How to Treat an Aching Back
Whether it’s from lifting too many heavy boxes or twisting your spine the wrong way, a stabbing pain in the back can happen to anyone.
When it comes to easing an aching back, some people swear by ice packs, while others find relief in heating pads. Some hit the gym to stretch, and others stay in bed. But the best remedy for back pain may be a little bit of all of the above.
What Causes Back Pain
People may say they’ve “thrown out” their backs, but the reality is that doctors often don’t know what's happening when a case of acute, or short-term, back pain strikes.
“For most people, it means their back hurts,” says Richard A. Deyo, MD, MPH,the Kaiser-Permanente Endowed Professor of Evidence-Based Medicine in the department of family medicine at Oregon Health & Science University in Portland. “But it’s often impossible to know the precise anatomical cause of back pain because the back has so many sources of pain.”
The idea of throwing your back out may itself be misleading, according to physical therapist , a clinical services manager at Beth Israel Deaconess Medical Center in Boston.
“People will say, ‘Oh, I threw my back out picking up a box,’ but it was probably the hundreds or thousands of episodes of bending before that that led to it,” Shillue says. “It’s repetitive use that puts us at risk for back injury.”
The good news, though, is that back pain is rarely serious, and the vast majority of people will get better with time.
“People are often fearful that they will be disabled by an episode of acute back pain, but probably 90 percent or more will get better," Dr. Deyo says. "It will take time, but they will get better.”
What to Do When Back Pain Strikes
Deyo and Shillue agree that when back pain strikes, the best advice you can follow is to resume normal activity as soon as possible. “The biggest myth is people should just lie down and not do anything,” Shillue says. “That can lead to more problems because the lack of activity causes joints to get stiffer and weaker.”
In fact, though it sounds counterintuitive, there is growing evidence that maintaining normal activity is better than bed rest for treating back pain. “I was trained as a physician to recommend bed rest for a week or two weeks," Deyo says, "but now there is plenty of research that suggests that it is not only not helpful — it is probably harmful."
Greg Shure, DC, a chiropractor and founder of Madison Square Wellness in New York City, agrees. “Movement should always be encouraged over rest to prevent the muscles from seizing up," he says.
To treat back pain, one of the first steps is to consider an over-the-counter non-steroidal anti-inflammatory drug such as ibuprofen, according to guidelines issued by the Agency for Healthcare Research and Quality in November 2019.
If you get frequent bouts of back pain, carrying these medications with you can be helpful. Be sure to follow package instructions for these medications, and talk with your healthcare provider before taking them if you have certain medical conditions (such as kidney disease, liver disease, heart disease, or a history of bleeding problems).
To Stretch or Not to Stretch
While being active is recommended during an episode of back pain, doing back exercises or stretches to ease acute back pain is not. “For acute pain, it is not wise to be doing specific back exercises so much as trying to maintain your normal exercise routine,” Deyo says.
Shillue also recommends avoiding positions or exercises that cause pain.
After the back pain has subsided, though, doing exercises that strengthen the muscles in the back can help reduce the risk of a repeat injury.
Deyo says it’s not clear yet whether one type of exercise is best at preventing and treating chronic back pain. So far, it seems that a combination of strength training, stretching exercises, and aerobic activity is most effective.
If back pain episodes become frequent, you may need more exercise. “It may be a warning sign that you need to strengthen the muscles that you need to support your back,” Shillue says.
Treat Back Pain With Ice or Heat?
The use of cold or hot compresses has not been scientifically proven to resolve short-term back pain, but it might help you feel better.
“There is not a lot of evidence that one is better than the other,” Shillue says. She usually recommends icing the affected area first to ease any immediate inflammation associated with back pain. Apply ice for about 15 to 20 minutes at a time, as often as needed, for the first 48 to 72 hours after an injury.
If your back pain is caused by muscle tightness, applying heat may help relax the muscles. But Shillue cautions not to leave the heat on for longer than 20 minutes at a time and never to sleep with a heating pad.
Both icing and applying heat are harmless ways to treat back pain, Deyo says, "but the reality is that neither produces a change in temperature in the tissues deep in the back so much as at the surface.”
“One rule of thumb is ice during the first 24 hours to help reduce the inflammation, usually 10 to 20 minutes every hour,” Dr. Shure adds.
When to Get Medical Help
Most cases of back pain resolve by themselves within a few weeks without medical attention.
“Many people feel they have to go to the doctor and get an X-ray or MRI scan, but the truth is those things are really not helpful for acute onset of back pain,” Deyo says. “There are a lot of opportunities to be misled by things that have been there for a long time and may not represent the cause of back pain at all.”
However, there are warning signs and symptoms that your back pain may need medical attention, such as:
- Weakness or numbness in one or both legs
- Loss of bowel or bladder control
- Back pain that doesn’t start to get better within a few days
Also, if you have a history of cancer or any ongoing medical issues, check with your healthcare provider if you experience back pain.
Video: Physiotherapist Upper Back Stretches Relieve Pain & Stiffness - Part 1
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