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DEAR MAYO CLINIC: I am 44 and relatively healthy. Two years ago, I hurt my lower back while gardening. I felt a sharp pain and could barely walk. It took about four weeks until it completely healed. Two months ago, I hurt my lower back again — this time while lifting my son. The pain does not seem to be getting better. Is there anything I can do to speed the healing process? How can I prevent this from recurring?
ANSWER: Lower back pain episodes are common among adults, with about 80 percent of adults experiencing lower back pain at some point during their lives. Lower back pain is one of the top five reasons that individuals seek medical care. In many cases, lower back pain resolves on its own. Most people have significant improvement in their pain within 14 days and symptoms usually level off after about 28 days.
Unfortunately, it’s not uncommon for lower back pain to recur. The biggest predictor of developing lower back pain is having a history of prior lower back pain episodes. As many as one-third to one-half of acute lower back pain sufferers will experience another episode of back pain within a year. A small percentage of those people go on to develop chronic lower back pain.
To ease your present lower back pain flare, there are a number of self-care steps you can take. First, modify your activities to avoid repeated bending, twisting or stooping, and don’t lift anything heavier than 5 pounds. Second, consider taking a nonprescription pain reliever. Anti-inflammatory drugs such as naproxen and ibuprofen may be of benefit for short-term use. If over-the-counter medications aren’t enough, talk to your health care provider. He or she may give you a prescription for a muscle relaxant, such as cyclobenzaprine, or other medications to reduce your symptoms.
Physical therapy is an important part of treatment for lower back pain. It may involve using heat and cold therapies, massage, stretching, and strengthening exercises — especially strengthening the abdominal core muscles. Practicing good posture and proper body mechanics also can help. Before you start a physical therapy program, consult with a physical therapist to find out which approaches are best for you and learn the proper technique.
Additional interventions that may benefit people with lower back pain also may include spine mobilization, massage, yoga, acupuncture and low-level laser treatment. Talk with your health care provider about the benefits and risks of these approaches, and whether they may be right for your situation.
Once the pain goes away, take measures to reduce your risk of future lower back pain episodes. Use good posture and follow your physical therapist’s instructions on how to move to ensure proper back biomechanics. Incorporate back-friendly practices into your daily life. For example, use a chair that has good back support at work and at home.
Avoid lifting objects that weigh more than 50 pounds. When you lift heavy objects, lift from the knees while you contract your abdominal muscles, keep your spine straight, and don’t twist your trunk. As you lift, hold the object close to your body.
Regular exercise can strengthen your muscles, which makes it less likely you’ll injure your back. Incorporate at least 150 minutes of aerobic activity into your routine each week, and make sure it includes a proper warmup. Exercise also can help you reach and maintain a healthy weight. That can protect you from future problems, too, as obesity often is associated with lower back pain.
Finally, if you smoke, stop. Smoking accelerates spinal degeneration, and that contributes to the development of back pain. If you would like guidance or support as you work to quit smoking, talk to your health care provider. Various treatment options are available that can help. — Dr. Peter Dorsher, Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, Florida