Step 5: What to do when pain begins

Many people will feel better within 1 week after the start of back pain. After another 4 - 6 weeks, the back pain will likely be completely gone. However, it is important to take the right steps when you first get pain. This can help make sure that you are one of the many people who get better right away.

No matter how often you get back pain, follow these steps every time you feel pain.

Activity level

It is a common misconception that you need to rest and avoid activity for a long time after you hurt your back. In fact, bed rest is NOT recommended. If you have no indication of a serious underlying cause for your back pain, then you should stay as active as possible. Otherwise, you should reduce physical activity only for the first couple of days and gradually resume your usual activities after that. Here are some tips for how to handle pain and activity early on:

• Stop normal physical activity for the first few days. This helps calm your symptoms and reduce any inflammation in the area of the pain.
• Apply heat or ice to the painful area, whichever feels better to you. Another good method is to use ice for the first 48 - 72 hours to reduce inflammation, followed by using heat to help loosen the muscles.
• Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). If you cannot take either of these for medical reasons, like a stomach ulcer, stomach inflammation, or a liver disorder, then check with your doctor for other pain relieving measures. Selective anti-inflammatory medicines called COX-2 inhibitors may be less harmful to the stomach, but serious questions have been raised regarding their effects on the heart.
• Muscle relaxants are not first-line therapeutic agents, but may be considered when there is significant muscle spasm. Such drugs cause drowsiness, and should be taken at bedtime.

Sleeping positions

Getting a good night's sleep when you have back pain can be quite difficult. Try taking a warm bath or practicing relaxation techniques before going to bed. Also, lie in a curled-up, fetal position with a pillow between your legs. If you usually sleep on your back, place a pillow under your knees to relieve pressure. A firm, but comfortable, mattress is recommended.

Learn More See Reducing Stress May Be Helpful.

What NOT to do

• Do NOT confine yourself to bed. Over time, bed rest can lead to loss of muscle tone and bone strength. This can cause depression, drain your energy level, and put you at risk for blood clots.
• Do NOT perform activities that involve heavy lifting or twisting of your back. Avoid exercise in the days immediately after the pain begins. You should gradually resume physical activity as soon as possible, particularly under the guidance of a physical therapist.

See your doctor

You should see a doctor the first time you have back pain, so that you can get a full examination. Your doctor will be looking to see if the pain is caused by a serious condition.

If you have any of the following symptoms, be sure to contact your doctor immediately:

• Fever
• Severe pain that is not resolving with conservative measures
• Numbness, tingling, weakness or loss of sensation of your legs
• Loss of bowel or bladder control

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