What not to do with a back that has just gone

WHAT NOT TO DO

With a back that has just gone, do not go to bed, do not start an opioid, do not get a scan in the first six weeks, and do not buy a lumbar belt. Most acute (new and short-term) back pain settles. Yet three of those four are still being recommended.

Start with the baseline, because it changes how you read everything below. A community inception cohort (a study that follows people from the first days of an episode) found that most improved substantially within six weeks. So the treatments on offer are competing against a condition that largely resolves on its own. That means the ones that slow recovery down do real harm, even when they feel like care.

Should you stay in bed when your back goes out?

Rest is the most natural response and one of the least useful. Guideline reviews agree that advice to stay active outperforms rest for acute low back pain. The gap is not subtle. The mechanism is not mysterious. Trunk muscles lose endurance quickly and the segment stiffens. You get up two days later with less capacity than you went down with.

Relative modification (changing only the activities that load the back) is a different thing, and it is sensible. Skip the deadlifts, keep walking. What you do in the first fourteen days decides more than most of what follows.

Do opioids help acute back pain?

This is the clearest result in the recent research, and it deserves to be stated plainly. The OPAL trial randomized people with acute back and neck pain to an opioid or to placebo, on top of guideline care. At six weeks the opioid group was not better. They did have more adverse events (side effects and harms). At one year they reported slightly worse pain. Earlier dose-ranging work in chronic low back pain had already shown small effects. Those effects were dose-limited by tolerability and clinically marginal.

Our position on opioids is not abstinence and never has been. It is that starting one for an acute back is a bad trade on the evidence. The population that arrives here on high doses usually got there one reasonable-seeming prescription at a time.

Do you need an MRI for acute back pain?

Absent a red flag, early imaging does not improve outcomes. The systematic review comparing imaging against no imaging found no benefit in pain, function or quality of life, and imaging costs more. What it reliably produces is findings. Past forty, nearly every lumbar MRI shows disc desiccation (a drier disc), a bulge, or facet arthrosis. Those same findings are also present in people with no pain at all.

A scan taken too early does not answer the question. It supplies a likely-looking culprit that then shapes every conversation afterward. Your scan described a back that belongs to somebody your age.

The findings that do earn an urgent scan are a short list, and it is short on purpose.

Does a back brace help lower back pain?

Lumbar supports have been studied mostly as workplace prevention, and the evidence does not support them for that. Worn during an episode, they do what a collar does to a neck. They take over the work the muscle needs to be doing. If you already own one, use it for a specific heavy task, not as a garment.

What should you do instead when your back goes out?

Keep moving within tolerance. Use a simple analgesic (pain reliever) if you want one. Sleep as well as the pain allows. Give it six weeks before concluding anything. Exercise is the treatment with the most consistent support — the type matters far less than that it happens. That is the most freeing finding in this field. Physical therapy fails most often when nobody established what it was treating.

And if it has not moved at six weeks, the question changes. It moves from how to manage it to which structure is generating it. That question is answerable. There is no scan that finds facet pain, which is exactly why so many people are still looking.

If your physician does order support, our back brace page explains how it should fit and why it never replaces your exercises.

Frequently asked questions

What is the worst thing you can do for lower back pain?

Going to bed. Rest feels protective. But advice to stay active outperforms rest for acute low back pain, and the gap is not subtle. Trunk muscles lose endurance quickly and the segment stiffens. You get up two days later with less capacity than you went down with. Starting an opioid for a back that has just gone is a close second.

How long does it take for a back that has gone out to get better?

Most people improve substantially within six weeks. In a community cohort that followed people from the first days of an episode, that was the usual course. So give it six weeks before concluding anything. If it has not moved by then, the question changes from how to manage it to which structure is generating it. That question is answerable.

Can I keep exercising with lower back pain?

Yes, with sensible changes. Skip the deadlifts, keep walking. Exercise is the treatment with the most consistent support for back pain, and the type matters far less than that it happens. Changing the specific heavy task is sensible. Stopping everything is not, because the muscles you rest are the ones your back needs working.

What painkiller is best when your back goes out?

A simple analgesic if you want one, not an opioid. The OPAL trial gave people with acute back and neck pain an opioid or placebo. Those on the opioid were not better at six weeks. They had more adverse events and reported slightly worse pain at one year. That makes starting an opioid for an acute back a bad trade on the evidence.