Back pain often responds readily to self-care and home treatment. Jane Varner, M.D., a family medicine doctor with Palo Alto Medical Foundation, answers questions on tried-and-true methods and common mistakes, as well as how to know if it’s time to call your doctor.
Can most back pain be treated at home?
Generally, yes. But it's important to look at all factors before deciding whether you need to see a doctor. Some people have chronic but stable back pain, meaning they occasionally have flare-ups, but they usually know what works for them so they feel comfortable treating the pain at home.
Then you have new-onset back pain that has a clear cause: Maybe you picked up something heavy or tried a new workout the previous day. That kind of pain responds very well to home care.
New-onset back pain without a clear reason offers more cause for concern. Maybe you woke up with it. Or maybe it came on gradually, but you have a medical history that merits more caution. Then it's important to get an evaluation by your doctor, just to rule out anything more serious.
For new back pain with a known cause, what should I do?
Take a non-steroidal anti-inflammatory medication like ibuprofen or naproxen. That's assuming you don’t take blood thinners or have kidney problems or high blood pressure. People in those categories should always check with their doctor first. NSAIDs are different from straight pain medications, such as aspirin or acetaminophen (Tylenol), because they target inflammation.
How long should I use NSAID medications?
Give it a few days, assuming the medication at the correct dosage is helping. That doesn't mean the pain doesn't return as the NSAID wears off, but that the medication helps the pain. If you're not noticing any change after two to three doses over the course of a day, consult with your doctor. You may need another approach.
You should be able to take NSAIDs for up to a week. If you're not getting better by then, contact your doctor.
What's better, ice or heat?
There’s no right answer. Try both and note which is most helpful. Ice helps reduce inflammation and can have a numbing effect. But sometimes putting ice on a muscle strain triggers pain and causes the muscles to tense even more. Heat has more of a relaxing effect in that case.
Should I rest or move?
Keep moving to the extent you can, since activity will promote blood circulation that helps the healing process. If you're in tremendous pain, wait it out until you feel better.
To get comfortable while resting, tuck a pillow under your bent knees to take the strain off your lower back.
Is stretching safe?
Sure, you can stretch if it doesn't cause more pain. If pain worsens during a stretch, wait a few days before you try again.
Simple stretches are best at first. For instance, you can just try to reach toward your toes from a seated or standing position.
What common mistakes do people make when self-treating for back pain?
Most people have pretty good instincts, but there are a few things my patients and friends do that I don't think are very effective. For instance, some like to apply ointments that generate a warm sensation. These won't hurt you, but they’re mostly creating a skin sensation that gives the perception of heat, so they're not really helping your back.
Others want to get a massage, which isn't a bad idea. But I would avoid any deep tissue massage, because if you're having a back spasm and someone works hard on it, the muscle may become more irritated. Light massage is OK, as are gadgets like high-density foam rollers, if done gently. As always, if the pain worsens during massage, stop and wait a few days.
Is it OK to visit your chiropractor or a physical therapist before seeing your doctor?
I’d say if you’re not feeling better after a week or two of home care, or you have accompanying symptoms like fever or numbness or tingling in your legs, visit your doctor first for a thorough evaluation. Your doctor will know your situation and history best and be able to recommend next steps that are right for you.