Having a new episode of back pain is an incredibly common experience, with some studies reporting that in the U.S. 25% of people report having back pain within the previous 3 months1. In 2017 it was estimated that at any given time, 7.5% of individuals worldwide had back pain, which equates to 577,000,000 people1. 577 MILLION PEOPLE! That’s a heck of a lot of people! So if you’ve recently hurt your back, you are not alone! Given that this is such a common problem, you’d expect that modern medicine would know exactly how to treat this issue, right? …Unfortunately, this just isn’t the case. Since 1990, low back pain has been, and still is, the leading cause of Years Lived with Disability1. Even with all of the advances in medicine over the last 30 years like improved imaging, pharmaceuticals, surgeries, etc., back pain continues to be a problem. So, while the perfect solution doesn’t yet exist for low back pain, we have some good evidence of what NOT to do when you start feeling pain in your lower back. With that said, here are my top five WORST things to do when your back is hurting!
1. Freak out
Maybe you felt a ‘pop’ in your back, or it started hurting over the course of a few minutes/hours. Consciously or not, your mind and body start assessing what has happened.
I think it’s safe to say we pretty much all know someone who has experienced some really severe back pain before, whether it was due to an accident or just happened all of the sudden. Maybe you’ve even experienced it yourself. All of those thoughts, emotions, and history you’ve heard about and experienced with back pain can have a very real impact on the symptoms you’re feeling. Imagine this scenario - let’s take two 25-year olds, John and Bill, and each of them are lifting weights in the gym. On the same day, they both feel a ‘tweak’ in their back. Both start getting some pain, stiffness, and achiness. Now, what I didn’t mention is that Bill has a parent who lives with chronic, debilitating back pain, maybe even so severe that they had several surgeries but couldn’t function or work. Bill immediately starts wondering if he’s going to wind up like his parent; he becomes stressed and fearful. That’s pretty reasonable given his family history, but this fear and anxiety can negatively impact his progress moving forward. So if you find yourself in Bill’s shoes, try to reassure yourself that the vast majority of back pain resolves within weeks to months, even if symptoms are very severe when they begin. Along with general fears about the future, severe low back pain can contribute to people being afraid to move for fear of increasing their pain or ‘damaging something further’ - professionals refer to this as kinesiophobia.
2. Complete bed rest
Along with the kinesiophobia I mentioned above, many individuals will assume that because their back is hurting, they should completely rest to allow things to heal. However, in the vast majority of cases, there may not be a tissue that needs to ‘heal’ in the traditional sense.
Research suggests that up to 90% of cases of low back pain are non-specific in nature4, meaning that the symptoms are not caused by damage to one particular muscle, joint, or ligament (including your disc!). As such, the premise that you need to rest to allow something to ‘heal’ may be off base. Instead, current best evidence suggests you should move! Allowing discomfort to be your guide in the short term can help decide in which ways to move, but complete rest is a no-go. If you can go on a walk and this doesn’t provoke your symptoms, but something like squatting does, then go on a walk! If walking bothers your lower back a lot but you can ride a stationary bike or use the elliptical, then those can help too. Try to find ways to move your whole body, as this can help the back feel better faster.
3. Start taking strong painkillers
Lower back pain can be incredibly severe. This can result in many people staying home from work, losing sleep, and missing out on valuable time and experiences with loved ones. It is perfectly reasonable to want some relief from those symptoms if it is as easy as taking medication to get through the day. However, not all medications are equal in the management of low back pain; some are better than others, but some should be avoided if at all possible. Of course, the medication class that most guidelines recommend strongly against are opioids. I think most individuals are aware by now of the risks of opioid medications so I won’t spend too much time on them, but I’d be remiss to not mention some of the downfalls of these drugs.
While some instances necessitate their use, such as surgery, the inherent risks of these drugs cannot be ignored. Side effects include nausea, vomiting, constipation, physical dependence, tolerance, and respiratory depression - just to name a few. Many would expect these drugs to be powerful in relieving the discomfort associated with low back pain, but one 2016 study found that opioids were no more effective in treating low back pain than regular strength Tylenol3. So all of those side effects and risks, with no more benefit than Tylenol? PASS. With that said, taking Tylenol (acetaminophen) or Motrin (ibuprofen) are safer options to help manage symptoms in the short-term.
4. Get an MRI “just to see what’s going on”
As we discussed before, trying to figure out the ‘source’ of low back pain when it arises is pretty instinctual; as soon as you feel that pain, it’s normal to try to figure out what caused it. For some, when the pain is very severe and lasts for more than a few days, they may even try to schedule an appointment with their doctor to hopefully get an MRI to show them what is going on with the tissues in their low back. These scans can be incredibly useful in the diagnosis of a multitude of different soft tissue diseases, so it may come as a surprise that many of the most recent, evidence-based recommendations in low back pain management recommend AGAINST getting an MRI, unless you have some very specific symptoms. Surely it would be helpful to see what’s going on with your ligaments and discs of your spine if we’re trying to treat your back pain, right?
As it turns out, there is much more to the story. Here is the premise for a study that may surprise you: in 2015, researchers compiled results from 33 different experiments, where people without any back pain underwent either a CT scan or MRI. This amounted to having images of over three thousand people, none of which were currently having back pain. The results are listed here below:
Brinjiki et. al 2015 4
I remember these findings surprised me when I first read them. 50% of 40 year-olds had disc bulges without any back pain? 33% had disc protrusion (herniation) without any back pain?? The reason I bring up these findings is this: if these people exhibit these findings on MRI/CT and they don’t have any pain, how can we definitively say that the same findings would be causing your pain? To go even further, you may have already had these structural findings prior to your back hurting! We just don’t know.
5. Maintain a ‘neutral spine’ at all times
Following a back injury, we might have some positions that relieve some pain and some that increase it. Extending the lower back might be very painful for some, while others may find bending forward is brutal. While it is perfectly reasonable to limit moving into those painful directions for a few days, this period shouldn’t last all that long. Trying to keep your back perfectly straight the entire day may end up slowing down the process rather than speeding it up! We’ve already discussed that there may or may not be an identifiable tissue ‘injury’ that is causing your pain, so trying to limit how much your spine is moving in an effort to allow something to heal may not be necessary.
Here’s a good example - pretend you’ve been experiencing some pain in your hand, and someone commanded you to ball your fist and keep it clenched all day long. Then at the end of the day, you finally go to open your palm - it’s probably going to be very painful, stiff, and achy. That’s essentially what we do when we keep our back in the same position all day long! If our spines were meant to be straight forever, we would have just one long straight bone like in our thigh. But, in actuality, we have 364 joints and 33 bones! They’re meant to move!
Thanks for reading!
Jesse Brown, PT, DPT
Along with his education as a Doctor of Physical Therapy, Jesse brings an extensive background in exercise to the clinic. With experience across all different types of weight training, including Olympic-style weightlifting, CrossFit, and powerlifting, you can be sure that Jesse has the expertise to help you get where you want to go!
When he’s not helping individuals in the clinic, Jesse can be found practicing what he preaches - lifting the bar. He is an avid weightlifter, competing and refereeing locally through USA weightlifting.
References:
Wu A, March L, Zheng X, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020;8(6):299. doi:10.21037/atm.2020.02.175
Krismer, M et al. “Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific).” Best practice & research. Clinical rheumatology vol. 21,1 (2007): 77-91. doi:10.1016/j.berh.2006.08.004 doi:10.1016/j.berh.2006.08.004
Abdel Shaheed C, Maher CG, Williams KA, Day R, McLachlan AJ. Efficacy, Tolerability, and Dose-Dependent Effects of Opioid Analgesics for Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med. 2016;176(7):958–968. doi:10.1001/jamainternmed.2016.1251
Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27. PMID: 25430861; PMCID: PMC4464797.