HERE IS WHAT YOU SHOULD DO
You wake up one morning, swing your legs out of bed, stand up—and there it is.
Your back hurts.
Maybe it is a dull ache across your lower back. Maybe you feel stiff and it takes a few minutes before you can stand completely upright. Or perhaps you bent over to pick something up and suddenly felt a sharp pain that made you wonder if you had seriously damaged something.
If you are over 50, there is a pretty good chance you have experienced some version of this.
And when your back hurts, your first instinct may be:
I better not move.
That sounds reasonable. If something hurts, shouldn’t you rest it?
Usually, no. For most uncomplicated episodes of back pain, prolonged rest is one of the worst things you can do.
So let’s talk about what you should do when your back starts hurting—and, just as importantly, when back pain deserves medical attention.
First: Don’t Panic
Back pain can hurt—a lot—without necessarily meaning that something dangerous has happened.
Muscles can become irritated. Joints can become inflamed. The tissues around your spine can become sensitive. And sometimes a relatively minor problem can produce surprisingly significant pain.
Think about getting a paper cut. The injury is tiny, but it can hurt like crazy.
Pain is your body’s alarm system. It tells you something is happening, but the volume of the alarm does not always tell you how much damage has occurred.
That distinction is important with back pain.
A painful back does not automatically mean you have “thrown out” your back, slipped a disc, or permanently damaged your spine.
Most episodes of acute low back pain improve with time and conservative treatment.
Keep Moving—But Be Sensible
Years ago, people with back pain were frequently told to go to bed and stay there.
We now know that prolonged bed rest can actually slow recovery.
When you stop moving, muscles become stiff. They can begin losing strength surprisingly quickly. Your confidence in your ability to move may also decrease.
Before long, you may find yourself moving less because you are afraid of hurting your back. Less movement leads to more stiffness. More stiffness makes movement uncomfortable. And suddenly you have created a cycle that can be difficult to break.
Instead, try to continue your normal daily activities as much as your pain allows.
Walk around the house. Take a short walk outside. Get up from your chair regularly.
You don’t need to prove anything. If walking for 30 minutes hurts, walk for five or ten minutes and see how you feel.
The goal isn’t to ignore pain. The goal is to avoid becoming inactive because of it.
Temporarily Modify the Things That Hurt
Staying active doesn’t mean continuing every activity exactly as you did before your back started hurting.
Suppose you normally do squats at the gym and squatting makes your pain significantly worse. This probably isn’t the week to set a personal record. Modify the exercise, decrease the weight, shorten the range of motion, or temporarily substitute something else.
The same applies to everyday activities.
If repeatedly bending over bothers your back, bring objects up to waist height when possible. If sitting for an hour increases your pain, stand up every 20 or 30 minutes.
This is different from avoiding movement altogether.
You are simply giving irritated tissues a chance to calm down while continuing to use your body.
Try Heat
For many people with muscular back pain or stiffness, heat feels wonderful. A heating pad, warm shower, or warm bath may help relax tight muscles and make movement easier. Try heat for about 15 to 20 minutes at a time.
Some people prefer ice, particularly immediately after an injury. That’s fine too. There isn’t one perfect choice for everyone.
If heat makes you feel better, use heat. If ice makes you feel better, use ice.
The important thing is not to spend three days lying on the couch with an ice pack strapped to your back waiting for the problem to disappear.
What About Pain Medication?
Over-the-counter pain relievers can sometimes help people remain active while their back settles down.
Acetaminophen may be appropriate for some people. Anti-inflammatory medications such as ibuprofen or naproxen may also help certain types of back pain.
But these medications aren’t appropriate for everyone.
Anti-inflammatory medications can affect the stomach, kidneys, blood pressure, and cardiovascular system and can interact with other medications. Acetaminophen also has dosing limits and may not be appropriate for everyone.
If you have kidney disease, heart disease, stomach ulcers, take blood thinners, or take multiple medications, talk with your physician or pharmacist before routinely using over-the-counter pain medicine.
And remember what the medication is doing.
It may decrease your symptoms. It isn’t necessarily fixing the reason your back started hurting.
Gentle Exercise Can Help
Once you can move reasonably comfortably, gentle exercise can become part of your recovery.
Walking is an excellent place to start.
You can also gradually add exercises designed to improve the strength and control of the muscles supporting your spine.
One of my favorites is the bird dog.
Start on your hands and knees. Tighten your abdominal muscles gently, then extend one arm and the opposite leg while keeping your trunk stable. Return to the starting position and repeat on the other side.
Don’t worry about how high you can lift your arm or leg.
The goal is control.
Other exercises may include bridges, gentle mobility exercises, and eventually resistance training.
The exact exercise matters less than gradually teaching your body that it is safe to move again.
Don’t Automatically Blame Your MRI
Here’s something that surprises many people.
If we performed an MRI on a group of older adults who had absolutely no back pain, we would still find plenty of abnormalities.
Degenerative discs. Bulging discs. Arthritis. Disc height loss.
These changes become increasingly common as we age.
You could think of some of them as wrinkles on the inside.
That doesn’t mean MRI findings should be ignored. Imaging can be extremely valuable when there are specific reasons to obtain it.
But an abnormal MRI doesn’t automatically identify the source of your pain.
We treat people—not pictures.
Know the Warning Signs
Most back pain isn’t an emergency.
But there are situations where you shouldn’t simply wait it out.
Seek prompt medical evaluation if back pain is accompanied by:
- New or worsening weakness in one or both legs
- Loss of bladder or bowel control
- Numbness around the groin or inner thighs
- Significant trauma, particularly if you have osteoporosis
- Fever or chills with significant back pain
- Unexplained weight loss
- A history of cancer with new persistent back pain
- Severe pain that is rapidly worsening
- Pain that consistently wakes you at night or doesn’t change with position
- New back pain in someone who is immunocompromised or at increased risk of infection
You should also talk with your physician if your pain simply isn’t improving, keeps returning, or is interfering with your normal activities.
Sometimes physical therapy, additional evaluation, or imaging is appropriate.
Once You Feel Better, Don’t Stop
This may be the most important part.
Your back starts feeling better.
Great.
Then you immediately stop doing everything that helped it get better.
Six months later, the pain returns.
Once the acute episode settles down, start thinking about prevention. Build stronger legs. Strengthen your core. Work on hip mobility. Walk regularly. Do resistance training. Practice lifting things safely. And don’t be afraid to use your back.
Your spine was designed to bend, twist, carry loads, and move.
The goal isn’t to protect your back from movement for the rest of your life.
The goal is to build a body that can handle movement.
Dr. Mike’s Prescription
If your back starts hurting, remember these five things:
1. Don’t panic.
Pain doesn’t necessarily mean serious damage.
2. Keep moving.
Avoid prolonged bed rest whenever possible.
3. Modify rather than eliminate activity.
Temporarily decrease movements that significantly aggravate your symptoms.
4. Gradually rebuild strength.
Walking, core exercises, and resistance training can all become part of recovery.
5. Know the warning signs.
Certain symptoms deserve prompt medical evaluation.
And perhaps most importantly, don’t allow one episode of back pain to convince you that you have a “bad back.”
You’re not a fragile piece of machinery with an expired warranty just because you turned 50.
Your body can adapt. Your muscles can get stronger. Your movement can improve.
And in many cases, one of the best things you can eventually do for a painful back is exactly what you may be afraid to do.
Start moving it again.
This article is for educational purposes and is not a substitute for evaluation or treatment by your healthcare professional.