Acute Lower Back Pain: What to Do? – Guide from a Physical Therapist

Lumbago: A Common and Benign Back Pain

There are two main categories of lower back pain, in the lumbar area (between the mid-back and the buttocks):

1. Lumbago, also known as acute low back pain or acute lumbago: pain that occurs suddenly.
2. Chronic low back pain: pain in the lower back that has been present, either intermittently or continuously, for about three months or more.

In this article, we will only discuss acute low back pain. This type affects individuals who have not had any recent back pain.

Quite suddenly, a lower back pain appears, causing concern and hindering certain activities.

Lumbago is very common: 60 to 70% of people in the United States will experience it at least once in their lifetime.

However, its prognosis is good: even though the pain can be extremely intense for a few hours or days, it diminishes regardless of what you do.

Even if the pain is sometimes sharp, very bothersome, and concerning, lumbago is considered benign.

This does not mean that you are overly sensitive or should not be in so much pain. It can be frustrating to hear that something is benign when you are suffering a lot.

It simply means that it will resolve itself: if it is indeed lumbago, you are not at risk of complications.

Moreover, having intense and bothersome pain initially does not necessarily mean that it will take longer for you to recover.

• 60 to 70% of people in the United States will experience lumbago at least once in their lifetime.
• Even if the pain is very intense and bothersome at the beginning, it will decrease no matter what you do, and you will not have complications.

How to Be Sure It’s Lumbago?

If this is the first time you are experiencing this type of problem, consult a healthcare professional: your primary care physician or a physical therapist (direct access to physical therapists is possible).

Through mainly a detailed interview, this person will be able to diagnose lumbago. Their role is also to reassure you.

The aim of the consultation is not necessarily to prescribe something at all costs: physical therapy sessions, medications, exercises, etc.

Dozens of studies show that these treatments do not necessarily provide significant benefits. We will discuss this further in the article under “Acute Low Back Pain: What to Do.”

Additionally, it is very rare that additional tests (blood tests, X-rays, MRIs) are needed.

This is not due to negligence on the part of the healthcare professional but rather to our current understanding of acute low back pain. These tests do not help treat acute low back pain better and can even generate anxiety and unnecessary over-treatment.

One of the main objectives of this medical or paramedical consultation is to determine if you indeed have common (also called non-specific) low back pain.

The goal is to identify any potential warning signs or red flags that may indicate an underlying condition causing the low back pain. This is rare, and there is a high likelihood that you have common lumbago.

Here are these warning signs. Even if you have one or more of these signs, it does not necessarily mean you have an additional condition. Simply consult a healthcare professional who will refine the diagnosis.

Warning Signs in Case of Back Pain

• Fever
• Pain primarily at night or at rest
• Loss of strength in the legs
• Loss of continence
• Loss of sensation in the genital area
• Fall or accident
• Unexplained weight loss
• History of cancer
• Intravenous drug use
• Prolonged use of corticosteroids
• Chest pain
• Significant spinal deformity
• Significant deterioration of general health

How Long Does Acute Low Back Pain / Lumbago Last?

📚 Read the more comprehensive article: Acute Low Back Pain: How Long Does It Last?

Be optimistic: intense pain diminishes very quickly, usually within a few hours or a few days at most. Sometimes, it may take 3 to 5 days to see improvement, but the pain will decrease regardless of what you do.

For many people, the pain disappears completely within a few days to a few weeks.

One of the best treatments for acute lumbago is to look on the bright side and stay optimistic:

• For many people, the pain diminishes quickly.
• It also completely disappears within a few days or weeks.

If you have found this article, it means you are adopting strategies to feel better. This will pay off!

That being said, you might want to know the precise statistics on the progression of lumbago. Here they are:

Keep in mind that these figures likely overestimate the intensity and duration of the pain: many people never contact a healthcare professional when they have back pain, especially if their pain disappears quickly.

Thus, they are never included in studies that track the progression of acute low back pain. The people included in the studies are likely those with a worse prognosis than others.

Here are the figures:

• 36% of people have no pain at all after a maximum of 2 weeks.
• 34% have no pain at all after a maximum of 12 weeks.
• 14% experience a reduction in pain but not complete disappearance.
• 10% have pain that fluctuates (decreases and then increases again).
• 5% have pain that remains high for 12 weeks.

In other words, you have a 1 in 3 chance of being completely pain-free within a maximum of 2 weeks.

In 95% of cases, your pain will decrease. If you are part of the remaining 5%, it doesn’t necessarily mean that you have something serious, even though the pain is bothersome.

• Back pain decreases within the first few hours or days (usually a maximum of 3 to 5 days).
• Pain disappears completely within 2 weeks for 1/3 of people.
• Be optimistic: you have a good chance of being among those whose pain decreases quickly.

How to Manage Lumbago Pain?

There are two very simple, free, and effective things you can do to relieve lumbago pain:

1. Trust in your natural self-healing abilities: Whatever you do, your pain will likely decrease in a few days, at most a few weeks.
2. Stay active: Continue to engage in daily activities as much as you can.

And that’s it!

I’ve been a physical therapist for 10 years, and almost every year, I see new devices supposedly designed to relieve or even cure back pain: posture correctors, acupressure mats, Nubax, inversion tables, ergonomic chairs, massage guns…

The list is almost endless. Unfortunately, there is little chance that these “miracle” solutions will relieve your pain.

If you notice a reduction in pain while using them, it’s likely due to:

• The passage of time.
• The fact that you tried this solution at the peak of your pain, when it was really unbearable, and it would have decreased on its own.
• The money or hope you invested in this solution.
• Simply doing something to alleviate your pain.

Generally, be wary of ready-made solutions for lumbago, which often use the same marketing arguments:

• Certified clinical results: Often, no rigorous studies are conducted.
• 800,000 people relieved: This number is often stated randomly or at best corresponds to the number of people who bought the device, without necessarily being relieved.
• Recommended by doctors: Often, at best, a single doctor has given a small opinion for a fee.

The Two Best Things to Do to Relieve Lumbago Pain Are:

1. Believe in your real and natural self-healing abilities, no matter what you do.
2. Continue doing physical activities that you can manage (walking, household chores, DIY projects, gardening, etc.), as long as the pain remains bearable while doing them.

Are Medications Effective for Relieving Lumbago Pain?

Hundreds of studies have evaluated the effectiveness of medications in relieving lumbago pain.

Here are the main findings:

• Paracetamol: People taking paracetamol are not more relieved than those taking a placebo.
• NSAIDs (non-steroidal anti-inflammatory drugs): People taking NSAIDs are slightly more relieved and functionally less impaired in the short term compared to those taking a placebo. However, this effect is not significant enough to be very useful, potential side effects exist, and some people cannot take NSAIDs.
• Morphine (opioids: codeine, tramadol): There is not enough data on the effect of morphine in these cases, and the potential side effects are significant.
• Muscle relaxants (methocarbamol, thiocolchicoside): People taking muscle relaxants are very slightly relieved compared to those taking a placebo, and the potential side effects are significant.

In France, the Haute Autorité de Santé suggests using paracetamol and NSAIDs as first-line treatments but does not recommend prescribing them systematically.

In practice, I observe that many patients who have called emergency services or consulted their primary care physician are prescribed a cocktail of medications: paracetamol + NSAIDs + opioids + (muscle relaxants) + (Lyrica), in addition to physical therapy sessions.

This is problematic because when taking multiple medications, it is difficult to know which one is effective. There is also the risk of interactions and side effects, along with their low efficacy on pain.

What Should You Do About Medications?

• If your doctor has not prescribed any medication, be relieved: this means they are fully adhering to national and international guidelines. Your pain will decrease, and you will not risk any side effects.
• If your doctor has prescribed several medications, and reading this article makes you question their use, you can discuss with them the relevance of taking these medications for you.

Only NSAIDs seem to have a small short-term effect on reducing lumbago pain, but their use is not necessarily essential.

Should You Follow Physical Therapy Sessions?

There are fewer studies on the effects of physical therapy compared to the effects of medications. The existing studies show that:

• People who undergo physical therapy sessions do not heal faster and are not more relieved than those who do not.
• People who do specific exercises do not heal faster and are not more relieved than those who do not.
• The most important factor is that people remain active and do not lie down all day.

In this context, physical therapists should primarily focus on reassuring the patients referred to them. This reassurance is a form of treatment in itself and the most effective, according to our current knowledge.

Repeated sessions are not necessarily required, except perhaps for those who need help staying active or who need more time to be reassured.

In any case, passive sessions where the person with back pain lies on a table seem irrelevant.

Here are some passive techniques often used by physical therapists in France for acute back pain, commonly referred to as physiotherapy:

• TENS (Transcutaneous Electrical Nerve Stimulation)
• Application of heat
• Manual therapy, osteopathy, spinal manipulations
• Physical therapy massage

There are few high-quality studies on the effectiveness of these techniques. People who receive this type of care do not heal faster.

At best, their pain is slightly less intense in the short term, by about 1 to 2 points on a scale of 10.

But this effect is not found in all studies, which are already of low quality, raising significant questions about the usefulness of these techniques.

Applying heat can be easily done at home as often as desired.

Just make sure not to place the hot pack directly on the skin; instead, put a cloth between the skin and the pack. Hot packs can be heated in the microwave and are easily found in supermarkets, pharmacies, or online.

If physical therapy sessions are prescribed, their primary goal is to reassure you and encourage you to stay active rather than remain bedridden.

Passive rehabilitation techniques (massage, TENS, ultrasound, heat) provide at best a small, short-term relief and are not truly beneficial for acute low back pain. People who undergo this type of session do not recover faster than those who do not.

What to Do in Case of Acute Low Back Pain? Treatment

If you or someone close to you is suffering from severe back pain, it’s completely normal to seek a quick solution.

Throughout this article, I have provided information on what we currently know about acute low back pain and how to overcome it.

Here are the key points to remember:

• Whatever you do (even nothing), there is a 1 in 3 chance that your pain will disappear completely within 2 weeks, and a 2 in 3 chance within 12 weeks.
• Medications are often unnecessary for relieving lumbago pain.
• Stay as active as possible. Continue working, moving, doing household chores, DIY projects, gardening, shopping, as long as the pain is bearable.
• Physical therapy sessions are not necessarily useful, especially if they are passive (the therapist massages you, applies electrodes, performs manipulations or stretches).
• There is no miracle solution to quickly reduce back pain, and new falsely promising gadgets are marketed every year.

What to Do in Case of Acute Low Back Pain

• Stay as active as possible.
• Believe in the body’s natural self-healing abilities: whatever you do, you have a 1 in 3 chance of being pain-free within 2 weeks after the onset of pain.

Other Common Questions About Lumbago

Here are answers to frequently asked questions from people suffering from lumbago.

Acute Low Back Pain and Work Leave

A work leave is sometimes prescribed for acute low back pain. Physical therapists cannot prescribe it. It is usually prescribed by a general practitioner.

Returning to work as soon as possible is crucial, as being active increases the chances of quick recovery.

Lumbago: Heat or Cold?

Heat provides more relief than cold. The purpose of using heat is simply to reduce pain temporarily, not to speed up recovery.

Lumbago: Is It Normal to Be Unable to Get Up?

Some of my patients have a lot of difficulty getting up in the hours or days following a lumbago. They may need to walk bent over or hold onto the wall. This can be alarming but is not necessarily a sign of severity. Remember, you have a 1 in 3 chance that your pain will completely disappear within 2 weeks, even if the pain is so intense that it is impossible to get up.

Symptoms of Acute Low Back Pain

You are likely experiencing acute low back pain if:

• You have pain in your back, between the middle of your back and your buttocks.
• Your pain has lasted for a few hours to a few weeks at most.
• Your pain does not radiate into your buttocks or lower (if it does, it is more likely sciatica).
• Your pain increases when you move.