Acute Back Pain Action Plan – The first 48hrs

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Ok, so instead of taking my own advice I ignored the niggly lower back. I mean it was different to the usual pain (which had been getting better) and yea the workout on Weds involved looooaaads of deadlifts, lunges and burpees. But who’d have thought I’d still be stiff from that less than 48hrs later and I was at risk of a back injury??!?! Yup….silly of me. And what’s more, we’ve all done the same. So, when your back ‘goes’ what are my tried and tested top tips for dealing with it?

First things first, what type of back pain is this advice for? This isn’t for the niggly lower back, the ache at the end of the day or the stiffness first thing in the morning. This is for that acute gnarly back pain – commonly described as ‘putting your back out’. 

There are a number of things that can cause acute back pain (muscle strain, joint subluxation or facet joint strain, disc herniation etc) but most acute back pain comes with pretty crippling muscle spasms, immobility and lots of swearing. The first 48hrs is about getting you in less pain, not causing any more damage and working towards being able to get some normal pain free movement going again.

Assuming you don’t have any nerve symptoms such as numbness, tingling, loss or difficulty of movements or going to the bathroom (in which case seek immediate medical attention) then here are my top tips.

First tip

Don’t get injured in the first place! Listen to your body, know your normal signs and whether you can train through it or not. And the older, more tired, more inflamed, less recovered you are then the less naive optimism will just get you through!

But assuming that advice is a little too late then what should be you doing to ensure the speediest recovery and minimal effect on training/life etc?

1. Painkillers

Now is not the time to be brave!

If the pain really is that bad…..then get on the painkillers. Follow the instructions, don’t go against any pre-existing medical advice, but dose up on the paracetamol and ibuprofen. The more comfortable you are, the more easily you can more, the more you’ll relax and the quicker the spasm will release and you can start healing.

2. Avoid ‘that’ pain

Typically acute back pain will hurt all of the time, but with certain movements will quickly peak to a 9/10; at the very least making you wince and more likely to make you stop immediately and catch your breath. This is ‘warning’ pain. Your body is trying to tell you don’t go there. This sort of pain is designed to stop you in your tracks and prevent you from doing further damage. RESPECT IT! I get that sometimes this may happen in necessary daily tasks. You’ll find moving very slowly and purposefully will allow your body to take time to find a way to make the movement without causing more damage. Please realise that this is your body making you stop – so if you want a quick recovery, listen to it.

3. Sleep, or at the very least rest

Quite cleverly bodies are designed to heal. And most of the time without some fancy modern invention, although they may well help speed the process along! Sleep is pretty darn restorative, not to mention you’re effectively immobilised for 8+hrs at a time. Let your body rest. Even if you haven’t suffered a traditional style injury (mine definitely wasn’t) then you’ve still caused trauma to the body. Let your body focus on healing that rather than fuelling you through a late night at the office or stressing out over stuff that can be left till next week. The associated spasm and load on the nervous system is not that dissimilar to when you are ill, you’ll find it will take it out of you. Again, listen to your body, if you’re feeling tired, sleepy or fatigued then take a lie down. It will help.

This tip also includes stress – getting worked up about what’s going on with your back, or other stuff is only going to slow down your progress. Try some box breathing or progressive muscle relaxation if you find yourself unable to settle down to rest.

Can’t sleep because of the pain? Then I refer you back to my first tip – painkillers.

4. Rocktape

Most chemists will sell rolls of kinesiology tape now, or at the very least pre-cut extortionately priced strips of the stuff. Its a nice passive intervention, you can stick it on and just leave it there doing its thing. There’s increasing amounts of evidence to show that it works, and I get good response from using it in clinic. There’s no precise skill in the application, so buy yourself some, look at a video on Youtube and apply the stuff.

5. Epsom salt baths

Now this is probably a tip that should be separated into two; heat and epsom salt baths. In the first 48hrs of acute back pain then personally I prefer the application of heat. I find that the release of the spasm allows a quicker mobilisation of the joints and tissues resulting in an overall speedier recovery. However I definitely have some patients that find heat aggravating. Very few seem to find a bath an issue though….so we’ll stick with this advice!

Grab yourself a soak in an Epsom salt bath. You can grab Epsom salts from most big chemists (see a theme here…painkillers, rocktape, epsom salts!). If you can’t get specifically epsom salts then a dead sea salt bath will do just as well. You are primarily looking to have a 20min+ soak in warm water that has a good dose of magnesium in. You need a minimum of 20mins to ensure the magnesium has passed through the skin barrier. Shorter is fine but you’ll be limiting the impact of the salts.

This should help nicely with the back pain, reduce muscle spasm and help improve recovery. Do this about an hr before bed and you’ll also get the benefits for sleep of the drop in body temperature and the drowsiness that the magnesium induces. FYI if you’re constipated then epsom salt baths are good for that too, but thats another blog post!

Surely there must be more I can do to help??

As I said the first 48hrs really are about you starting to heal, and not causing any more damage. Booking in for a sports massage appointment is a really good idea, but if you can’t even roll over in bed without wanting to kill yourself then it’s probably worth waiting a few days then coming in for some treatment. Stick with these simple tips, look after yourself and nourish your body. Put everything in place for you to heal and your body will get there. After those first 48hrs things should start to settle down a bit – then we can begin the hard work of working out what happened, how to fix it and how to stop the darn thing happening again.

Stage 1 Acute Back Pain Action Plan – First 48hrs

5 steps: Healing, pure and simple.



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Sports Massage Therapist

Vicki Marsh MSc BA (hons) studied at Oxford University before training as a Sports Massage Therapist. With over 12 years experience she specialises in chronic pain & complex cases as well as coaching Crossfit & Weightlifters.She runs specialist workshops, creates online courses and has spoken at events such as COPA on how to grow a successful business.

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