Acute Low Back Pain: What To Do, What Not To Do
Today, I saw a young gentleman with sudden onset of fairly severe low back pain, who was seen in the ER over the weekend and was terrified he was going to have surgery. Here's what I told him to do versus what he had been told in the ER:
1. Get moving!!!
The ER told him to lay down and essentially not move and that bedrest would help. This is very dated thinking and is likely to make his problem much, much worse. He is experiencing pain inhibition, meaning he doesn't want to move because he is scared it will hurt, but paradoxically, the less he moves, the more stiff and immobile his spine becomes, and the more it hurts. On review of his MRI, I already saw some atrophy of his multifidus muscles (deep spinal stabilizers). I encouraged him to get moving, very gradually, such as light walking and moving around the house. I also encouraged him to get an evaluation with a skilled, McKenzie-based spine physical therapist as soon as possible, for directionally-based exercises.
2. Try a non-addictive, low dose nerve pain medication for pain.
He was prescribed hydrocodone, which, as a nonspecific narcotic, is unlikely to improve his low back pain and, of course, runs the risk of dependence/addiction. He was also prescribed very high dose ibuprofen, which runs the risk of stomach ulcers, heart attacks and strokes. He asked about curcumin (turmeric) supplement, which many patients take effectively. High dose fish oil would be another option.
3. I gave him reassurance that he has a mild-moderate back problem which could be easily treated with the interventions as above.
He had been told he had a 'terrible spine' and the dreaded 'degenerative disc disease'. I explained that the dreaded 'degenerative disc disease' is an MRI finding, and that in research studies many healthy individuals without any back pain have evidence of disc degeneration on MRIs.
Bed rest, narcotics and a doomed diagnosis of degenerative disc disease: this is OUTDATED treatment! Gentle/guided exercise/movement, targeted, short term nerve pain medications and reassurance that his back will respond to appropriate intervention is what this young man needed. Understand your body and get up-to-date care!! Keep moving, Dr. V