Suite 401, Gateway Hospital Medical Centre, 36 Aurora Drive, Umhlanga Ridge 031 566 5959

ABC of Acute Back Pain

I recently injured my lower back. It happened in typical fashion, not whilst doing the heavy activity (in my case a harder mountain biking session than usual) but rather during a rest break as I was throwing an empty wrapper into a bin. I got stuck and every slight movement resulted in sharp pain.


I knew immediately what I had hurt, I’d heard hundreds of patients tell a similar story. The disc. Fortunately I knew what to do to get the best outcome. It took 3 weeks and I am pain free. I can’t promise you will have the same outcome but I’ll give you the advice and activities I followed to help myself.


Let me analyse my actions…


1. I chose heat over ice.

acute back pain heat ice

A hot bath with some Epsom salts and later a hot beanbag. Why? The basic answer is because I felt muscle spasm coming on, which was adding to my pain and would hinder movement.


The longer reason is a bit more complex…


I’m sure many people have heard that with an acute injury, your first course of action is to follow the RICE regime – Rest, Ice, Compression, Elevation.


Let me address the C and E first. So, we are focusing on acute back pain with this article. Whatever information you come across, you must always consider the condition, symptoms and area of pain first. Then ask, does this apply? After which you need to adjust the information using some common sense and wisdom (okay, I have an advantage, I studied this stuff).


Back to the C and E. I’d be very interested in seeing how someone manages to compress the back, let alone elevate it. We can simply just forget about C and E because whatever positions of Elevation you’ve dreamed up in your mind, the pain in your back simply won’t allow you to achieve it.


Now let’s address the use of ice. The thought behind the use of ice is to reduce swelling or the fancy term, oedema. Ice also slows down the conduction of nerves, in so doing, it has an analgesic effect. So in the short term it helps get the injured body part up and running faster. But is it good in the long term?


Swelling is part of the self-healing that the body goes through, in fact it is the start of something called the inflammatory phase. It’s a pretty important part of the healing process and shouldn’t be stopped. There are even some studies that show that regular ice use in the inflammatory phase (first 72 hours) impacts negatively on later tissue strength (2).


So do I use it or not?


Back to focusing on the back. The structure that has been injured is buried so deep under layers of other tissue, that cold won’t penetrate deep enough to have any impact. So in this case there is no point in using ice.  Also, clinically I have seen how heat relaxes back muscles and there is a  study that has shown that heat is superior to applying cold in acute back conditions (1).


2. I chose movement and exercise over rest

acute back pain exercise

If you injure your back, the majority of people will tell you to go rest, don’t move too much, lie down. I mean the RICE regime has been recommended by medical professionals for years. Rest must help. Let me now introduce my friend, the MEAT regime – Movement, Exercise, Analgesics and Treatment.


It is a fine line of balance that must be achieved between deciding on rest and movement. Remaining still feels so much better because moving from one position to the next hurts (imagine sharp daggers into your back). But is remaining still or in one position considered rest? Rest according to my humble opinion isn’t lying in bed all day.


Rest means staying away from the activities that put pressure on your spine such as sitting, picking up heavy objects and driving. But it doesn’t stop there, great activities that are considered movement when done in small quantities become activities that put pressure on your spine when done in large quantities e.g walking, standing.


Okay let me simplify.


  • I stayed away from sitting or standing for long periods, alternate regularly.
  • I went for short walks in between alternating, less than 10 minutes (no scientific evidence attached to that time but it works).
  • I did rest in bed for the first 2 days but did gentle exercises like pelvic tilts, cat/cow and sliding the legs up and down into hip flexion. Every hour.
  • As pain got better, I increased the range of movement and difficulty of exercise. I trusted my pain but gently convinced it that movement was okay.
  • I went to a physiotherapist to confirm that I was on the right track with the gentle mobility exercises.


I was able to continue working. The fact that I stand and constantly move for my job and don’t spend much time sitting was a major factor in my quick recovery…perhaps an argument for the standing desk can be made.


3. Analgesics and muscle relaxants over anti-inflammatories

acute back pain pills

Do you recall that I spoke about the inflammatory phase of healing? Well, it is a crucial 48-72 hour period straight after an injury, which dictates your body’s progress through the rest of the healing process. It is a good thing, not the demon we have all come to believe that inflammation is.


In fact, stop the natural process and the tissues don’t heal as strong according to some studies. So I am of the school of thought that believes in avoiding anti-inflammatories for the first 2-3 days. Take analgesics instead and if muscle spasm isn’t relieved by heat, you can chat to your pharmacist or GP about a muscle relaxant that might help (so that you can move and exercise).


I started taking anti-inflammatories after 2 days and I can say with full confidence that they did not help relieve the pain, because the inflammation was not the problem.


In some cases, the body goes a bit crazy and overproduces inflammatory substances, here a case can be made for taking them. But still preferably not in the first 2-3 days.


4. I had some physio sessions

acute back pain figurine

I did this in order to help me restore movement and reduce muscle spasm. I mentioned before that muscle spasm and poor movement is what I attribute much of the pain experience to. So it goes without saying that supporting my body by relieving muscle spasm and getting it moving in the right way would help.


I believe in the techniques of my profession in achieving this and I value the advice of my fellow colleagues when it comes to exercise. So I had physio, got some confirmation that I was on the right path with my movement and exercise regime and just some assurance that all would be fine.  


Every step of this process was crucial to my recovery. I can’t place importance on one above the other. But I can say this, skip the exercise and movement and you delay your recovery by weeks or even months. Healing is just as much my own responsibility, or even more so, than the input I get from the medical world.


I hope my journey helps a few of you. I am planning on putting together a PDF document of my recovery exercise regime. Please contact me if you think you would be interested in this kind of a programme. Just remember, a physio is trained to take your condition, your unique situation and body and work out a programme for the best outcomes.


5. References

  1. French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. A Cochrane review of superficial heat or cold for low back pain. Spine (Phila Pa 1976). 2006 Apr 20;31(9):998-1006.
  2. Takagi, R, et al. Influence of Icing on Muscle Regeneration After Crush Injury to Skeletal Muscles in Rats. J of App Phys. February 1, 2011 vol. 110 no. 2 382-388
  3. Järvinen M, Lehto M, Sorvari T. Effect of some anti-inflammatory agents on the healing of ruptured muscle: an experimental study in rats. J Sport Traumatol Rel Res. 1992;14:19-28.
  4. Mishra DK, Fridén J, Schmitz MC, Lieber RL. Anti-inflammatory medication after muscle injury: a treatment resulting in short-term improvement but subsequent loss of muscle function. J Bone Joint Surg. 1995;77A:1510-1519.

Disclaimer: Although this advice is tried and tested and follows research protocols, Physio Squared cannot take any responsibility for injuries or health conditions that may arise as a result of following the advice. If you have any concerns about injuries or conditions you currently have, please seek a medical assessment by your local health professional or physiotherapist.

Leave a Comment