason to completely avoid stretching muscles and tissues in the legs and back during an acute episode, but stretching should not cause more severe pain. In the vast majority of cases back pain is not at all dangerous. The outcome for those remaining as active as possible is nearly always better. 4
Local application of heat or ice can temporarily reduce pain and heat may facilitate stretching, but does not necessarily speed long-term recovery. The simple exercises below are often enough to resolve the situation if done consistently and without causing too much extra pain. 1. Lying on the carpet, or a rug, with the knees together, roll the knees to one side then the other without forcing the movement. The movement should feel relaxed, and should not cause too much pain. Continue for about a minute 3 or 4 times a day. 2. and 3. On all fours try to tilt the pelvis first one way then the other so that the back arches up and sinks down. Again do not force the movement. Stop or make it more gentle if it hurts too much. 5
Most low back pain has a lot to do with your regular posture, particularly in positions in which you spend a lot of time. Adjusting your sitting position at work, for example, so that you maintain a curve in your lower back is very likely to help over a few days, even if it feels somewhat uncomfortable to begin with. MEDICATION Your doctor may recommend simple painkillers and/or antiinflammatory medication. These can be very effective over the course of a few days. OTHER TREATMENTS If the back pain: Persists for more than 6 weeks without easing Moves down the leg below the knee Is accompanied by (or is replaced by) pins and needles, numbness or weakness Is accompanied by feeling unwell..then it is important to have an assessment by a qualified physiotherapist who will advise on treatment and rehabilitation. Treatment including manipulation, exercise programmes, acupuncture and soft tissue release may prove effective. Once again the more active you are in your treatment and exercise the better the outcome is likely to be. If necessary you may be referred for further investigation. In general plain X-ray is not useful and is not recommended for low back pain. It involves a great deal of radiation exposure and rarely results in any useful information. In a small minority of cases MRI investigation is required. Your therapist can discuss these and other options if necessary. 6
Acute low back pain can be a very painful experience, but fortunately often resolves fairly quickly. There are situations when the pain does not improve satisfactorily which should then prompt examination and treatment. The primary goal is to resolve the acute episode as quickly as possible and secondarily to prevent future episodes through proper education, exercise and conditioning. The most important advice is to keep active and to understand that: It is very likely to resolve with the simple measures described It is very unlikely to be serious. This leaflet has been written to help you understand more about the problem with your back. This leaflet is not a substitute for professional medical advice and should be used in conjunction with verbal information and treatment given. 7
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