First steps in caring for low back pain

Self-care for low back pain
Since most episodes of low back pain are self-limited, it is often advisable for patients to try self-care early in the course of low back pain. In most cases, treatment for low back pain should center on a combination of:

• A short course of rest, limited to one to two days

• Pain medication, such as NSAID’s (e.g. ibuprofen) and/or acetaminophen

• Application of ice and/or heat on the lower back to decrease inflammation.

Slow mobilization and gentle stretching is then advisable, and the sooner a patient can return to his or her normal functional activities, the sooner the episode of lower back pain will usually get better. Walking is often an excellent exercise for low back pain since it is gentle on the back and helps oxygenate the soft tissues in the back to stimulate a healing response. If walking is too painful, exercising in the water (water therapy or pool therapy) is usually tolerable. This is because the water counteracts gravity and helps to support the patient’s weight in a controlled fashion.

Sitting upright (e.g. in an office chair, driving) will often aggravate low back pain, since this position loads the back three times more than standing. Sitting in a reclining position, however, relieves pressure on the lower back and is often the most comfortable position for patients experiencing an episode of low back pain.

When to seek help for low back pain
If the lower back pain symptoms do not start to abate within one to two weeks, medical attention should be sought from either the patient’s primary care doctor or chiropractor. The assessment of the patient begins with a history of the patient’s low back pain and includes questions such as:

• Where is the pain?

• Is there more low back pain or more leg pain?

• How long has the pain been present?

• Does anything make the low back pain better?

• Does anything make the low back pain worse?

• What treatments have been tried?

• Have there been other episodes of lower back pain?

A physical exam will also be done to assess the patient’s nerve function and motion in the lower back. Sometimes diagnostic studies (such as an x-ray) will be recommended to better assess the anatomy of the patient’s spine.

Beginning treatment for low back pain
Combining the information from the patient’s history, physical exam, and diagnostic studies, the health provider will then recommend a course of treatment. Generally, conservative (non-surgical) treatments for the low back pain will be recommended first, but if these fail, back surgery may be a reasonable option.