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Acute Low Back Pain

​​​A common condition that occurs, as the low back and pelvis region carries the majority of our body weight. ​​

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Low back pain is defined as pain in the low back or around the tailbone and hip regions. It is not uncommon to overstrain this area and up to 90% of people develop acute lower back pain during their lifetime. It can present with or without associated pain into the legs. The intensity of the pain may be so severe that your mobility may be affected, limiting your ability to get out of bed, change positions from sitting to standing, or bend over to wear your shoes. This intensity of pain often leads to patients panicking and worrying about the cause of pain. However, it is reassuring to know that although th​e pain may be very intense, the majority of patients with back pain symptoms do not have a serious problem with their back.​​

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What are the signs and symptoms that I need to be concerned with?

A rare but serious spinal condition, Cauda Equina Syndrome, can lead to permanent damage or disability and will need to be seen by an Emergency Specialist.

Some of the warning signs of Cauda Equina Syndrome are:

  • ​Loss of feeling/pins and needles between your inner thighs or genitals
  • Numbness in or around your back passage or buttocks
  • Altered feeling when using toilet paper to wipe yourself
  • Increasing difficulty when you try to urinate
  • Increasing difficulty when you try to stop or control your flow of urine​
  • Loss of sensation when you pass urine or bowel motion
  • Leaking urine or recent need to use pads
  • Not knowing when you bladder is either full or empty
  • Inability to stop​ a bowel movement or leaking

Acute (sudden onset) back pain may sometimes be related to trauma like a fall on the buttocks or a lifting injury, but it is also often linked to a period of unaccustomed activity, ranging from prolonged bending/squatting or sitting in awkward postures too often/long over a short period.

Acute back pain is common. Studies have shown that more than 8 out of 10 people suffer from at least 1 episode of significant back pain in their lifetime. The majority recover within 6-12 weeks.

Unfortunately, 3 out of 10 people report that they continue to suffer from their back problems that significantly affect their lives. Poor recovery has been shown to be is less related to the severity of your back injury but more often related to unhelpful thoughts, emotions and perceived inability to cope with the ongoing situation.

If you experience anxiety or distress related to this back pain episode, or have been experiencing negative emotions or currently are in a stressful work or difficult family situation, let us know and we can work together to help you. Remember to highlight this to your doctor, nurse or physiotherapist today or during your next visit.

As you can see, pain management is a ‘whole-person’ approach and all factors that contribute to your pain experience has to be considered to formulate a useful treatment plan.

Adopt the ‘relative rest’ approach.

  • Do not rest in bed completely but try to sit/stand and walk little bit often. You are allowed to perform your daily activities and tasks as tolerated. 
  • Adopting 1 posture or position for more than 20min is not recommended in the first 2 weeks after an episode of significant lower back pain.
  • There is no best resting posture. Some people prefer to lie on their tummy while some prefer to lie on their back with their knees supported by a pillow. Select the posture that you feel most comfortable in. Even the most comfortable posture doesn’t allow you to remain in the same position the whole time.
  • Do not aim to walk for long distances continuously. If you are familiar with the destination, plan your journey, with frequent sitting breaks.
  • Walking is often healthy for the back and may be a good gauge of your recovery. If pain allows, you can start walking comfortably.
  • You may aim to increase walking duration by 10-20% weekly before you see your physiotherapist.

Let your pain be a guide to how much you can participate in your daily activities:
Pain Score 1 - 3: (mild pain): 
  • You may carry on with your usual activities like walking, light housework, deskbound work. Take breaks often.
  • You may not require painkillers; if required, use the minimal effective dose.
  • If you are pain-free, you should  start low and progressively do more before you perform intensive physical activity.

Pain Score 4 - 6: (moderate pain):
  • You may consider carrying on with your usual activities but do less that before and always take regular breaks before your pain gets worse.
  • You should be using painkillers so that you can sleep and cope better in your usual activities, unless the risks outweigh the benefits.

Pain Score 7 - 10 (severe pain):
  • ​You should be using painkillers.
  • Avoid intensive physical activities.
  • You may find that pain affects your sleep almost every night. You have difficulty turning in bed, getting up from the toilet seat, chair. You are unable to stand up straight or have to keep your back very straight and you cannot tie your shoelaces.

Seek advice with your physiotherapist if you're unsure about safe activity levels.​​

​ Can I return to my physically-demanding work again?
Reducing your pain and learning how to manage your daily activities is the priority in the early recovery phase. Predicting when you return to your physically-demanding work is more complex as this depends on how you respond to treatment. Sometimes, treatment for spine-related pain include invasive therapies like injection or surgery and decisions like these depend on your progress with recommended treatment. This is a good question to discuss with your healthcare provider.

Should I take painkillers?
You may be prescribed with more than 1 type of painkillers and this is not because your injury is more serious than others. Pain is complex and addressing pain with different types of painkillers can be more successful with lesser risk of undesirable effects of each medicine.

Take your medication as prescribed if the pain affects your sleep, ability to perform your usual routine or participation in activities prescribed by your physiotherapist. A successful recovery depends on the early management of pain. Painkillers not only help to relieve pain, some can control inflammation, while some allow you to sleep better so that your body has a greater potential to recover.

With more effective pain management, most people can still perform their usual activities at home.

What should I be avoiding?
In the initial 6 weeks after an episode of significant back pain, it is expected that you are not your usual self. The presence of pain does not necessarily mean that you should avoid movement. On the other hand, complete bed-rest is detrimental to your overall recovery and should be avoided.

Contributed by Physiotherapy, Rehabilitation, Allied Health Services
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