What You Need to Know About Acute Low/Mechanical Back Pain: Treatment and Return to Work

Best Rest
Short-term bed red is recommended for patients with severe back pain and muscle spasms. Bed rest greater than 48 hours is rarely recommended. If you have rested in bed for 48 hours, we recommend that you get up and move about.

Physical Activity
The Center for the Spine recommends early physical activity to promote rapid recovery from back pain. For moderate to mild back pain, the Center for the Spine recommends maintaining a near-normal schedule from the onset.

Ice and Heat Application
Applying heat and ice alternately to the back is helpful to relax the muscles and decrease muscle inflammation. We generally recommend that you apply heat for 20 minutes. Next time, apply ice for 20 minutes. If you find that one application is more helpful than the other, then use only that application. Generally, heat and/or ice should be applied two to three times per day.

Medications
If there is a muscle spasm, a muscle relaxant may be prescribed for a short time (3 to 4 days). Non-steroidal antiinflammatory drugs (NSAIDs) such as ibuprofen or naproxen are frequently prescribed. They serve as analgesics (pain relievers) and as anti-inflammatories (to decrease muscle inflammation). Occasionally, if the pain is severe, you will be given an analgesic that can be taken with the NSAIDs and/or muscle relaxant.

Physical Therapy
In many cases, physical therapy is an essential part of acute back pain rehabilitation. It is important that you work with a physical therapist trained in the exercise approach to promote rapid healing.

The Center for the Spine encourages active physical therapy to shorten recovery time and return you to work and leisure activities as quickly as possible. Active physical therapy is an exercise program that may require home exercises as frequently as every two hours while you are awake. The exercises generally take about 5 minutes to do and do not require special equipment, nor do you need to go to a gym to do them.

Passive physical therapy methods may be recommended for short-term use only. Passive methods produce short-term symptom relief, but no lasting improvement occurs. Passive therapy procedures include massage, ultrasound, diathermy, heat and traction. Some patients may also benefit from manipulation.

When can I return to work?
We usually recommend that you return to work promptly. If you can not do your regular job initially, it is in your best interest to return to some kind of modified duty (light or restricted duty). Your health care provider can give you a prescription for a limited period of modified work duty.

It is very common to be afraid to promptly return to work and other activities due to fear of re-injury. The Center for the Spine health care providers know from experience that with proper treatment, the risk of re-injury is very low. It is in your best interest to return to a normal lifestyle promptly. Early mobility has been found to directly result in a more rapid recovery. Maintaining a positive mental attitude is also imperative to a quick recovery.

What is the outlook for people with back pain?
The prognosis for complete recovery is excellent. Most people with acute mechanical back pain respond very rapidly to treatment; 90 percent of people with acute low back pain are symptom-free in 1 to 2 weeks. Many of the remaining 10% recover within 3 months. It is important that you maintain a positive mental attitude, continue to engage in regular daily activities, and return to work promptly.

Recurrences of back pain are common. Continuing your home exercise program may help reduce your risk of another episode.

This information is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.