Low back pain, the first 72 hours
What to do in the first three days, and why lying still makes most backs worse.
Get the one-page sheetWhat is going on
Most low back pain is not a disc, a slipped anything, or damage you could see on a scan. The tissue is irritated and the muscles around it have gone protective. That guarding is what makes it hurt to move, and it is also what keeps it stiff.
Back pain can be severe without being serious. A spasm that stops you getting out of a chair feels like something has torn. In the large majority of cases nothing has, and the intensity of the pain says very little about how long it will take to settle.
The first day
Keep moving inside what you can tolerate. Short walks of five or ten minutes, several times a day, do more for you than lying down. The research comparing bed rest with staying active has pointed the same way for thirty years, and it still gets ignored.
Change position often. An hour sitting still is usually worse than pottering about. If lying down gives you relief, lie on your side with a pillow between your knees, or on your back with your knees bent over a pillow, and treat it as relief rather than the plan.
Simple pain relief has a job here. Being able to move is the treatment, so anything that lets you move is helping.
Days two and three
Add gentle range. Roll your knees side to side, tilt your pelvis, stand up and sit down slowly a few times an hour. None of it needs to look like exercise.
Expect the pain to move about. It often eases in the back and is felt more in the buttock before it settles, and that is usually a good sign rather than a worrying one.
By day three most people can do more than they could on day one, even if it still hurts. That trend matters more than the number you would give the pain today.
What does not help
Bed rest past the first day. It leaves you stiffer, weaker and more frightened of moving, and none of that shortens the episode.
A scan in the first six weeks, unless one of the red flags applies. Scans of pain-free backs are full of findings. Disc degeneration turns up in a large share of people who have never had a day of back pain, and the proportion climbs with every decade. A picture of a bulge you were walking around with last year rarely changes what we would do.
Early imaging, strong painkillers and injections are what happens to ordinary back pain when nobody has a plan for it.
Try this first
- Walk for ten minutes, three or four times a day, even if it is only round the house
- Roll your knees gently side to side, ten each way, morning and night
- Change position every twenty or thirty minutes rather than sitting it out
- Stay at work if you can, with whatever you need changed while it settles
Get it looked at if
- You lose feeling around the back passage or genitals, or you cannot control your bladder or bowels. Go to A&E the same day.
- Pins and needles or weakness in both legs
- Pain that is constant at night and eased by no position at all
- It started with a fall or an accident, or you take steroids or have osteoporosis
- Two weeks gone and nothing has improved at all
What we would do
We work out what is driving it, which in most backs is a mix of load, position and how the surrounding muscles are behaving. Then you get two or three things to do rather than twenty.
Want this as a one-page sheet?
The version we hand out in clinic. Print it, stick it on the fridge, work through it.
Related: Lower back pain physiotherapy · All patient guides · Our blog
This guide is general information about a common problem, not a diagnosis of yours. If something is not settling, or it does not match what is written here, come and get it looked at.