The onset of any acute back pain injury can be as daunting and tricky as it is common.
Staggeringly, over 60% of people will experience an episode of acute low back pain in their lifetime.
And not only do you have to figure out how to manage your pain, but you're faced with so many important questions as well.
What's wrong with your back? Is this something you'll have to deal with forever? How long will you be in pain? How do you go about fixing it?
Unfortunately, not all of these questions have immediate answers. So it's fair to say the first few days can not only be painful, but scary as well.
With this in mind, it's important to have an initial game plan. Steps you can take irrespective of the cause of your back pain and any pending diagnosis. More importantly, you need things to help you get your initial pain under control so you can make the absolute best decisions possible about the direction of your rehabilitation.
So without further ado, here is a seven-step action plan for you to do to help kickstart your recovery from acute back pain.
And for a summery check out the video below.
Step 1: Find a Comfortable Position
The very first thing you need to do is try and find a comfortable position. This can be tough if you feel like there are no comfortable positions. But wriggle around until you find what's most comfortable. A position you can tolerate.
Depending on the type and severity of your acute back pain you may find comfort in any of the following positions:
- Lying on your back
- Lying on your back with your feet up on something
- Lying on your stomach
- Lying on your stomach with your back arched
- Lying on your side
- Sitting on a chair
- Sitting on a chair and leaning forward
- Standing and leaning up against a wall
- Walking around
We want a position that minimizes your pain and allows you to relax as this is crucial for step number two.
Step 2: Practice Deep Breathing
This is potentially the most important step to master. It may sound a little strange, but we can use deep breathing to help control your initial pain.
One of the main reasons it's so important to find a comfortable position early on is that it gives you an opportunity to down-regulate an acutely heightened nervous system.
And in order to understand why this is important, we need to quickly discuss what pain is, and how it relates to a heightened nervous system.
What is Pain?
For the longest time, we've looked at pain as a consequence of tissue damage. However, we now know that this just isn't the case. Well, it is and it isn't... Let me explain.
Pain is based on your brain and nervous system's perception of threat.
At its core, your body generates pain as a way of trying to protect you from something threatening. Yes, that can involve actual tissue damage - an acutely bulged disc, an irritated joint, a stress fracture, etc, but there's far more to this equation than just tissue damage.
In times of stress, the body defaults to its primitive "fight or flight" response. This response sees a heightening of specific bodily functions to give you the best chance of survival. Think of that sudden rush of blood you feel when a car cuts in front of you on the road, or if someone scares you as you walk around a corner. It's the same basic premiss with pain. There's heightening that comes with pain and injury that needs to change for things to settle.
So what's important to understand here is that the faster we can regain control of that heigtened nervous system - by bringing it back to a more neutral baseline, the faster we can decrease our brain and nervous system's perception of threat, and subsequently decrease our pain experience from acute back pain.
So, how can you do this?
Box Breathing
Box Breathing is a simple, and fast-acting way to down-regulate a heightened nervous system.
Breathing is important here because the body associates certain physiological states with specific breathing patterns. Anxiety and stress go hand in hand with faster and shallower breathing patterns - similar to those tiring at the end of a run. When relaxed and calm, the body usually adopts a deeper, slower breathing pattern.
So with this in mind, we want to use this slow, deep, cyclical breathing pattern to cue the body into a safer and less threatened state, decreasing pain in the process.
In order to do this, give the following a go while in your comfortable position:
As the name implies, you want to continually breathe in, pause, breathe out, and pause with the same cadence until you feel your body drop down a gear or two. This could take ten minutes, or it could take 30-60 minutes. Just stick at it until you feel things begin to settle.
The amount of time for each cycle depends on what feels most comfortable and natural for you. Five seconds is a good starting point but feel free to increase or decrease that number based on what feels best for you.
Clearly, the speed and magnitude of change you can make depends on the severity of any tissue damage and how threatened your nervous system has become, but you should still be able to make inroads regardless.
Step 3: Don't Automatically Reach For Pain Medication
This may be tougher for some than others, but if you can avoid reaching for any pain meds or anti-inflammatories early on your body will be better for it eventually.
And here's why.
Pain, by definition, is your body's way of letting you know your boundaries. It's there to help protect you from additional harm. So if you can get by without masking your pain, you'll have a much clearer understanding of what you can and can't do without making things worse.
It goes without saying, but if you mask your pain and then go and do something your body isn't ready for, you're likely just adding time onto the end of your recovery. Short-term gain for long-term pain if you will.
Having said that, you don't have to be a hero. By all means, look after yourself if your pain is horrible, it stops you from sleeping, or you just have to get things done. It just needs to be a considered choice.
Hopefully, it's an easier choice if deep breathing works well for you.
Step 4: Heat Over Ice (If at all)
In the same way you might automatically reach for pain meds, many will also look to use ice or heat in the acute stages of back pain.
Interestingly, much like pain medication, there are things to consider here as well.
Traditionally you could mount a case for either heat or ice. However, the answer becomes a lot clearer once we discuss the effects of each on pain and the healing process.
So what is the best?
Well, the answer is actually maybe heat, but potentially neither!
And here's why:
Ice For Acute Back Pain
I've covered this in a lot more detail before, but the short version is that, while ice certainly can help with pain relief from acute back pain, it may also delay healing and recovery.
Related: Why You Shouldn't Ice an Injury
We traditionally use ice to decrease pain, inflammation, and swelling, yet these ideas directly contradict what the body needs to do to de-irritate and heal.
As discussed above, pain provides movement boundaries. So using ice to numb that pain again leaves us open to doing too much.
Similarly, the inflammatory response is a natural, automatic response to injury. Swelling is the natural by-product of the inflammatory cycle. Yet despite the crucial nature of these processes we are often so quick to try and stifle them with ice.
As with pain medication, ice can still be useful depending on your immediate goals. However, you again need to be aware that you are likely slowing your overall recovery at the same time.
Heat For Acute Back Pain
Interestingly, the negatives surrounding ice for acute low back pain doesn't automatically mean heat is better.
Where ice decreases blood flood flow - the very thing carrying important nutrients and chemicals needed for recovery, heat obviously promotes blood flow. So the key point here is to ask one simple question.
Do we want more blood flow to the area?
In short, the answer is not necessarily. The reason being that the body will send what it feels is an appropriate amount of blood flow to the injured area. And at the other end of this cycle will be an appropriate amount of swelling the body needs to clear with movement.
The consideration with heat is that as blood flow and swelling increase, we need an appropriate increase in movement to help evacuate that waste. And this isn't always easy if you're incapacitated by acute back pain.
And if we promote more swelling without evacuation we run the risk of increasing pain, muscle atrophy, and immobility.
Thankfully, there is a more effective way to use heat on an acutely injured back.
When You Should Use Heat For Acute Back Pain
One little known aspect of any acute back injury is pre-existing stiffness in the surrounding areas. Mechanically, this stiffness alters normal loading and can set your tissue up to fail when it does. And this stiffness is fair game when it comes to heat.
For example. If you've irritated your L1 facet joint, the chances are the base of your ribcage is also stiff - and has been for a while. Applying heat to any stiffness above the painful facet joint may feed much needed slack back into the area, allowing it to de-irritate much faster.
Similarly, surrounding heat application can also help down-regulate a heightened nervous system, positively affecting your local pain. Just remember that placing it directly over the source of your pain may work against you long-term.
Ultimately, if you feel either ice or heat helps improve your ability to cope with acute back pain, then back yourself in. Just understand their potential side-effects.
Step 5: Feed Slack to the Painful Area
The idea here is to try and feed as much mechanical slack to the affected area as possible. By restoring as much normal function and loading to the area as possible we want to create an optimal environment for recovery. This means going on the hunt for tight muscles and stiff joints above, below, in front, behind, and surrounding the source of your pain.
As mentioned above, poor mechanical loading precedes most acute back pain. And this poor loading is usually a consequence of hidden tightness and stiffness somewhere else.
The two main culprits for this are thoracic/rib cage stiffness and restricted hips. And going after these restrictions can speed up your recovery.
Below is a video detailing how to use a tennis ball to locate and mobilize any trunk stiffness.
And you can do the same thing with your hips.
I find something as basic as a tennis ball or lacrosse ball work fantastically well. Obviously your initial comfortable position will dictate where you can place the ball. But it's important to address as much surrounding dysfunction as possible.
If the surrounding tissue has become sensitized, use deep breathing to settle it down.
It also probably goes without saying but you don't need to push through the irritated area. Everything else though is fair game.
Step 6: Time to Get Moving
Now that your heightened nervous system is down-regulated and you've fed slack back into the affected area, it's time to get moving.
Many of the body's healing and recovery process are tied to movement so we need to make it a priority at some point. We need movement to facilitate the removal of swelling. We want your muscles to stay active and engaged. We don't want your tissue to tighten unnecessarily. If for no other reason than we'll have to address this at a later date.
The important thing to consider here is that there's a time and place for this. In a perfect world, the deep breathing and mobility exercises will allow you to feel comfortable moving around again without too much additional pain. However, the reality is that you are going to have to find a balance between periods of respectful movement and periods of rest and recovery - regardless of how small that window may be.
Again, your choices around pain medication and ice can really help at this point. If possible, you'll learn pretty quick what (and how much) is appropriate for you to do if you haven't masked the pain beforehand.
Step 7: Seek Professional Help
The first six steps in this seven-step acute back pain action plan require you to fend for yourself. And you can make some significant inroads into the severity of your initial back pain. With a bit of luck, you may even be able to conquer it within the first 24 hours.
However, the reality for many is that you should still seek specific advice.
I'm clearly biased in that I think everyone should see a Physical Therapist for everything. But at the end of the day, you need to see someone you trust. Someone who can expertly assess your acute back pain and tell you exactly what's going on, what additional things you need to do, and how long you can expect it to hang around.
The things you'll need to focus on if you've just irritated a spinal joint will be different to those with a stenosis or disc-related issue.
More importantly, you need to figure out exactly what set your back up to fail when (and how) it did. Otherwise it might come back again in the future.
And as a bit of a clue, back pain is usually a consequence of one (or a combination) of the following.
- Something somewhere is stiff
- Something somewhere is weak or deactivated
- The way you load you back is poor in terms of postures or positions
So it's important you work with someone to figure out how this relates to you and what strategies and exercises are needed to address it.
Conclusion
Ultimately, this seven-step action plan is here to help you minimize the impact of your acute back pain and minimize recovery time.
This whole process may only take a few hours for some yet days for others. But the key is knowing that you have far more control over this initial intense period than you realize.
You just have to listen to your body as best as you can and gently guide it down the path you want it to take.
If you're struggling with acute back pain and just don't know what to do, please feel free to reach out to me via the comments below, the videos above or the Your Wellness Nerd socials. I'm genuinely all ears!
It may be a nasty experience for you at the moment but stick at it. Best of luck!
- Grant