I threw my back out and I just don’t want to go to the doctor’s office. Is that ok and what can I do?
Low back pain and joint osteoarthritis are two of the top three reasons why people seek care from a doctor in the US (skin conditions being the third). It is estimated that 80% of all Americans will experience back pain at some point in their lifetime. Most of the episodes are self-limiting, but it’s a scary thing to experience back pain. Even your good pain doctor here has had severe back pain a number of times, so I get it. So when do you need to seek medical care? If you have weakness in the legs or foot drop, you need to call me. If you have severe nerve pain into the legs or arms, you need to call me. If you lose control of your bladder or bowels, you need to go to the ER. But if your pain is limited to the axial column of the spine, anywhere from the neck to the tail bone, it is ok to treat it yourself conservatively for up to a month before coming in to see someone. Really.
At the time of the acute onset of back pain, use direct heat at the region of the pain. Everyone asks about heat versus ice. Well, we don’t really know long term, but for the first 24-48 hours you want heat. You want to promote the blood supply to the region of the injury to bring in the inflammatory mediators that our body naturally disperses to heal an injury – platelets, macrophages, cytokines, etc. There are great over the counter adhesive patches that can disperse heat for up to 6 hours. Mentholated topical products can promote vasodilation in the region to help bring in inflammatory mediators that help at the time of the acute injury. It makes sense that a good CBD topical may help – but again we don’t really know.
There are over the counter analgesics that are very good for acute low back pain as well. The three categories you can choose from are salicylates (Aspirin), acetaminophen, and nonsteroidal anti-inflammatory medications. I would choose one medication and use it at the max dose for 2-3 days before switching to an alternative. Below are max dosages of OTC meds you can utilize.
Aspirin Extra-Strength 500 mg. Max dose is 2 every 6 hours, no more than 8/24 hour period (4000 mg). Start to back off after three days. Do not use if you have a history GI Bleed or GI irritation.
Acetaminophen (Tylenol) 500 mg. Max dose is 2 every 6 hours, no more than 8/24 period (4000 mg). Start to back off after three days. Do not use if you have a history of liver disease.
Ibuprofen (Advil) 200 mg. You can take 4 (800 mg) every 8 hours for a week and then start to back off. Do not use if you have kidney disease, GI issues, or are on a blood thinner.
Naprosyn (Aleve) 220 mg. You can use 2 (440 mg) every 12 hours for a week and then start to back off. Do not use if you have kidney disease, GI issues, or are on a blood thinner.
Aside from using topicals and taking oral medications, the main thing that you can do for the majority of acute lower back pain episodes is to not be afraid of it. You need to still move the spine. I repeat: You still need to move the spine. And even if it hurts, you need to do it. Gentle movements accompanied with the breath will get you through this episode more quickly. Think forward bends and gentle twists, four count inhalations and four count exhalations with each movement. A foam roller for myofascial release is nice as well. It is normal to be afraid of hurting yourself more with movement, but if done with thought, care, and intuition I promise you will get yourself through this episode quicker and in the end be in a better physical state. There are many good online resources. Just google “gentle exercises for acute lower back pain”. But please do not forget the breath with these movements.
I certainly do not want you to feel like you cannot call if you have any questions about an episode of acute lower back pain. You should not feel stranded on your own if you are worried. That is why we are here for you. But if you feel comfortable managing your pain on your own for a short period to see if it is indeed self-limiting, hopefully these guidelines will help you know what you can do safely on your own.