Really bad back pain in your 20s? Dont panic

 

 Recovering from a mild to moderate back or neck or a sports injury/sprain in your 20s or 30s (and, for some, their 40s) is usually straight forward. Most  get better no matter what the  treatment.

But what happens if sudden back pain   hits   9/10   intensity ?  I have had calls from 20 something year olds in tears with back pain. Some cannot get out of bed, without help, for two to three days.

This is a surprisingly common problem.  

Perhaps it started after  a sudden twist. Or helping a mate move house. Or it might have built  up slowly after a slight twinge at the gym.

It is  USUALLY a distressing and serious pain problem but RARELY a serious medical or injury problem. It is an ordinary back ache  creating extraordinary pain.

Get it checked out. Use telehealth if too painful to visit a medical practitioner.

Red flags=Get to emergency:

·    Sudden sensitivity to light/ a raised temperature/odd rashes/staying awake all night with pain/ unable to get comfy at all (despite tips below ) / loss of sensation in your limbs (can’t feel a pin prick or heat)/have difficulty moving your ankle up or down  or a dragging foot.

·  An emergency is when a movement is  lost NOT when it is painful to move. Even though grandma might call severe pain a pinched  nerve, this is unlikely. A true pinched nerve  stops transmitting both sensation, pain and movement  messages.  This might need  emergency surgery.

·  An emergency can either hurt more relentlessly (keeping you awake all night) than what I’m about to describe OR it  may not hurt as much . 

Get radiology  (scans or x-rays)   ONLY if a fracture or a disease or a true pinched nerve is suspected.  A good practitioner should decide if needed with a few simple questions. The research has been strongly against x-rays and scans for back pain  for 30 years  because they make people anxious, not better. Finding a disc bulge  is not a helpful guide to treatment. They are common. It  is, however,  a reminder to take more care in future. Intense pain should do the same .

What is it?

Intense sharp pain was once thought to always be an injury or damage. We now know this is unlikely: it is more likely to be a muscle sprain plus spasms. To be technical: an acute neuromuscular protective/ healing reaction to muscle overload. Back pain starts in childhood, as warnings  not to overdo it. These early warnings and niggles are usually  forgotten or ignored. The inflammatory system, however, gets better at warnings and pain. Ignore it and, if suddenly overloaded, it will create intense  pain, inflammation and muscle spasm. This   first affects MANY  in their  20s 30s or 40s. Severe pain peaks at 30.  Unless dealt with, and sensible self care kept up, it can linger months and/ or recur in one form or another for life. 

Soem practtioners wil disagree with this:I’d like to see the evidence for alternative viewpoints. The above accords with international guidlines for the treatment of back pain which, universally, recommend AGAINST frightening diagnoses of damage/bulges etc (1)

 It is horrible but not a medical emergency if:

1.     Pain  is sharp  when lifting/leaning / sitting/stillness/ changing  position/first getting up.

2.  Pain should ease when resting/ lying/ taking an anti-inflammatory and a pain medication or using a heat pack.

3.     Waking 3-4 times a night when turning is normal in this state, so long as it is possible to get comfy again. Good, individualised advice should see this night waking gone in a week.  

4.      Likewise odd feelings such as a bit  numb / cold  /    achy  for a week usually sit in the OK pile. Again: actual loss of feeling is an emergency situation.   

5. Pain shifts around. It often progresses from a back pain to a hip or groin pain after 3 days. And then, possibly, back again. Remember: back muscles are also hip muscles. It can also trigger knee or thigh pain that can come and go. This is known as referred pain. It is sometimes called sciatica, but it is NOT a pinched or damaged nerve.

Reminder: Do not hesitate to see or telehealth a doctor.

 Treatment:summary

No onetreatment has been proven effective. The best approach is   MULTIMODAL.

Rest for 2-3 days but keep moving:   little,  gently, frequently.

Take an anti-inflammatory (or use a antiinflammation gel),  AND a mild pain killer such as paracetamol(discuss this with your Dr/ chemist). Even though pain is awful, nothing stronger will help and  can cause  more problems

Avoid sitting for the first 24 hours. Either walk around OR lie on your back or over a pillow on your tummy. Lie flat with knees ‘crook’ bent . Do not lie propped up like a banana.

Gets lots of SIMPLE inexpensive soothing sensory input:  massage and warmth. A simple elastic sports brace can do wonders in the  first 48 hours. Warm baths, hydrotherpay pools  and (gentle) spas can help as it is a muscle  spasm not an injury. 

Ease it out with gently actions. Do not try to stretch it out.

Minimise pain if possible  although this can be hard in the  first 24-28 hours.

 Ease off triggers such as (whichever hurts) lifting, leaning, or sitting, being still for long periods. THEN within 24 hours commence  a gentle rehabilitation   program to gradually regain muscle power, muscle coordination, FULL flexibility, agility and the ability to sit without pain. No step in this can be rushed. Do not give up exercises when pain first eases. See an exercise  rehabiliation practitioner .

Most  need 2-3 days off work:  longer if  doing manual work or lifting. Most will be  out of sports  for 2-6 weeks depending on how severe the pain is. Be patient.  

References

1.            Corp, N., et al., Evidence-based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines. European Journal of Pain, 2021. 25(2): p. 275-295. 

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