Biologically and physiologically, the back is a tremendously complicated place. In order for the back to be free of pain, it requires that bones, nerves, and muscles are functioning properly. These structures need to be in the proper position, be healthy, be able to move completely, and be strong. Mechanical and non-specific back pain affects millions of Americans-85% of Westerners will experience back pain at some point in their lives. Despite being such a common problem, only recently have clinicians determined the best practices to treat low back pain. Back pain treatment must be multi-faceted and comprehensive, moving patients from acute injury to lasting health.
Stop the inflammation
Most low back pain is caused either from a single severe injury or the accumulation of several small insults over time, so-called mechanical low back pain. The structures in the back become inflamed, tender, and the area is irritated with specific movements or certain positions. Therefore the first step in back pain treatment is to reduce the inflammation. One of the best, fastest, and least expensive ways to reduce inflammation after an injury is to apply ice to the affected area. Since inflammation is simply a collection of inflammatory cells, cytokines, and other molecules, the ice slows down these cellular and molecular processes. Ice also reduces the ability of pain receptors and nerve fibers to send pain signals to the brain. When tolerated, NSAIDs (non-steroidal anti-inflammatory drugs) also reduce inflammation. Opioid medications like morphine and oxycodone, on the other hand, are not useful or recommended.
Rest, but not too long
Physical therapists and physical rehabilitation physicians call the rest period used for back pain treatment "relative rest." Relative rest is participating in less activity than is typical for a given person. It certainly includes eliminating any activity that is contributing to the back pain. Relative rest is not total rest, however. At one time it was suggested that people simply "take it easy" until back pain subsided. This meant people were laying around waiting for their pain to go away. This is not helpful and almost always makes matters worse. Think of relative rest as preventing further or continued mechanical injury to the back. Do not think of relative rest as waiting for healing to occur.
Work it out
Soon after ice and relative rest (within days), the next phase of low back pain treatment improves the back's range of motion and muscle flexibility. Usually this entails stretching and bending exercises focused not only on the muscles of the lower back, but also on the muscles that support the injured area. Stretching also works (to a smaller, but important degree) on tendons, ligaments, and the surrounding fascia. Exercises that lengthen muscle reduce tension on nerve tissue. In this case, heating the tissues, rather than using ice, is preferable. Heating pads, warm baths, and heated compresses (careful not to burn the skin) facilitate stretching and lengthening exercises.
Build it up
Comprehensive back pain treatment should include strength building exercises; however, muscle conditioning exercises should be done only after the back pain has subsided. While it is certainly better to stay active during back pain treatment, putting too much stress on the back too quickly risks repeated injury. The goal of strengthening the back muscles is to provide a solid framework for ligaments, bones, and joints to operate. If the muscles are strong enough to support the strenuous forces, they will protect the surrounding structures.
Get it together
Once the pain is gone, the muscles are loose through stretching, and strong through conditioning, the final phase of back pain treatment is coordination training. This back pain treatment is focused on establishing balance, even in the face of difficult terrain and positions. Most of us can balance when walking straight on level ground, but low back injury occurs in awkward, jarring positions. Coordination exercises put the patient in progressively more taxing positions so that the sensory fibers, muscles, and brain can react appropriately when needed. Thus when the next injurious event happens in daily life, the back is ready to weather it without undue strain or injury.