Acute Low Back Pain

Low back pain is one of the leading reasons for physiotherapy visits in Australia.  Low back pain can present as Acute Back Pain – usually sudden onset and generally settling over 1 day – 6 weeks.  It can present as Chronic Back Pain – lasting longer than approximately 6 weeks, or longer than expected for acute injury recovery. Some people experience Acute-on-Chronic Back Pain – recurrent bouts of the same pain over a long period of time.

Back pain can affect people of all ages and backgrounds.  It can be incredibly debilitating, costly and frustrating.

Acute Low Back Pain

Frustratingly, acute low back pain can be brought on by anything from exercises (you name it, we’ve seen it), repetitive lifting (gardening, moving house?!), prolonged sitting, and even innocuous things like sneezing or bending to tie your shoes!  This can be incredibly frustrating. But more annoyingly – it can make people anxious about returning to exercise, work, or even activities they love.  For these reasons, an understanding of what is happening is key!

Causes of Acute Low Back Pain:

In many of the cases of acute low back pain there is no evidence of new or acute injury, or damage in the back.  Most cases of low back pain result from protective pains and muscle spasm, and even movement inhibition – all of which serve as very effective alarm systems for when our body senses that we need a warning. 

The pain is very real!

The pain is very real and the spasm is very real, but thankfully this doesn’t always align with injury or with long-term prognosis. This protective response can result from over-stretching our bodies in unfamiliar or unexpected ways (that first yoga class is always a shock to the system); doing more repetitive movements than our body feels is safe or necessary (too much gardening, paving or carpet laying); and sometimes just for getting out of bed the wrong way! 

Other factors:

Often these seemingly innocuous causes of acute low back pain have some other precursors.  These may be: increased time spent sitting at work over several weeks (starving our back and nerve tissue of movement which is what keeps it happy and healthy); more time spent in travel (long flights or car trips/commuting); stress – in all forms; illness – even things like the common cold can “wind-up” our protective pain system; and lack of quality sleep, just to name a few.

It’s Important!

Understanding these other precursors is important as it helps us to rationalise our pain experience.  We want to get back to the activities we love without fear. And we want to do what we can to prevent future flare-ups.

Acute low back pain can present as:

  • Sharp catching sensation that limits movements (sometimes feeling like it takes your breath away). This is often most limiting with bending forward, or extending fully upright.
  • Sometimes acute pain can present as a dull ache that is hard to pin-point.
  • It can feel like a grabbing, spasming and overworked muscle. 
  • Sometimes it can feel like generalised stiffness that takes time to get moving – especially in the morning. 

It can be Nerve related – But don’t stress

Low back pain can involve irritation of the nerve tissue which may result in radiating pain into the buttocks or leg, pins and needles, or numbness and altered sensation.  Back pain that has symptoms of nerve involvement is important to get checked by your physio or GP.  However, don’t fear – nerve related pains can settle well with the right advice.

What to do when Acute Low Back Pain strikes?

When acute low back pain strikes, it is tempting to adopt a position of comfort (foetal position on the couch is what we hear a lot of) and hope the best. However, there are some key steps to take early in the process to help resolve the issue quickly.


Keep Moving


Keep Moving

Even if it is small gentle movement.  Short regular walks or small repetitive stretches can be a lovely way to keep the back moving. 

Be wary of the Quick-Fix

It can be tempting to try to stretch the pain away by pushing hard into painful movements. Trying to “crack” the back to ease the tension, or trigger-pointing until you are black-and-blue.  This isn’t necessarily the best approach (despite what your trainer/ colleague/ partner/ acquaintance says). Everyone will respond differently to pain and to treatments.  Exercises with acute low back pain should be regular and smooth, and while not always painless, it should not make your pain worsen or linger.

Use hot or cold packs

These can provide a simple and safe form of pain relief.  We generally recommend hot packs for back and neck pain (unless there is a super acute inflammatory process at play), as the gentle heat has a great effect on calming pain, and helping to promote relaxation and movement.

Pain relief medication

Paracetamol or ibuprofen can be effective first line management (1) to help settle the pain and allow movement. 

Seek reassurance and advice


Seek reassurance and advice


    1. Australian Acute Musculoskeletal Pain Guidelines Group. Evidence-Based Management of Acute Musculoskeletal Pain – A guide for clinicians. Bowen Hills: Australian Academic Press; 2004.