House Call: 6 questions on how to treat back pain

We see a lot of acute back pain this time of year, sometimes from slipping on ice, snow sports and just being inactive. Sometimes it’s been building up for a while with repeated stress and strain, then you are doing some seemingly harmless activity like picking up a newspaper and crunch - your back is stiff and painful. Those flares of back pain can put everything in life on hold and create anxiety about what is wrong. Back pain is one of the most common reasons people seek medical care or miss work. In fact, back and neck pain are the leading cause of disability and affect 85% of adults in their lifetimes.

Fortunately, most back pain can be resolved with self-care through rest, moderate activity, over the counter medications such as anti-inflammatories like Advil if you can take them, topical pain relievers, and other treatments such as massage, acupuncture and physical therapy.

How do you know when rest and moderate movement will put you back right as rain and when you might need to seek out medical evaluation and advice? Despite back pain being so common, patients still have many questions about how to approach back pain treatment.

Should I go to the emergency room or just shake it off?

Back pain can often be managed without your clinician or medical evaluation. That said, there are some red flags with back pain that indicate you should get seen quickly.

If you have pain from a trauma or accident like a car accident or a fall from up high, you should get evaluated promptly. If you are having new symptoms like weakness and numbness in the arm or leg, any paralysis even if brief, back pain with a fever that started at the same time, or reduced bladder or bowel control, you should get evaluated. People with certain medical conditions like immune-disorders or a history of cancer should also see a clinician about back pain.

The good news is that most back pain outside of the categories above will improve on its own with time and self-treatment. It just takes time; anywhere from a few days up to six to twelve weeks.

What’s best? Activity or rest?

Back pain is painful! The impulse is often to stay in bed until it feels better. It’s important to avoid activities that you know aggravate your pain, but movement can speed recovery in most back pain. Not overdoing it and some resting can help you heal, but bed rest and inactivity can make your pain worse or last longer. Do what you can tolerate without aggravating your pain. Avoiding lifting, twisting or high impact activities may be reasonable early on. Studies show that being slightly bent forward and lifting and lifting and twisting put the most strain on the spine. Keep moving with activities like walking, swimming or gentle yoga. Ultimately, you should be able to return to usual activities after back pain or back injuries.

Should I worry if it takes weeks to heal?

Typically, back injuries and back pain are like other strains and sprains and can take six to twelve weeks to heal. This includes disc problems and herniations. Most back pain is caused by strains or sprains in your muscle, not by problems with the bones, joints or discs in the spine. It still can take some time to heal.

If you haven’t seen much improvement for a few weeks with home care, talk to your provider about alternative approaches, physical therapy or medications for your back pain. If your pain is severe, (particularly if associated with progressive weakness or numbness in a leg or legs) or if it’s been four to six weeks with little improvement, you may need a clinical exam, which will be able to diagnose the majority of back problems.

Do need an MRI to diagnose my back pain?

For most patients, diagnostic tests are not necessary in the first six weeks of back pain. Virtually every guideline in the United States, Canada, Europe, Australia and New Zealand advises against imaging in the first six weeks of a back pain episode, except in emergencies. Aside from being fairly uncomfortable to go through, imaging like MRIs only show us what you look like, they can’t tell us where or if you hurt. They don’t tell us how you should be treated, and they can’t predict your outcome or your future.

In addition, as we get older there are normal age-related changes including things like bulging and herniated discs, nerve compression and spinal narrowing. While these normal age-related changes may show up in an image, it doesn’t necessarily mean it’s the cause of pain.

MRIs are most often recommended if a serious condition is suspected and we are evaluating if you need a surgery. Only a small number of people require back surgery for their back pain. Sometimes surgery is an appropriate option, but it also can come with risk of further complications. A clinical exam can identify many back problems and help determine if further testing is needed.

Can back pain be rewired in your brain?

Your brain and nervous system affect pain. Essentially, an injury switches on the nervous system to help with healing. But in chronic pain, the switch doesn’t get turned off despite healing or in some cases surgery or other interventions. Studies have shown that this problem is a result of complicated changes that take place in the nerves and the brain. The pain becomes locked into the nervous system.

Research shows that altering how your brain processes pain can actually reduce pain, even when there is a structural problem. Exercises that work to change your reaction to the pain, cognitive behavioral therapy, and mindfulness mediation and breathing can all make back pain easier to cope with. Over time, these exercises and practices can also change the brain’s relationship to pain, rewiring how pain is processed and ‘dampening’ the pathways of pain.

Is back pain avoidable as I age?

We definitely need to tend more to our bodies as we age, but back pain may be preventable. There are many things you can do, or not do, to avoid risks of back pain. Paying attention to posture including home office ergonomics, being cautious about overexerting ourselves, and maintaining your healthy weight are all good self-care for a healthy back and body.

Having a plan to keep your musculoskeletal system in shape and flexible is critical, really onward from 30 years old when you are at the peak of strength and muscle mass. It’s not just about your back, you need strength and flexibility around your spine, core and abdomen, so exercise like Pilates and yoga are excellent. I recently started weight training again, not to bulk up but to build strength and because I enjoy it—which is key to sustaining an exercise plan. Some health plans include access to online and in-person fitness programs or you can check out lots of free resources on YouTube.

It’s a big interruption when you have back pain even for a day, so prevention is the best remedy of all. When you do have those strains and aches, paying attention to your symptoms and what aggravates or helps it and focusing on self-care and moderate activity will usually get you up and running again quickly.

David Ward is a family physician at Kaiser Permanente in Spokane.