Surviving Lumbago: The Low-Down On Back Pain

iStock_000014522484Small85%. That’s the percentage of you who will, at some point, be plagued by low back pain. Sure, there are more exciting topics out there, but maybe none more pertinent to the majority of us.

One word of advice: don’t help your friend move his refrigerator down the stairs. There. That is all.

Have a nice day.

I see people come in in droves with low back pain, often with a history of helping a buddy move this piece of furniture or that appliance. Tell your friend to stay put. Moving is overrated.

For me, my bout with low back pain was less sexy than that. It was also less noble. No, I was on a boat and bent over to lift the cushion that covered the built-in cooler. It’s ok. You can laugh. That cushion was as light as you’d expect. I never claimed to be a manly man. My take-home message from that was that almost anything can exacerbate an episode of mechanical low back pain. You move the wrong way, with or without weight involved, and bam – “threw” your back out.

My episode was mild, lasted a few days, and never came back. But, when you do have lumbar pain, you’ll have to make a decision about whether you need to see a doctor. That’s when you’ll want to reference this post. Maybe bookmark this. You know your time is coming.

Since I’m an emergency physician, I have to point out the things that I look for that make me think this is NOT just strain of the muscles of the low back. In other words, if you have low back pain and these confounding factors, you should go see a doctor.

• trauma – if you fell off a ladder onto your back, or your crazy cousin hit you with his car, you need to be seen. There could be a broken bone causing your pain. Get an x-ray.

• weakness – if you have legitimate weakness, not just pain with movement, but the “I can’t pick my foot up off the floor” weakness, you need to be seen.

• loss of bowel/bladder control – inability to urinate, or peeing and pooping on yourself should be cause of concern. Sounds obvious, right? Seriously, go to the hospital.

• risk for infection – fevers are a red flag for me. If you are chronically on medications, like steroids, that put you at risk for infections, or if you have a nasty habit of shooting up illicit drugs, especially if you’re running a fever with your back pain, go see a doctor.

• risk for cancer – if you have cancer, or had cancer, you’re more likely to need x-rays, especially if your pain is lasting a while, or you didn’t do anything to cause it.

Assuming you simply tweaked your back and are suffering, you might be able to get by without seeing a doctor. The first thing you need to understand is that most mechanical low back pain gets better in 2-4 weeks. That’s not a typo. I didn’t say 2-4 days. So, part of figuring out if you need to be seen is setting reasonable expectations for your recovery.

Most of the time the pain in the low back is from straining muscles and ligaments. Sometimes it’s from a bulging disc. If you notice the pain radiates from your low back down your leg, it might be a disc that is bulging (also called herniated). Even most of these get better without surgery.

So, what to do. Try taking ibuprofen and Tylenol for your back pain. You can try a heating pad (low to medium setting, and don’t fall asleep on it), or you can try an ice pack (for 10-15 minutes out of each hour while you’re awake). If you can get that area numb, it doesn’t hurt so much. Don’t sleep on anything really hard or really soft. A nice, firm mattress is the best. If you lie on your back and put a pillow behind your knees, this can relieve some of the pressure on your back. Gentle stretching and strengthening exercises can be helpful.

If the pain is too much, you may need to see a doctor for some prescription pain relief. Use this only as a last resort. Narcotic pain medications tend to delay how long it takes you to get better from your back pain. In addition, they are addictive.

Some people benefit from seeing their MD, or going to physical therapy, or by seeing a chiropractor. The studies show that they all get you better at about the same rate, just each using different modalities.

So, when you do hurt your back, try some home meds and ice. And time. That’s the main one. Come see me if you have one of the worrisome features we discussed, or if your pain is just not manageable. Or, if you need a work note. We specialize in those, too.

What experiences have you had with low back pain? How long did it take to improve?