Conservative Measures: Back Pain

Content provided by the Faculty of the Harvard Medical School

Conservative measures

People with low back pain were once routinely prescribed lengthy bed rest and, sometimes, narcotic painkillers or surgery. Those days are over. Today conservative measures are usually recommended first, along with a healthy dose of physical activity.

For the overwhelming majority of people with low back pain, the problem usually stems from strain or sprain due to overuse, an unaccustomed activity, excessive lifting, or an accident of some kind. Less often, a nerve compression problem is to blame. In most cases the best thing to do is to wait and watch to see if the problem resolves on its own. However, if the pain is severe, or if you experience pain or weakness in your legs or are having problems with your bladder or bowels, you should see a doctor immediately (see Table 2 for guidance).

Opting to wait and watch doesn't mean that you do nothing. There are a number of steps you can take to ease your pain and speed healing. Conservative measures include taking over-the-counter analgesic and anti-inflammatory medications and using cold packs for the first couple of days (to counter inflammation), followed by heat packs (to promote healing). Once the initial severe pain has abated, some individuals choose to turn to other methods, such as gentle, appropriate exercise, acupuncture, and massage.

Experience has shown that in time most acute backaches that develop because of sprain or strain will get better without treatment. Sometimes this happens within days. More often, however, painful backs mend more slowly. The best bet for eventual relief is likely to be persistence and patience, allowing natural recovery to take place. Back motion and activities like exercise or lifting should be resumed gradually. In most cases, you'll eventually recover completely from a sprain or strain in about 4–8 weeks.

Although it may take longer for them to heal, many people with nerve compression problems will also benefit from a wait-and-watch approach. For example, 90% of people with sciatica or herniated disks will recover on their own within six months.

Last updated:	January 23, 2007