It’s most likely happened to you before: You bend down to put on your running shoes or grab the groceries from the trunk, and before you know it, a quick and intense pain shoots down your spine. Your back seizes up and you can barely walk, let alone run.
Acute low back pain like this is incredibly common, with 1/4 of adults in the US reporting they have suffered from low back pain that lasted at least one day in the past three months. The American College of Physicians has developed new guidelines on non-invasive treatments for low back pain and published them in the February 2017 Annals of Internal Medicine.
HOW TO TREAT LOW BACK PAIN
The good news about acute low back pain, says study author Timothy Wilt, MD of the Minneapolis VA Center for Chronic Disease Outcomes Research, is that it doesn’t stick around. “Acute back pain will almost certainly get better soon. Try to avoid unnecessary, costly and potentially harmful and invasive tests and treatments,” he says. Heat, massage, acupuncture, spinal manipulation and NSAIDs (but not acetaminophen) may help. In fact, the authors found nonspecific low back pain tends to get better on its own regardless of treatment.
As for chronic back pain that lasts more than 12 weeks, the study calls out exercise, physical therapy, acupuncture, mindfulness training, tai chi and yoga as things to try before medication. “Know that symptoms may wax and wane. Talk with your doctor and select treatment options that work for you,” Wilt says, noting that family doctors are a great place to start because they are very familiar with back pain.
The ACP guidelines make it clear you should only consider stronger medications, such as opioids, if you exhaust all other options. Because of the issues involved with these drugs, like potential addiction, they can do more harm than good.
CONSIDER SHORT-TERM PHYSICAL THERAPY
Robert de las Alas, DO, a family medicine practitioner with Indiana University Health Physicians, sees many patients with low back pain. He will often do spinal manipulation (as an osteopathic doctor, this is part of his training). He also commonly recommends physical therapy. “When we sit all day, the muscles that help support you when you stand are flexed, and you don’t use them. When you do use them, there are imbalances and it’s easy to tweak your back.”
He finds that many people only need two or three sessions of physical therapy to learn exercises that help strengthen the stabilizer muscles that affect your low back.
START SLOW, BUT STAY ACTIVE
A runner himself, De las Alas realizes how frustrating it is when you can’t run — and then when you do run, you’re worried about re-injuring yourself. He likes to remind people that movement is good. “Your back is a joint, and joints want to move. When you don’t move, that’s when things tighten up.” He recommends walking first. “From there, it becomes a negotiation with your body. To start back with running, only do about one-third of what you would normally do.”
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LISTEN TO YOUR BODY
Though the ACP guidelines advise about therapies that may help, your body is your best guideline. Dealing with low back pain that comes and goes (and you often can’t figure out what you did to bring it on), is very frustrating. It doesn’t mean you need to stop running. Wilt, who has experienced bouts of low back pain himself, and is a three-time Boston qualifier, has some sage advice: “If we didn’t exercise every day that we had an ache or pain, we would never get out of bed,” he says. “Modify your workout routine, but don’t become a prisoner to discomfort.”