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Acute Low Back Pain

Back pain is very common, affecting approximately 80% of the population at some point in their lives.  We have learnt a great deal about it over the years and the information here is based on the latest research.  Always remember that there is a lot you can do yourself.

Low back pain

Back pain or back ache is not usually due to any serious damage.

Most back pain settles quickly.

It can be very painful and you may need to reduce some of your activities for a couple of days, but resting longer than this does not help and may do more harm than good, so keep moving.

Your back is designed to move.  The sooner you get back to normal, the sooner your back will start to feel better.

People who are physically fit generally get less back pain and recover better if they do get it, so take time to consider what you could do to improve your own fitness when this episode settles.

In the acute stages:

Bed rest can do more harm than good.  It is better to stay active if you can.

If you have to go to bed, try to start moving again after 2 days.  Gradually increase your activity day by day.  This can temporarily cause you some discomfort but be assured that this is normal and it is important to persevere.

Take any prescribed medicines regularly; don’t wait until the pain becomes out of control before you take them.  It is advisable to take pain relief on a regular basis for the first 48 to 72 hours at least.  This should include Paracetamol 500mg 2 tablets every 4 to 6 hours with Ibuprofen 400mg every 8 hours.  These can be bought from the Pharmacy.  Pain relief containing Codeine is also available from the Pharmacy and may be needed if these are inadequate.

You should seek medical attention urgently if you are having difficulty passing urine, experience numbness in the “saddle” area around the anus or experience weakness in one or both legs.

Use heat (hot water bottle / wheat bag) or cold (bag of frozen peas wrapped in a wet towel) to give short term relief in addition to your medication.

Do NOT stay in one position for longer than 20 – 30 minutes.  It is important to keep moving around.  Prolonged sitting, especially in a low, soft armchair is harmful at this stage.

Positions that people find comfortable when their back is really sore include:

  1. Lying on the floor on your back with your head resting on a pillow. Knees bent, lower legs elevated and supported on a chair parallel to body but at right angles to thighs.
  2. Lying on the floor face down with a pillow under your lower abdomen.
  3. Lying on the floor on your back with your head resting on a pillow. Knees bent slightly with a pillow placed underneath them.

How to stay active:

The idea is not to stay in one particular position or do any one thing for longer than 20 – 30 minutes without a break.  Aim to try and move a little further and faster each day.

Sitting is a common position that increases back symptoms.  This can be helped by changing positions frequently, and by using a lumbar roll (rolled up towel) to help support your back whilst sitting upright.

A hard upright chair is better than a soft armchair at this point if sitting is uncomfortable.  Also remember that when we sit down to have a rest we do not rest our backs, only our legs.  Sitting is hard work for a back.

If you sit at work, make sure you are not sitting stooped.  Stand up and stretch backwards regularly and take frequent walks away from your desk if possible.

Changing from sitting to lying to walking regularly in an hour will stop you from seizing up in any one position.  Use the oven timer or your mobile phone to help you remember to move every 20 minutes.

If not improving after 2 to 3 weeks you should seek the advice of your GP or Physiotherapist.

Should I Have an X-ray?

If your back pain has come on recently, unless as a result of a fall or direct trauma, then an x-ray of your back may not help identify the cause of pain. There are two main reasons for this.  Firstly, most back pain comes from the soft tissues of the back (such as ligaments and muscles) and these cannot be seen on an x-ray.  Secondly, as we get older we all have changes in the bones of the back, which are due to normal ageing; these changes (sometimes described as wear and tear or degeneration) will be visible on an x-ray, but may not be causing the pain.

Read more about non specific lower back pain in adults.

Reproduced with the kind permission of NHS Fife Physiotherapy Service.