Ruck Spine and SportS
Acute Low Back Pain: 7 Rules for Self-Management
Acute low back pain can be extremely frightening, incredibly debilitating, and can cause great distress and anxiety.
The following evidence-based strategies are designed to help you manage acute low back pain flare-ups effectively. Acute pain is often intense, but it is important to remember that pain does not always equal damage. These rules provide a framework for reducing intensity and regaining function.
RULE 1: BE POSITIVE!
This cannot be understated. Acute pain is bad enough. How you speak to yourself is important! Self-dialogue can either DAMPEN or AMPIFY your pain. We are looking for pain dampening behaviors!
Positive Self Dialogue:
• I’m going to get better
• It will be ok
• This is just temporary,
• I’ll return to everything I was doing before
• My back is strong.
VS.
Negative Self Dialogue:
• I’m screwed
• I’ll never get better, I’m broken
• I’m done with ______hobby/sport
• I’ll die if I can't exercise
• My back is weak
• I need someone to fix me now
RULE 2: DON'T RUSH TO SEE MULTIPLE PROVIDERS
Visiting lots of providers will NOT increase healing time! In fact, seeing too many providers can prolong healing time by giving you contradictory information, exposing you to unnecessary worry, unnecessary testing, and in some cases, unnecessary intervention.
Find a provider you trust who will help GUIDE and COACH you through the acute episode and teach you not only how to self-manage but how to stay as active as possible while the episode plays out. In addition, this provider should discuss a plan of action to get you back to doing what you love
RULE 3: STOP TELLING EVERYONE ABOUT YOUR PAIN!
Between family, friends, and co-workers, I have patients that share their pain experience with literally dozens of people. This is a form of CATASTROPHIZATION. Catastrophizing is anticipating the worst possible outcome and making a bigger deal of your pain than it needs to be.
Telling lots of people leads to unnecessary (and too much) contradictory suggestions and advice. Everyone will claim to know the magical solution. They’ll all have recommendations of who to see and what to do. People generally think they know way more about low back pain than they do. Their advice is often based on nothing more than their own experience. Lots of advice leads to FOMO and the feeling that you should be doing something different than what you are.
RULE 4: STOP BEATING UP YOUR PAIN
Remember, your pain is NOT from a muscle that suddenly got tight and needs to be worked out like a piece of dough. The feeling of tightness and tension is your body’s response to pain and inflammation. I’ve had acute low back pain patients that spend the day trying to stretch into the pain, with the hopes that it will melt away. Intuitively, this makes sense, but it usually doesn’t help and often makes them feel a little worse.
Some gentle manual therapy is probably ok if it helps but don’t spend the day stretching and trying to beat the pain into submission. You may get very temporary relief but in the big picture you are just mashing and pressing on painful tissues, bringing more attention to the area and making a sensitive area more sensitive.
RULE 5: AVOID GOING TO THE ER
Unless you think you are dying, avoid going to the ER for acute low back pain. Exceptions would be if pain is accompanied by fever or some other neurologic, cardiac, respiratory, gastrointestinal or urinary symptoms.
You’ll likely be there for hours, sitting around (which will make you feel worse!). You may end up getting unnecessary testing and intervention. They do not want to see acute low back pain nor are they equipped to give you the proper advice and home care recommendations. I’ve never seen this go well. Keep the ER for true medical emergencies.
If you feel you need some pharmacologic assistance with regard to anti-inflammatory options, reach out to you PCP or go to urgent care
RULE 6: TAKE AI ADVICE IN STRIDE
These tools are incredible, but they are not nuanced to the complexity of the individual. Nor are they able to see where your pain is (yet), examine you (yet), or touch the area of discomfort. Without understanding nuance and the multifactorial nature of low back pain, these tools may leave you frustrated and scared.
RULE 7: REMEMBER, YOU'RE NOT BROKEN
This may be the most important thing to remember. You are not fragile, broken, or out of place. Your spine is not crumbling, and your discs are not exploding. Sometimes patients feel better just from hearing this!
These outdated narratives are still pushed by many providers who manage low back pain. They are not up to date on modern, evidence-based principles of acute low back pain. If a provider focuses on everything that is wrong with you and what they need to do to, “fix” you, find a new provider. Remember, your spine is adaptable, strong, and resilient, even in the presence of pain
NATURAL HISTORY OF ACUTE LOW BACK PAIN
Did you know that most acute low back pain will improve on its own in 1-4 weeks, regardless of intervention? This, as with other conditions, is referred to as the injury’s, “natural history”. That’s not what the chiropractor or PT will typically share with you. He/she will certainly take the credit for the 3x per week sessions that, “cured” your pain! With the concept of natural history in mind, why would we seek treatment or care? If you seek treatment, the goal should be to get you more comfortable so that you can move better and begin to restore movement. The treatment should be one of coaching, encouragement, and education and NOT one of getting “fixed”. Consulting with a rehab professional can potentially reduce the frequency of recurrences and perhaps when episodes do happen, they are not bad and go away quickly. Most importantly, you’ll know exactly how to self-manage acute flare ups!