This may be the most frequently asked question I get: My low back hurts, what should I do about it? The answer is clear: it depends! There are any number of different anatomical structures and disease processes in the low back that can be the cause of your pain. And sometimes there are no clear causes from any particular structures! We call this non-specific low back pain, and it occurs quite frequently.
However for our purposes we will group back pain into 3 categories:
-
The Annoying Ache
-
The Sharp, Stabbing “I Can Barely Get Out of Bed” Pain
-
The Serious “I Need To Go To The Hospital” Pain
We will deal with number 2 and 3 today. The first thing to cover is the red flags, meaning warning signs that you should head to the ER. Here is a basic list of the most important:
1) Bowel and Bladder Changes: meaning either urinary retention (being unable to urinate), or bowel incontinence (being unable to hold back a bowel movement), although any changes in your bathroom habits should prompt a discussion with your doctor.
2) Saddle Sign: If you have numbness or tingling in the area between your legs or buttocks (anywhere that would be covered by a bicycle seat) then you should also skip straight to the ER. If you want a picture of what this means, find the Wikipedia page for Cauda Equina Syndrome.
3) Significant Neurological Signs: If you are noticing significant weakness, your foot is dropping, your legs are collapsing under you, or both legs are painful, numb, or tingling then you should seek direct attention.
Obviously if your pain is so great that you cannot stand it, then by all means go to the ER. But just pain is likely not indicative of something that needs urgent surgical treatment.
So with those exceptions out of the way, what do I do when I have sharp, stabbing back pain that is keeping me from moving? Here are 3 principles:
-
Total Bed Rest is NOT best: You likely will have to take it easier and modify or stop many of your normal activities that cause an aggravation of your symptoms, but you should not just lay in bed and not move at all.
-
Pay attention to what aggravates your pain: If you know what brought the pain on, that is great. But whether you do or not you should try to take note of things that make the back feel better or worse so you can share this with your PT. For example, “I tend to notice that my pain increases with sitting for a long time or with bending down to tie my shoes, but it feels better when I stand and walk around.”
-
Gentle movements that reduce pain are beneficial. Try things like lying on your back and bringing one, or both knees up to your chest. You can also try lying on your back with your knees bent up, then letting your knees and legs rock back and forth gently from side to side. If you are able to, you can assume a cat/cow or Child’s pose position, or even try a Cobra. All of these depend on if you are able to tolerate the position and movement without aggravation of your pain. Again, gentle movement helps calm the back down, too aggressive and you can re-irritate the back. Your therapist will help you find this balance when you are able to come to your session, in the meantime, try your best and err on the side of caution.
Make sure to check back next time for what to do with that annoying aching pain!
