An acute attack of lower back pain can be very traumatic both mentally and physically. It can come on from something innocuous; I’ve treated people who’ve brought on an episode when tying a shoelace, or even sneezing. It can come on when you are particularly deconditioned, like after a laparotomy (open abdominal surgery) or caesarean childbrith in women. The third most common occurrence is during more strenuous activities, like during a heavy lift in the gym, moving heavy furniture.
Whatever the circumstance of the pain onset, the pathway to recovery can be a tricky one. Acute flares of mower back pain can be incredibly painful, and pain relief is the most important factor in controlling symptoms in the short term. Your pain is unlikely to improve very quickly if you are bed bound. As much as it may feel like the last thing you want to do. The best way to start the healing process is to get up and start moving. If you need to take pain relief to enable this to happen, then it is advisable to begin with. If simple over the counter pain medication does not do the job, speak with your GP and the can prescribe you stronger medication.
A more natural solution can come from physiotherapy. A combination of gentle manual techniques can begin to encourage movements in the right areas, and unlock areas of tightness. Tractions can send positive feedback to areas in spasm and begin the process of release. Mobilisations and soft tissue release can then be used to further add benefit.
The sooner you seek physiotherapy intervention, the quicker the healing process can occur and the fast you will get back to normal life.
Once you restore some normality to your movements, and start to mobilise with more freedom, the key is then to encourage a greater range of movements to keep the area of pain improving. Physiotherapy can then prescribe some gentle exercises specific to your needs and restore normal movement patterns. Sometimes at this stage there is no need for manual therapy, but if there is residual or stubborn areas of tightness, then additional release may be required.
When the acute flare has passed, you may be left with a dull ache or a more chronic type of pain in the lower back. Some people can feel no pain at all. It is important once some normality has been restored that you begin to incorporate some strength exercises. This is probably the most important step when recovering from a flare up of lower back pain. The pain will likely have originated because of some muscular imbalance and weakness in the lower back. This can only be corrected with strengthening exercises. It is strength work that will build the muscles to support the spine and prevent excessive force translating through the spine in the future. Strong backs are much more resilient and protected against pain.
If you have not been given strengthening exercises after a flare up, you are not protected from future episodes. Physiotherapy and Pilates based exercises are shown to help protect the structures in the spine (NICE, 2016)