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First aid

Back pain

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Does this describe your symptoms?

  • Upper, mid or lower back pain that occurs mainly in the midline
  • Not due to a known major (e.g., auto accident, fall) back injury

General Information

  • Lower back pain is a cause of countless visits to doctors' offices and emergency rooms. It is the second most common cause of lost work days, after cold and flu symptoms. Over 80% of people at some point in their lives have back pain.
  • In most cases, the cause of lower back pain is not serious, and the pain usually subsides within 4-6 weeks, without special treatment.

Lumbar Strain

  • New lower back pain in the 18-50 year old age group is usually from straining some of the 200 muscles in the back.
  • Often the triggering event is carrying something too heavy, lifting from an awkward position, or bending too far backward or sideways.
  • Individuals with strained back muscles often note that the pain is increased by bending or twisting movements. They also note that the pain can be reduced by assuming certain positions and that the back muscles are tender to touch.

Bed Rest

  • Complete bed rest is inconvenient and unnecessary in the most patients with back pain.
  • Research has shown that continuing ordinary activities within the limits permitted by pain results in a speedier recovery than rest.

If not, see these topics
  • CHEST PAIN, if the pain is in the part of the upper back that overlies the rib cage rather than the spine.

When to Call Your Doctor

Call 911 Now (you may need an ambulance) If
  • Passed out (fainted)
  • Very weak (can't stand)
Call Your Doctor Now (night or day) If
  • You feel weak or very sick
  • Severe pain
  • Visible sweat on face or sweat is dripping down face
  • Associated abdominal pain
  • Weakness of a leg or foot
  • Tingling or numbness in the legs or feet
  • Numbness in groin or rectal area
  • Unable to urinate and your bladder feels very full
  • Blood in urine
  • Fever and pain over lower ribs of back (flank)
  • Vomiting and pain over lower ribs of back
  • Pain or burning with urination and pain over lower ribs of back
  • Pain goes into groin or scrotum
  • Pregnant and pain is not relieved with rest
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think you need to be seen
  • You have a history of cancer, HIV, or intravenous drug abuse
  • Fever
  • Rash or blisters in same area as pain
Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
  • Back pain lasts more than 2 weeks
  • Back pain is a recurrent, ongoing problem
  • Over 50 years old and you have not experienced similar back pain previously
  • Back pain lasts more than 3 days and it interferes with normal activities or awakens you from sleep
  • Pain radiates (shoots, spreads) into the thigh or down a leg
Self Care at Home If
  • Mild back pain and you don't think you need to be seen

  1. Reassurance: Heavy lifting or excessive twisting can cause lower back pain. With treatment, the pain usually goes away in 1 to 2 weeks.
  2. Local Cold or Heat: During the first 2 days after a mild injury, apply a cold pack or ice bag (wrapped in a moist towel) to the sore muscles for 20 minutes four times a day. Wrap the cold pack in a towel to prevent frostbite. After 2 days, apply a heating pad or hot water bottle to the most painful area for 20 minutes whenever the pain flares up. Wrap hot water bottles or heating pads in a towel to avoid burns.
  3. Sleep: Sleep on your side with a pillow between your knees. If you sleep on your back, place a pillow under your knees to reduce stress on your lower back. Avoid sleeping on your abdomen. The mattress should be firm or reinforced with a board. Avoid waterbeds.
  4. Activity: Continue ordinary activities as much as your pain permits. Continued activity is more healing for the back than rest. Avoid any activities that significantly increase the pain. Avoid heavy lifting, twisting, and strenuous exercise until completely well (Note: complete bed rest is unnecessary).
  5. Pain Medication:
    • For pain relief, take acetaminophen or ibuprofen.
    • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
    • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
    • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
    • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
    • CAUTION: Do not take acetaminophen if you have liver disease.
    • Read the package instructions thoroughly on all medications that you take.
  6. Prevention:
    • The only way to prevent future backaches is to keep your back muscles in excellent physical condition.
    • A sedentary lifestyle (lack of exercise) is a risk factor for developing back pain.
    • Walking, stationary biking, and swimming provide good aerobic conditioning as well as exercise for your back.
    • Being overweight puts more weight on the spine and thus increases the risk of back pain. If you are overweight, work with your doctor to develop a weight-loss program.
  7. Good Body Mechanics:
    • Lifting: Stand close to the object to be lifted. Keep your back straight and lift by bending your legs. Ask for lifting help if needed.
    • Sleeping: Sleep on a firm mattress.
    • Sitting: Avoid sitting for long periods of time without a break. Avoid slouching. Place a pillow or towel behind your lower back for support.
    • Posture: Maintain good posture.
  8. Strengthening Exercises:
    • During the first couple days after an injury, strengthening exercises should be avoided.
    • The following exercises can help strengthen the back. Perform the following exercises 3-10 times each day, for 5-10 seconds each time.
      • Bent knee sit-ups: Lay on back, curl forward lifting shoulders about 6 inches off the floor.
      • Leg lifts: Lay on back, lift foot 6 inches off floor (one leg at a time).
      • Pelvic tilt: Lay on back with knees bent, push lower back against floor.
      • Chest lift: Lie face down on ground, place arms by your sides, lift shoulders off the floor.
  9. Call Your Doctor If:
    • Numbness or weakness occur
    • Bowel/bladder problems occur
    • Pain persists for more than 2 weeks
    • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: David A. Thompson, M.D.

Last Reviewed: 1/19/2009

Last Revised: 4/5/2008

Content Set: Adult HouseCalls Online

Portions Copyright 2000-2009 Self Care Decisions LLC; Copyright LMS, Inc.

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