How to deal with back pain, and how to prevent it from returning

June is a beautiful time of year in Washington state, and if you’re like me, you are taking advantage to get projects done outside and to enjoy the outdoors. But if you develop a flare of back pain, all those plans and activities could be put on hold. Back pain is one of the most common reasons people seek medical evaluation or miss work. It can stop us in our tracks and make it difficult to do much of anything.

The good news is most back pain will improve relatively quickly with rest, stretching and medications that are available over the counter. Paying attention to risk factors and good self-care can make it less likely to flare again in the future. So, how do you avoid back pain? What’s your course of action when it shows up? How do you know when to call your provider?

Should I get an MRI or Xray when it hurts?

When back pain strikes, most flares can be attributed to the musculoskeletal system. This includes strained muscles that run along the spine or bulged discs between the bones of the spine that can cause inflammation or even pinched nerves. Fortunately, these causes of pain usually improve with time and some relatively minor interventions.

For most patients, diagnostic tests are not necessary in the first six weeks of back pain according to the American Board of Internal Medicine Foundation in their Choosing Wisely campaign. This is because some of the common causes of back pain don’t show up on imaging studies (like strained muscles) and other incidental findings (like bulged discs) may be present without necessarily being the cause of the pain. Instead, it is better to make treatment decisions based on the patient’s symptoms and history.

When should I get evaluated by a provider?

Though most flares of back pain can be managed initially without your medical team, there are some situations that should prompt an evaluation in the office. This includes pain that started with a trauma like a fall from height or after a motor vehicle accident. Pain that is severe and not improving with rest or any pain not improving after a few weeks should be evaluated.

Neurologic symptoms may warrant evaluation as well. For example, pain that radiates down the leg could indicate a pinched nerve which can respond to conservative therapy, but new symptoms of weakness, numbness or back pain with a fever that started in association with the back pain should be evaluated by a medical professional. Patients with symptoms of reduced bladder or bowel control including urinary retention or urinary or fecal incontinence, patients with a history of cancer, people who are immunocompromised, or who have unintentional weight loss should also have their back pain evaluated by a medical professional.

If in doubt, you can get in touch with your health care team to check in on your symptoms.

Do I move around or just rest?

Since certain activities can aggravate back pain, it is important to avoid those activities when back pain is present. These may include motions that require more activation of muscles in the low back, like bending over or leaning forward unsupported. But movement that does not strain the muscles is actually good for most back pain. I recommend to my patients getting into a pool where the water’s buoyancy supports the back but allows for motion that is therapeutic. Stretching exercises similar to some basic yoga positions (like sphinx, child’s pose, cat and cow) can also be very helpful. Walking can also be helpful in mild to moderate low back pain or for maintaining a healthy back.

Can medication be part of the solution?

Low back pain usually involves inflammation which can aggravate pain symptoms and delay healing, so anti-inflammatory medication is often the first thing to consider. Non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen and naproxen are available over the counter and also have anti-pain properties, so it can help with pain and promote recovery (not merely masking pain symptoms). I recommend to my patients that they follow dosing instructions on package information and take the medication with food and water to reduce the risk of upset stomach. In some instances, these medications can be hard on the kidneys, raise blood pressure, cause upset stomach or increase the risk of bruising or bleeding. If you have a history of kidney disease, stomach ulcers or take other medications that increase the risk of bruising or bleeding, talk with your healthcare team before taking an NSAID.

It might take a few weeks to feel better. If you don’t see improvement in two weeks or so with these more conservative treatments, or you can’t take NSAIDS, you can contact your provider about alternative prescriptions medications or evaluation. Even if you are seeing some improvement but you still aren’t getting better after four to six weeks, talk with your provider.

How can I keep this from happening again?

There is a saying that an ounce of prevention is worth a pound of cure, and that rings true about back pain. There are several risk factors for developing back pain in the first place and most of us have at least one. These can include increasing age (over 30 or 40 years old), muscles of the abdomen and low back being deconditioned or out of shape, being overweight, over-exerting ourselves and poor posture or ergonomic positioning. Working to reverse these risk factors before a flare of back pain is well worth the effort.

After you’ve recovered from a bout of pain (or before you even have it), making small changes with exercise, weight loss and workspace set up or work routines can make a big difference going forward. We can’t reverse the aging, but we can focus on keeping strength and not over exerting ourselves.

Low back pain is like Achilles’ heel – a weakness that we don’t appreciate until it is too late. Several years ago, I had developed acute low back pain after switching offices. After a week of excruciating pain, I vowed to do regular stretching exercises and get plenty of steps every day to prevent a recurrence. However, a few months later I was suffering again. I got more serious about prevention, committing to more regular activity and also making adjustments to my chair and desk to improve ergonomics. This time my efforts have paid off, but it is no time to “rest on my laurels.”

Keeping up with good habits and good care at home when back pain does start to flare up can help you get and stay on the road to recovery.

This article originally appeared on Kitsap Sun: When is back pain treatable at home?