Any of these injuries can result in a two-or-three day period of acute pain and swelling in the injured tissue, followed by slow healing and gradual reduction of pain. The pain may be felt in the low back, in the buttocks, or down the leg, sciatica, (often the pain is felt primarily in the buttocks , leg or foot with very little actual back pain). Onset of pain may be immediate or occur some hours after exertion or an injury.  There may be a slow onset - pain gradually increases over several days or weeks.

Sex or Age Most Affected

Adults of both sexes, usually between ages 20 and 40.

SIGNS & SYMPTOMS           Top of page

• Pain or deep ache of the low back or buttocks.  There may be burning or tingling of the leg or foot. It may be continuous, or only occur when you are in a certain position. The pain may be aggravated by coughing or sneezing, bending or twisting.  Pain is generally increased with prolonged sitting or standing.
• limited range of motion (less than normal movement) of the low back.
• Stiffness of the back and hip muscles.

Causes               Top of page

• Exertion or lifting.
• postural strain ( improper position when sitting - standing - bending)
• Severe blow or fall.
• Back disorders, ruptured lumbar disc.
• Infections.
• Nerve dysfunction.
• Osteoporosis, tumors.
• Spondylosis (hardening and stiffening of the spinal column).
• Congenital problem.
• Childbirth.
• Often there is no obvious cause.

Risk Increases With

• Sitting for long periods.
• Bending over while working - yard work - painting - house work.
• Participation in sports without warming up ( stretches).
• Sharp increase in athletic activity (weekend athlete)
• Overweight
• Poor posture with sitting - standing - bending - sleeping.
• Wearing high heels .

How to Prevent

• Exercises to strengthen /stretch lower back and hip muscles.
• Learn how to lift heavy objects.
• Use proper bending techniques with repetitive bending and lifting light objects throughout the course of the day.
• Learn how to sit properly.
• Proper back & neck support for your car/bed/sofa/chair.
• Lose weight, if obese.
• Choose proper footwear.
• Wear special back support devices for jobs that require heavy or repetitive lifting.

WHAT TO EXPECT WITH IF YOU SEE AN MD:

Diagnostic Measures

• Observe your symptoms.(What makes the pain worse/better)
• Medical history and exam by a doctor  & referral to a physical therapist for persistent symptoms.
• Laboratory blood studies to determine if there is an underlying disorder, x-rays of the spine, sometimes a CT or MRI scan.  
• Testing (see above) is often not done unless the person is not responding to conservative (rest, medications, physical therapy) treatment.

Appropriate Health Care

• Treatment will depend on severity of the pain and discomfort.
• Acute -sudden onset of pain or severe pain - low back pain may require bed rest for first 24 hours and use of ice for first 72 hours.  This usually follows trauma, a car accident, a fall or sharp pain /popping/giving out felt in low back.  SELF CARE  Additional treatment will be determined by severity of the problem. Recent medical studies indicate that staying more active is better for back disorders than prolonged bed rest.
• Chronic- slow onset(over months or years) or low grade pain(constant dull ache).   This may respond best to heat.  If you are not getting relief with heat, try ice.

• WHEN TO SEE A PHYSICAL THERAPIST            
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• Physical therapy should be prescribed when you have been treated by your M.D. but pain  persists beyond 1-2 weeks or if you have had multiple episodes of pain over the past year.  
• In most states you can go directly to a physical therapist. Depending on the nature of the condition, the therapist may refer you to a physician .  The physician can prescribe medications, order tests and check to be sure you do not have a more serious medical condition that may be causing your symptoms.
• Physical therapy treatments should address risk factors, prevention & a home exercise program in addition to pain reduction treatments. SELF CARE.
• A physical therapy evaluation should include:
  1. History( The therapists will ask: How did you hurt yourself, When did the pain first appear? What makes the pain worse/better? Have you had this type of pain before?  What were you doing just before you felt pain?  What does your daily routine involve? etc.)
  2. Physical exam: ( You will be asked to do certain movements to determine what movements increase your pain, Your posture - how you sit & stand - will be evaluated, Your muscles will be palpated(massaged) to look for painful "knots" or spasm (increased tension), The mobility and quality of the motion of your joints will be checked, Your may have your reflexes tested, etc.
• Physical therapy treatments will vary depending on the condition.  A through treatment will include a few basic elements:
  1. Pain reduction may include use of heat, ice, massage, relaxation, stretches, joint mobilization and other modalities including ultrasound & electric stimulation.
  2. *A home program  may start out as simple as a list of things to avoid.  This should increase gradually as you progress to include exercises, stretches and some type of simple first aid.  The goal is for you to gain control over the symptoms as you gradually eliminate the cause of the problem. * This is where physical therapy differs from traditional chiropractic care. 
  3. Prevention includes:
     • discussing risk factors for your specific condition.
     • exercises to increase strength and flexibility.
     • training in how to sit, stand, bend, move, return to sports, etc. without re-injuring yourself.
     • Suggestions for basic equipment including chairs, lumbar supports, wrist rests, etc.  Depending on the person and the condition this may require purchasing a few items.  Many "lumbar supports" can be made from simple items in the home such as pillows, towels, blankets. ( Your jacket can work as a lumbar support if you are out and you run into an unfriendly chair.)
• Options are available such as physical therapy, acupuncture, orthopedic care, treatment by a chiropractor, physiatrist or neurologist and others including surgery for damaged disk, or a local injection(epidural). 
• Massage may help.  Be sure the person is well trained or the massage may cause more harm than help.          top of page

HOME TREATMENT The goals of self-care are to relieve pain, promote healing and avoid re-injury.  For the first two or three days: Immediately after an injury and for the next few days, the most important home treatments include:

• Ice pack or cold massage applied to the low back for ACUTE strains Get in a comfortable position and apply cold packs or ice for 15-20 minutes three or four times a day or up to once an hour for at least the first three days. Cold decreases inflammation, swelling and pain.
• Heat applied for 15 -20 minutes while resting in a comfortable position with heating pad or hot water bottle for CHRONIC strains .  Use caution with heat as this can increase swelling. If you are not getting relief with heat you may respond better to ice. SEE DEFINITION OF ACUTE VS CHRONIC.
• Use a firm mattress (place a bed board under the mattress if needed)
• Wear a special back support device.
• Learn stress reduction techniques, if needed.
• Take breaks if you have to stand or sit for long periods. 

• Sit or lie in positions that are most comfortable and reduce your pain, especially positions that reduce leg pain.

• Do not sit up in bed, and avoid soft couches and twisting positions. Avoid positions that worsen your symptoms, such as sitting for long periods of time. Avoid bending from the waist.

• Bed rest can help relieve back pain but may not speed healing. Stick with what makes you feel better. Unless you have severe leg pain, one to three days of rest should relieve pain. More than three days is not recommended and could actually delay healing. Try one of the following:

POSTURES FOR ACUTE PAIN RELIEF                     Top of page

• Lie on your back with your knees bent and supported by large pillows, or on the floor with your legs on the seat of a sofa or chair.
• Lie on your side with your knees and hips bent and a pillow between your legs.
• If you have to sit add a small pillow to support your lower back.
• How big should the pillow be? Exactly where do I put the pillow?  Use what gives you the best pain relief. ( We are all a little different.)
• Good posture means ear, shoulder & hip are in a straight line - this is the same for standing, sitting & lying down.

Which exercises are for you?

• If you have injured your back within the last two weeks, or you have more pain in you leg than in your back or buttocks, see First aid for back pain.
• Discontinue any exercises that increase pain or that causes pain to move towards the foot (i.e.: pain moves form buttocks to thigh or thigh to feet).

• Gradually increase any exercise that helps you feel better. STRETCHES

EXERCISES TO AVOID Many common exercises actually increase the risk of low back pain. Avoid the following:             Top of page

• Straight leg sit-up.

• Bent leg sit-ups during acute back pain (may be safe if back is kept neutral ).

• Leg lifts (lifting both legs while lying on back).

• Lifting heavy weights above waist (military press, biceps curls while standing).

• Any stretching done while siting with legs in a V position.

• Toe touches while standing.

FIRST AID FOR BACK PAIN stop any exercise or treatment that increases your pain. When you first feel a catch or strain in you back, try these steps to avoid or reduce expected pain. These are the most important home treatments for the first few days of back pain.

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First aid # 1 ICE As soon as possible, apply an ice pack to the injured area. (10-15 minutes every hour). Cold limits swelling, reduces pain and speeds healing.

First aid # 2 MEDICATION Some medications are available without a prescription.  If the non-prescription dose does not relieve your pain CALL YOUR DOCTOR.  Take aspirin or ibuprofen reglularly as directed on the bottle(call your doctor if you've been told to avoid anti inflammatory medication). Acetaminophen  (tylenol) may also be used. Take these medications sensibly;  never exceed the dosage suggested on the bottle, the maximum recommended dose will reduce the pain. Masking the pain completely might allow movement that could lead to re-injury.

First aid # 3 TAKE SHORT WALKS (three to five minutes every three hours) on level surfaces (no inclines) as soon as you can to keep your muscles strong.   Only walk distances that you can manage without pain, especially leg pain.   Remember, this is part of your exercise program. Don't try to do two things at once.  Shopping, carrying packages or walking your dog, unless the dog does not pull on the leash at all, will strain your back.

First aid # 4 RELAX YOUR MUSCLES Listen to soft music - Practice deep breathing - try one of the commercially available relaxation tapes.

First aid # 5 STRETCHES           Top of page                  
When to see M.D.   

1. PRESS UPS - begin and end every set of exercises with a few press-ups.
   • Lie face down with hands at shoulders.
   • Prop yourself up on your elbows, keeping lower half of your body relaxed. If it is comfortable rest on your elbows for 10 seconds - increase slowly to 30 seconds.
   • Keep hips pressed to the floor. Feel the stretch in your lower back.
   • Lower upper body to the floor. Repeat 3-10 times, slowly.
   • Stop if pain is increased or has moved towards the foot.

   • CLICK HERE FOR PICTURE

2.  
   • PELVIC TILT  -  This exercise gently moves the spine and stretches the low back
   • Lie on you back with knees bent and feet flat on the floor. (use a small towel roll under the curve in your low back if this more comfortable.)
   • Slowly tighten your stomach muscles and press you lower back against the floor. Hold for 10 seconds (do not hold your breath). Slowly relax.

   • CLICK HERE FOR PICTURE

3. TRUNK ROTATION The trunk rotation exercise stretches the hips and the rotator muscles of the low and mid back.  Use caution with this exercise.  Rotation Stretches the ligaments that support your discs.  Start with a very small range. Move the knees side to side a few degrees.  slowly increase the range as tolerated.
   • Lie on your back with your knees bent
   • Slowly move both knees side to side
   • Feet should stay on the floor
   • Hips should come up off the floor to allow the low back to twist. 
   • CLICK HERE FOR PICTURE

    

4. KNEE TO CHEST The knee-to-chest exercise stretches the low back and hamstring muscles and relieves pressure on the bone facets, where the vertebrae come together.
   • Lie on your back with knees bent and feet close to the buttocks.
   • Bring one knee to your chest at a time, keeping the other foot flat on the floor, or the other leg straight, which ever feels better on your lower back. Hold for 5-10 seconds.
   • Relax , lower knees one at a time and return to starting position.

   • CLICK HERE FOR PICTURE

   •  
5. HAMSTRING STRETCH  This stretches the muscles in the back of your thighs.  Flexibility of these muscles allows you to bend your legs while keeping your back in a neutral position. Stop this exercise if it increases leg pain or if you feel a pull in your back.  ( You should feel a stretch along the back of your thighs, not in your back.)
   • Bring your knee to your chest.
   • Straighten leg until you feel a stretch along the back of your leg.
   • Support low back with a towel roll if this is more comfortable.

   • CLICK HERE FOR PICTURE

Do the first aid exercises three to four times a day .

When you can complete the stretches shown above you can try the standing stretches.  
Click Here

After two or three days of home treatment:

• Continue daily walks ( increase to 5-10 minutes three to four times a day) and the first aid exercises.

• Try swimming DO NOT DO ANY EXERCISES THAT INCREASE YOUR PAIN. Start with floating on your back (no more than 5 minutes your first time in the pool) Lap swimming or kicking with swim fins is often helpful to prevent back pain from reoccuring.

• When your pain is gone slowly resume normal activities.  Continue to use caution with lifting, bending, sitting & sports for 6 - 8 weeks, after the pain is gone, to allow the back to heal.  If you have a regular exercise program begin easy exercises that do not increase your pain. Start with  2-5 repetitions twice a day and increase to 10 as you are able.  

Activity

• Try to continue with daily work or school schedules to the extent possible. Use care in resuming normal activities.  Stop activities that cause increased pain.
• A gradual stretching/strenghtening  program can help reduce pain. (Use caution  - sometimes you don't feel pain until the day after you exercise.)
• Physical therapy is indicated for Acute ( severe ) pain that does not respond to bed rest or for Chronic ( less severe, but lingers over several weeks/months years) pain.  Physical therapy can be prescribed by your doctor and is generally covered by insurance.  A physical therapist is licensed to treat you without a doctor's prescription but in many cases he/she may advise you to see a M.D. to rule out a more serious problem.  Generally, physical therapists and M.D.'s work together to provide you with the best care.
• Avoid strenuous activity for 6-8 weeks.
• After healing, continued use of good body mechanics (good posture with sitting, standing, bending, driving and resting) can prevent future problems.  A physical therapist can instruct you in a basic program of back care including maintenance exercises and a first aid program to prevent a minor injury from becoming a major injury.

EXERCISES TO AVOID Many common exercises actually increase the risk of low back pain. Avoid the following:             Top of page

• Straight leg sit-up.

• Bent leg sit-ups during acute back pain (may be safe if back is kept neutral ).

• Leg lifts (lifting both legs while lying on back).

• Lifting heavy weights above waist (military press, biceps curls while standing).

• Any stretching done while siting with legs in a V position.

• Toe touches while standing.

Possible Complications

Chronic low back pain and restricted lifestyle.

DONT LIVE WITH PAIN - THERE ARE SIMPLE TREATMENTS INCLUDING SLOWLY PROGRESSIVE EXERCISE PROGRAMS THAT CAN HELP MOST EVERYONE WITH CHRONIC LOW BACK PAIN.  THIS IS USUALLY COVERED BY INSURANCE.  IF YOU NEED HELP A PHYSICAL THERAPIST CAN ASSIST WITH REDUCING PAIN AND SETTING UP A HOME PROGRAM.

CALL YOUR DOCTOR IF:           Top of page

• You have mild, low back pain that persists for 3 or 4 days after self-treatment .
• Back pain or leg pain is severe.
• Back pain or back and leg pain that goes away for short periods but keeps coming back.
• New or unexplained symptoms appear.
• Physical therapy should be prescribed when you have been treated by your M.D. but pain  persists beyond 1-2 weeks or if you have had multiple episodes of pain over the past year.

Probable Outcome

Gradual recovery, but back troubles tend to recur.  A home program can prevent continued back problems.

Physical therapy can help you prevent long term problems.

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