Dealing with an acute low back pain attack

People always ask what to do when they have acute back pain. There are many answers depending on the exact nature of your problem but one thing people forget about is that pain is a perception and not a thing.

One common way of looking at how you perceive pain is to visualize your nervous system being like a telephone exchange. When a signal comes into the spinal cord it is prioritised according to the speed it comes in at, it’s intensity and what other competing signals are arriving at in roughly the same time period. Sensations , such as temperature(hot or cold),vibration, auditory information etc, arrive on insulated nerves and move at a fairly quick pace. Pain travels on uninsulated fibres and thus tends to arrive less quickly and can be blocked out by the faster signals that arrive first. A perfect example is a toothache that you hardly notice all day as you are bombarded by other information yet it is felt as a pounding toothache once you get into bed. Once the other signals are absent your nervous system becomes focused on what is left and you perceive the remaining pain as much stronger than you might have during the day. This is one reason why so many treatments have a short term effect that reduces what you feel yet don’t really get rid of the underlying problem. If you put on a heat rub/ice pack, have a massage, use a TNS machine then you will have some relief but only as long as the effect of the treatment remains. If there is still an underlying irritation it will all come back until you have dealt with the thing that is irritating your body in the first place.

The simple answer is when you first have an attack of back pain the best thing is to find a comfortable neutral position (usually lying on your back with your legs up on a stool/couch or on your stomach with a couple of pillows underneath) and apply any form of treatment that provides an alternative sensation to help settle down how much your nervous system is focusing on your back pain. Once you have had a day or so to let things settle then you have a wide choice of treatments that might help depending on what has gone wrong. With acute attacks many things will help including manipulation, massage, exercises and possibly other treatments such as acupuncture.

In the long run, you are best to calm your back down, have some form of treatment to settle your back further and then go back and focus on the things that really matter. Most back pain occurs because of bad habits, poor posture, trauma or working too long at something your body does not tolerate well. If you learn to take care of yourself better in your day to day activities you will find you have less (or maybe no) attacks and be better prepared to get on with your life.

Best of luck with taking care of yourself!!


24 thoughts on “Dealing with an acute low back pain attack

  1. You made some nice points there. I did a search on the topic and found most people will go along with with your website.

    • Thank you for your comment. I like to think I am up to date with current evidence based practice and I have been involved in physio/physical therapy since the late 1970’s. It is a field that is ever developing so I am always happy to hear if something new has been found that I have not seen before. I really am only posting what I would tell my patients, in effect trying to give others a chance to help themselves and save themselves some degree of suffering or frustration when direct help may not be at hand. If you ever have something to contribute please come back to me as I have found my best teachers have often been the people that have had to go through dealing with problems themselves. I started out, long before being a physio, as a person who was frustrated by the lack of explanation and instruction when I had back, neck and other injuries. I hope this blog helps others to avoid what I had to go through. Best wishes. Ross

    • If it was a kidney problem, it wouldn’t stay the same. Either they get better or they get a lot worse. Try this exercise:Get a small hand towel, fold it in half lengthwise and then roll it up so you’ve got something the size and shape of a swiss roll. Lie on your back on the floor with the rolled up towel supporting your spine in the area where you get the pain. (That’s in the direction of your spine not across it).If it hurts for a few seconds and then gives you a lot of relief, it’s a disc problem. Stay there for 10 minutes and do this every day. Visiting a manipulative practitioner may help.If it makes things worse, it’s sciatica. Go and see your doctor.If it makes no difference, you’re a hypochondriac. Try getting out more.

      • You make a couple of good points! I am not sure that I would be so quick to make the conclusions that you have made. Yes, using a towel as a fulcrum may help to reduce disc pain as it allows the disc pressure to equalise some. I would add regular extension exercises (like the cobra in yoga) but I would do these every 2-3 hours as long as the pain moved to the centre of the back, the pain became more intermittent or there was an increase in mobility. Often mobility may improve before pain goes away. Any type of manipulative practitioner may help: doctor, physical therapist, chiropractor or osteopath.That being said, many times people get better without needing any sort of manipulation if they improve their disc mobility and change the habits that have increased the load on the disc in the first place. Sciatica is, by definition, related to compression of the sciatic nerve in the buttock (often related to piriformis muscle compression) and will improve with heat, self massage (tennis ball/foam roller) and stretching. If it makes no difference there is always the possibility of organic disease of one sort or another that is not particularly irritable at the time that you are suffering from the back pain. To be sure, you really need someone to give you a thorough examination and clarify with appropriate tests what is most likely.

        I could add more but I just wanted to clarify things a bit and to add that not everyone is a hypochondriac because the source of their complaint is not readily changeable.


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    • Thank you very much for your comment. I am not sure if or where this blog shows up at the moment but it’s good that you dropped by in any case. Hope it has been some help to you.

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    • Thank you for your comments. In regards to your question I am afraid I have to ask if you could clarify what you are asking as it’s not 100% clear to me. Perhaps you could send me a private note or elaborate further here? Best wishes.

    • Being in a car accident is a sure way to end up with back pain. Te arrihitts was probably already there, that would no be caused by the car accident and show up so quickly. Arthritis is a slow progressive problem, and it hits most people, you haven’t said how old you are so I can’t tell if it’s due to age at this point. But, MRI’s see just so much, esecially in the back, they can miss so much, believe me. I hate having one taken of my back, which is done just about yearly and they see a little change, but not much and my back is so bad I can’t walk, sit or lie down witout pain. My pain is from an auto-immune disease and will be with me for my life.Anyway, going to a pain doctor is the best way to go, as long as you go to a good doctor, not one who just gives out drugs and doesn’t really care about how you feel and how you are coming along. ANd without a doubt pysical therapy is a must, you don’t get better without working at it.

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