Acute Low Back Pain Patient Education Handout associated with UMHS Clinical Care Guideline

This information is not a tool for self-diagnosis or a substitute for medical treatment. You should speak to your health-care provider or make an appointment to be seen if you have questions or concerns about this information or your medical condition.

What is low back pain?
Almost everyone has back pain at one time or another. The pain may be in the center of the back or to one side, or even move down the leg. Symptoms may also include pain in the back and the buttocks or legs, stiffness, limited motion and spasm.

What are the risk factors?
Things like obesity, lack of exercise, heavy physical work, accidents, vibration (i.e., driving a truck), smoking, and family history may add to the chance of having low back pain.

Being overweight may increase risk for low back pain because of the added stress on the back.

How does it occur?
We don't know a lot about just what does cause low back pain. Pulled muscles, strained ligaments, tight joints or small tears in the disks (shock absorbers which are stacked between the spine bones) are all likely causes. The problem is that these tears and pulls don't show up well on x-rays.

Should I have an x-ray?
As a rule, most people with low-back pain do not need an x-ray. X-rays do not provide any useful information that has an effect on treatment. Your doctor may order x-rays or other studies if your specific symptoms indicate a need for these tests or if your back pain does not go away in 4-6 weeks.

How is it treated?
The good news is that 90% of people with acute low back pain recover within 4 - 6 weeks.
Basic points of a program for treating low back pain include:

• Stay active. Lying in bed or cutting back on activity is not helpful. People get better faster if they stay active at home and work. Common exercise such as walking, swimming or riding a stationary bike can be helpful in many cases. Your doctor may limit your activity if your job or the sports you play are very physical.
• Stretching. A healthcare provider will suggest doing stretches 2-3 times daily in most cases. Hold the stretch for 20-30 seconds, take a break and do it again. If a stretch seems to make things worse, or if it causes pain to go down your leg, seek further advice from a healthcare provider or your doctor.
• Ice packs (plastic bag with ice cubes and water, wrapped in a towel) applied for 20-30 minutes at a time may feel cold at first, but they actually may decrease pain, spasm and inflammation in the back. There's nothing wrong with trying heat if it works, but ice may be better.
• Exercise. Common aerobic and conditioning exercises, such as brisk walking, swimming or riding a stationary bicycle can be very helpful.
• Medications may be prescribed by your doctor. It's much more helpful to take them regularly as opposed to only when you hurt.

• trouble controlling your bladder or bowels
• numbness or weakness in the feet legs, groin or rectal area
• the pain gets worse or extends into your leg and below the knees
• pain limits your normal activities for more than 4 weeks
• shooting pain down the leg

• Don't push with your arms when you move a heavy object. Turn around and push backwards so the strain is taken by your legs.
• Participating regularly in an exercise program will help your back, plus it will keep you healthy, overall. Before starting any exercise program you should inform your doctor and see a professional trainer or physical therapist for exercise advice that fits your needs. For aerobic exercise such as walking, bicycling or swimming, start with low intensity exercise about 5 - 10 minutes of exercise a day, three days a week, and slowly work up to 30 minutes of exercise a day for five days a week. If you can't start with 5 - 10 minutes of exercise, do 2-3 minutes, or whatever you can. Strength training is also good for your body and back. You can start with leg strengthening exercises that will help your back when it comes to lifting heavy objects. Use strength training machines if you can. Start with lighter weights, completing 10 to 15 repetitions before increasing the weight at your next workout. Keep in mind that, stronger muscles will allow you to do more work and help reduce the risk of back injury.
• When lifting a heavy object keep the object close to your body and bend your knees. The stronger your legs are, the easier it will be to lift.
• When you sit, sit in a straight-backed chair and hold your spine against the back of the chair.
• Bend your knees and hips and keep your back straight when you lift a heavy object.
• Avoid lifting heavy objects higher than your waist.
• Hold objects you carry close to your body, with your arms bent.
• Avoid sitting in one place or in one position for a long time. Get up and stretch, walk about and change positions.
• Use a footrest for one foot when you stand or sit in one spot for a long time. This keeps your back straight.
• Sit close to the pedals when you drive and use your seat belt and a hard backrest or pillow.
• Lie on your side with your knees bent when you sleep or rest. It may help to put a pillow between your knees.
• Put a pillow under your knees when you sleep on your back.
• If you smoke, ask your doctor for help on how to quit. Smoking limits blood flow to the discs and muscles in your back and slows their healing.

How do I rest my back?
To rest your back, hold each of these positions for 5 minutes or longer:

• Lie on your back, bend your knees, and put pillows under your knees.
• Lie on your back, put a pillow under your neck, bend your knees to a 90-degree angle, and put your lower legs and feet on a chair.
• Lie on your back, bend your knees, and bring one knee up to your chest and hold it there. Repeat with the other knee, and then bring both knees to your chest. When holding your knee to your chest, grab your thigh rather than your lower leg to avoid over-flexing your knee.

When can I return to my activity or sport?
The goal of rehabilitation is to return you as soon as is safely possible to your normal activity. This includes strenuous activity and sports. If you return too soon you may worsen your injury, which could lead to permanent damage. People recover from injury different rates. When you can return to your activity will depend on how soon your back gets better. It does not depend on how many days or weeks it has been since you were injured. Most of the time, the longer you have symptoms before you start treatment, the longer it will take to get better.

It is important that you have fully recovered from your low back pain before you return to any strenuous activity, which includes sports. You must be able to have the same range of motion that you had before your injury. For sports you must be able to run, jump and twist without pain.

Exercises for low back pain