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Acute lower back pain: What you should know

  • Published
  • By Capt. James Arnold
  • 36th Medical Group
Acute lower back pain is one of the most common reasons adults visit their primary care doctor in the clinic. 

In fact, 60-70 percent of all people will "throw out" their back at least once in their lifetime. The exact cause of lower back pain is not well understood, but the vast majority will resolve on its own two to six weeks after the initial injury. 

The following is helpful advice and answers to common questions regarding LBP.

How do I get better?
The most important element in the healing process is time and relative rest. The spine will eventually heal, relieving the pain and allowing your back to work normally again. 

To help get relief in the meantime, take an over-the-counter anti-inflammatory medicine like Ibuprofen (Motrin, Advil) or Naprosyn (Alieve), which can decrease your pain and inflammation. 

Patients with history of stomach ulcers or known kidney disease, however, should avoid the above medications and instead, take acetaminophen (Tylenol). 

Depending on your pain level, activity should be limited but never completely stopped. Even for very severe pain, bed rest should be limited to 24-48 hours after the injury. 

Walking, moving and gentle stretching is essential to getting relief sooner and retraining muscles to go back to their normal length. Heavy lifting and high impact exercise, like running, should be limited while still in pain since those activities can re-injure your back and slow healing.

When do I go see the doctor?
Always go see your doctor if you have weakness, numbness or pain involving one or both of your legs below the knee. Also, if you develop numbness involving the inner thighs or lose control of bladder/bowel function, go to the emergency room. This may be a sign of a serious medical condition requiring emergent treatment. Always go to the doctor if your pain is the result of a direct blow to the low back. 

If you have pain and symptoms only related to the low back, but it's intolerable and not well controlled with Ibuprofen or Naprosyn, come see your primary care doctor. The doctor can prescribe a muscle relaxant and give stronger pain meds when needed. 

They can also, based on your history and exam, offer a stretching and exercise prescription and/or offer a consult for spinal manipulation or physical therapy, all of which can improve symptoms while your back is healing. 

For active duty patients, your primary care provider can alter your profile to limit your activity as described above while your back heals.

When do I need an X-ray or MRI?
In most cases, an X-ray or MRI is not needed for acute LBP. Unless you develop any of the concerning symptoms listed above that warrant a visit to the doctor's office, your doctor will not need any imaging to effectively treat your low back pain. 

If your pain persists with no improvement beyond four-six weeks of treatment, the doctor may order an x-ray to look for arthritis of the lower back or other causes involving the bones of your back. MRIs are for patients who develop radiating pain, numbness or weakness down one or both the legs below the knee. 

These symptoms can be the result of a herniated disc in your low back and may require more extensive treatment and management.

Can I re-injure my back?
Absolutely. The most common risk factor associated with having an episode of lower back pain is having had a prior episode of lower back pain. Proper mechanics in the work place and at home are essential to maintaining a healthy back. Lifting with your legs and lifting heavy objects with a partner is key. 

If the back is injured over and over again, the wear and tear on the back will be irreversible and can lead to lifelong disability. If repetitive back injuries occur in your workplace, make sure your supervisor reports this to the flight medicine clinic. 

Our doctors and biomedical personnel are trained in assessing the workplace environment and can give recommendations that can protect you from injury. 

If you have any questions about acute low back pain, please contact 366-WELL at the 36th Medical Group.

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