by Serge MAKOVETZ, BSc, MBChB, Dip. Spots Med.

Back pain is often categorized into two main types: acute and chronic. Although relative terms, acute is often used to describe a condition that comes on suddenly and lasts for a 4-6 weeks. It is not necessarily more severe than a long-term, or chronic, problem but often requires immediate treatment. Acute and chronic problems are not totally distinct, in that the former often arise as a result of weaknesses caused by an underlying chronic condition or weakness of the supporting structures of the spine. If unresolved, an acute problem may progress to become a chronic one. Research shows that maintaining the mobility of the back with exercise and an early return to normal activities is the best way to prevent this.

Most common acute back problems are caused by an injury or a strain. This can occur when a facet joint is normal range of movement. Such strains may be the result of incorrect lifting position fall or an awkward movement – for instance, while playing sport.

How serious is your problem?
When you are suffering from back pain, the first priority is to assess the severity and possible cause of your problem. This is important in deciding what action you can take for yourself or whether you need to seek the advice and help of a spine-care practitioner.

It is also important to consider the possibility of a non-spinal cause of back pain. Occasionally certain conditions affecting the internal organs can also cause pain in the back. These include kidney infections and gynecological problems. In such cases you may experience other symptoms in addition to having pain in the back. If you are unwell and also experiencing severe back pain it is therefore important that you consult your doctor.

If this is the first time you have experienced this particular back problem or it represents a recent, severe flare-up of a previous back problem, then for the purpose of initial management it should be considered an acute problem.

Consult your spine-care provider at once if you are experiencing acute back pain and if:

  • Pain follows an injury or fall and you also have pain or numbness in, or difficulty moving, an arm or a leg.
  • You have impaired, or loss of, bladder control.
  • You have a fever, feel generally unwell and have a severe headache or other symptoms, such as a change in bowel habit.
  • You are over 60 or have been immobilized by illness or injury or taking steroids for many years.
  • You have chest pain or pain in your left arm.
  • You are pregnant.

If none of the above applies to you, try the immediate action measures recommended below.Consult your back-care practitioner for an assessment of your back as soon as you are reasonably mobile.

An attack of acute back pain can be severe and disabling. It may immediately follow a strain, such as lifting an excessively heavy load or a fall. Sometimes, however, the effects of the injury may not become apparent until you wake the following morning and experience difficulty in getting out of bed because of pain and stiffness. In either case there are several measures you can rake to help relieve your symptoms and prepare yourself for an exercise program to speed recovery.

In general, any period of rest following an acute back problem should not last for more than 24-48 hours. Even during this rime try to encourage, if the pain allows some movement in your back – you may be able to do a gentle knee hug lying on your side. Once the pain has abated so that you can undertake a greater variety of movements, you can start to mobilize your back with some gentle exercises.

An early return to normal activities reduces the risk of your problem becoming a chronic condition.

Rest positions
When acute hack strain first strikes, taking the pressure off your spine, especially if a disc injury is suspected, is usually necessary. Ideally you need to lie down, as this removes downward gravitational pressure on the disc and allows your muscles to relax more easily. Preferably lie on a bed, as the floor does nor provide sufficient support and is more difficult to get up from. Sometimes, sitting supported in a chair is more comfortable, so be guided by what feels best. Never remain in a position that increases your pain. Try to change your position regularly, avoiding sudden painful movements. As soon as you can, get up to walk around for a few minutes every hour.

Your choice of position
It is important that you choose aposition that provides maximum relaxation of every area of your support in key areas is often most comfortable. However, for some people other positions offer better relaxation and greater pain relief, so adopt whatever position gives you most relief. If choose to lie down, place a pillow under your head and neck if you wish. Bend your knees and place one or more pillows under your knees for support, or rest your lower legs on a footstool or seat of a chair so that your legs are bent at a right angle. This position allows your lumbar curve to flatten towards the bed or floor, gently stretching your back muscles. If you back is still hurting, you may find that placing a small rolled-up towel in the small of your back (under the lumbar spine) helps to reduce the pain. If you are uncomfortable on your back, try lying on your side, knees curled up towards your chest so that your spine is flexed. Less commonly, you may find relief from pain by lying on your front with a pillow under your waist so that your back is slightly arched.

Pain-relieving medication
Although pain is useful in alerting us to injury or disease, there is no need to put up with continuing pain when it can often be alleviated by appropriate medication.

Several over-the-counter medications are effective for acute back pain. Non-steroidal anti-inflammatory drugs (nsaids) may be a better choice than paracetamol because they are anti-inflammatory as well as pain-relieving. Do not take these medications without the advice of your doctor if you have a history of asthma or stomach ulcers, and discontinue them if you feel any stomach discomfort. Always read the precautions on the package and do not exceed the recommended dose. Preparations containing codeine will have a slight constipating effect.

If over-the-counter medications do not provide adequate relief, consult your doctor, who may prescribe more powerful medication and possibly a short course of muscle-relaxant drugs if your back is in severe spasm.

Much of the pain from an acute back strain may come from the muscle spasm that follows the injury. Having found a position in which you can rest physically, try to concentrate on relaxing the painful muscles. Breathe in through your nose for a slow count of four; hold your breath for a count of three, then breathe out fully through your mouth for a count of six. On the out-breaths try to let the tension in your body disperse, starting with your head and jaw and working down your body, arms and legs to your toes. Do this for several minutes as often as you can. Other relaxation techniques may also he of benefit.