In new-onset low back and neck pain, prolonged bed rest is not advised during the first days; continuing daily activity as far as the pain allows is preferred. The nature of the pain, its radiation and any accompanying symptoms are assessed. If there are warning symptoms such as loss of strength in the leg or the arm, a physician should be consulted without delay.
Low back pain is a common complaint. The World Health Organization (opens in a new tab) reports that in 2020, 619 million people worldwide were affected by low back pain, and that low back pain is the single leading cause of disability in the world. The same source states that in most cases of acute low back pain the symptoms settle on their own, and that in most people the condition follows a good course.
Neck pain is similarly common; the World Health Organization (opens in a new tab) reports that neck pain affects 222 million people.
In about 90% of cases, the pain cannot be attributed to a particular structural cause; the remainder may arise from causes that need separate assessment. The aim in the first days is to make that distinction possible.
What is done in the first days?
- Do not stop activity altogether. Prolonged bed rest is not advised. Continuing daily movement as far as the pain allows is preferred.
- Temporarily reduce the movements that increase the pain. Heavy lifting, picking up a load while bending forwards and staying in the same position for long periods are limited during the first days.
- Review the way you sit. Sitting with the back supported, keeping the screen at eye level and standing up from time to time during long periods of sitting are particularly important in neck pain.
- Consider your sleeping position. Sleeping face down is generally not considered suitable for the neck.
- Record the course of the pain. Note when it increases, which movements bring it on, and whether or not it radiates.
- Consult a physician about medication. The choice of painkiller and how long it is used are assessed together with your other current medication.
What is asked during the examination?
- When and how the pain began; whether there was a strain or an injury
- The site of the pain and its radiation (pain that spreads into the leg or the arm is assessed separately)
- Whether there is numbness, tingling or loss of strength
- Whether there is night pain, and whether the pain settles at rest
- Whether there is fever, weight loss or a history of cancer
- Whether there is any new difficulty holding urine or stool
- What medication is being taken, and whether there are co-existing conditions
In which patients is it assessed differently?
In the situations below, the assessment proceeds differently.
- In patients with a history of cancer (low back pain is assessed separately and as a priority)
- In patients with a diagnosis of osteoporosis and in patients over 65 (a fracture may develop even with a minor strain)
- In patients taking long-term corticosteroids (the risk of osteoporosis is also reviewed)
- In patients with fever or weight loss, or who have recently had an infection (spinal infection is also considered)
- In patients receiving treatment that suppresses the immune system (the possibility of infection is also considered)
- In pregnant patients (both the cause of the pain and the medicines that can be used are different)
- In patients whose pain started after an injury (priority assessment for fracture is needed)
- In patients under 18 years of age (assessment lies within the field of paediatrics; this content has been prepared for adults)
Points to be aware of
Imaging is not needed for every episode of pain. Imaging is generally not requested during the first days; whether it is needed is determined by the examination findings and the presence of warning symptoms. Early, unnecessary imaging may produce findings with no clinical relevance.
Prolonged bed rest does not speed up recovery. The World Health Organization emphasises physical approaches that increase muscle strength and the ability to move.
Do not extend your use of painkillers on your own initiative. The duration and the dose are determined by the physician together with your other current medication.
The pain settling does not mean the cause has gone. When pain recurs, the triggering factors are addressed separately.
Results vary from person to person. The time taken to recover and the path to be followed are not the same in every patient.
When should you see a physician without delay?
If you notice these symptoms, consult a physician without delay:
- Low back pain accompanied by fever
- New low back pain in a person with a history of cancer
- Unintentional weight loss accompanying the pain
- Pain that began after an injury
- Pain that does not settle at rest at night and wakes you from sleep
In the event of loss of bladder or bowel control, loss of strength in a leg or arm or foot drop, or numbness in the inner thighs and around the anus, go directly to the emergency department.
Frequently asked questions
Should I stay in bed during the first days of low back pain?
Prolonged bed rest is not advised. The World Health Organization reports that in most cases of acute low back pain the symptoms settle on their own, and emphasises approaches that preserve mobility. Continuing daily activity as far as the pain allows is preferred.
Should I have an MRI scan during the first days?
It is generally not needed during the first days. Imaging is requested on the basis of the examination findings and whether there are warning symptoms. Unnecessary early imaging may reveal findings that have nothing to do with the pain.
How long does the pain have to last before I should see a physician?
If there are no warning symptoms, pain that does not settle within a few days, or that steadily increases, should be assessed. If, however, there is loss of strength in the leg, numbness, loss of bladder or bowel control, fever or weight loss, consult a physician without delay.
Should I apply heat or cold?
This varies with the nature and the cause of the pain; no definite rule can be given. The type of application and how long it lasts are determined after examination. Nothing is applied to broken skin or to areas with loss of sensation.
My neck pain is causing headache; could they be related?
It could be. Tension-type headache may be related to musculoskeletal problems in the neck region. For this reason, headache is also asked about when neck pain is assessed. For details, see our article The Differences Between Tension-Type Headache and Migraine.
Should I exercise when I have low back pain?
Not staying immobile, and keeping up daily activity as far as the pain allows, is generally advised. Which exercise suits you, however, is determined after examination. Movements that increase the pain or produce numbness are not continued. There is no list of exercises that is “suitable for everyone”.
Sources
- World Health Organization, Low back pain fact sheet, 19 June 2023. https://www.who.int/news-room/fact-sheets/detail/low-back-pain (opens in a new tab)
- World Health Organization, Musculoskeletal health fact sheet, 14 July 2022. https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions (opens in a new tab)
