The first thing to do when your lower back begins to hurt is to close your eyes. Take a deep, cleansing breath. As you exhale repeat the following mantra to yourself: As bad as it hurts right now, it almost always goes away. Let your mind wander, and remind yourself that you are in good company. Eight out of ten people have severe back pain at some time in their lives; and nine out of ten of them get better on their own. The bad news is that only half have made a full recovery by 12 weeks. So what are you supposed to do for 3 months?
Evaluate Your Pain
The first thing is to take stalk of what’s going on. Ask yourself these questions:
- Are you having urinary issues? (This could include: urinary retention, urgency, a feeling of bloating or constipation, and numbness in your private areas.)
- Do you have a history of cancer? Have you lost weight over the last few months without dieting? Any bleeding from either your mouth or your rectum?
- Is there any chance to have an infection? (Symptoms could include: fevers, shakes, chills, or feelings of nausea and sick consistently)
- Have you been in any accidents lately in which you could have broken your back?
If you answered yes to any of these questions, you really need to get in to see your doctor urgently. If you don’t have a doctor, you should go to the emergency room for evaluation.
If you do not have any of the above symptoms mark your calendar on the day the pain began. It will be helpful as time goes by to have this written down.
The best thing to do at the start of your pain is just baby yourself. Anti-inflammatory medications really help. Aleve or ibuprofen are usually the best unless you have a history of Ulcers. In that case, take Tylenol. I always recommend taking Prilosec along with anti-inflammatory medications to prevent an ulcer. If you normally exercise, lay off of your usual routine, and start light walking. Walking in the pool can be easier if the pain is too much while walking. Try to avoid doing nothing, you want to stay active during this time.
Seeing a chiropractor 2-3 days a week for up to 3 weeks is often helpful if you feel you need additional help. Muscle relaxants are not a bad idea either, especially if you are having trouble sleeping. I usually recommend Zanaflex, Flexeril, or Soma which you can take at night right before going to bed. Moist heat is also beneficial and feels good. Although cold packs are known for reducing inflammation, they’re actually not helpful for the early back pain, and should be avoided.
Re-evaluate After 6 Weeks
After about 6 weeks with lower back pain with no improvement, you have to determine whether or not the pain could be from a pinched nerve root. Check out this resource to help you understand your lower back pain and determine if your pain is root pain, joint pain, or disc pain. Nerve root pain is mostly in the leg, not the back; it feels like electricity flowing from your back and into your leg. This pain is usually associated with numbness and weakness in your leg.
If you do have root pain the place to start is your primary care doctor, ask for an MRI scan. Then you may want to consider an epidural injection. Epidural injection can relieve pain for up to 100 hours. We now know from the most reliable studies possible that having an epidural injection will not make a difference in the long run. Therefore, it’s a good idea to have an epidural injection if you think pain relief for the next 100 hours is worth having an injection deep in your spine.
Between six and twelve weeks if you’ve had enough of walking, moist heat, anti-inflammatories, and rest then it may be time to consider physical therapy. You will need a prescription for therapy, so see your doctor first. After visiting your physical therapist three times a week for up to three weeks, if the pain is not improving then it’s time to ask your doctor to order an MRI scan of your back.
At Twelve Weeks
If you get to 12 weeks and are still in pain there is likely a structural cause that will require a procedure or possibly even a surgery to fix. If you haven’t had one you need to get an MRI. Once you have an MRI reach out to one of our spine care specialists to get a second opinion about your potential treatment options.