Lower-Back "First Aid"

by Gregory N. Arends, M.D.

The overwhelming majority (85%) of us will experience an episode of acute lower-back pain in our lives. The episodes are most often self-limiting, but can often be very painful and debilitating. What can you do if this happens to you?

Firstly, it is very important to differentiate back pain from back and leg pain. If you are experiencing leg pain, particularly in the thigh and below the knee, most likely you have a herniated inter-vertebral disc that is “pinching” a nerve. This can be a medical emergency (especially if associated with bowel or bladder incontinence, dense numbness or weakness, or erectile dysfunction), and needs to be evaluated by a physician immediately. Pain localized to the back rarely represents such an emergency. It is usually caused by relatively benign muscle or ligamentous strain or sprain or some chronic condition that has been aggravated by recent activity. If this is the case there are some steps you can take to reduce your discomfort.

Bed rest for no more than 48 hours can help painful spastic back muscles relax. A simple elastic low-back support brace (available at most pharmacies) may be worn during this period as a reminder to keep your back in a “neutral” position. Ice should be applied to the back throughout the day (3 to 4 times per day) for no more than 20 minutes per icing session. This can afford tremendous relief. The use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) may be of benefit, too. These need to be used with caution as they carry a significant potential side-effect profile. They are available as over-the-counter preparations (Advil, Alleve, Motrin, etc.) but as with all medications should be cleared by your physician prior to use. They should never be used in doses other than those recommended by your doctor or on the label.

If the above measures help control or reduce the pain, a more proactive measure can be undertaken. In the absence of cardio-pulmonary disease, press-up exercises (push-ups with the lower limbs remaining on the floor) can be extraordinarily beneficial for most cases of low-back discomfort. Performing 3 sets of 10 repetitions of this exercise twice or three times daily can help maintain low back flexibility, range of motion, and better “disc-health”. If these exercises are aggravating to your back pain, stop performing them and seek the care of your spine-specialist.

The combination of relative rest, bracing, ice, anti-inflammatory medications, and simple low-back exercises as first aid for your low back can be a powerful tool against acute attacks of low-back pain. Should any back pain last for more than 48-72 hours, contact your physician.