Winning the WAR on Low Back Pain – Managing the attack

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One day it starts. Your back hurts even though you did nothing to injure it. The pain is intense. You feel sharp pain shooting down your leg. You bend forward and your muscles spasm. It’s almost impossible to straighten up.

Maureen Dwight

When you feel like this you have probably missed the warning signals and have entered the Attack stage in the WAR on low back pain. Watch the you tube video here:

Signs of the Attack 

In may last blog I reviewed the stages of low back pain and gave you a guideline for recovery. Each stage has it’s own strategies and it’s important to know whether you are in the Warning, Attack or Recovery Stage (WAR).

Although it may seem obvious, the symptoms of  the Attack stage can be confused with the initial stages of Recovery.  The key characteristics that tell you that you are in a full-blown Attack are:

  • Unrelenting pain. The pain may wax and wane but you are never pain free.
  • Short term relief with changing positions however the improvement doesn’t last.
  • Symptoms present less than 3 months.

How long will the pain last?

When you are in the Attack stage you need to be prepared that your symptoms are not going to disappear overnight.  They may last for a few weeks or even a few months.  Fortunately, the odds are in your favour as you have a 95% chance that within 3 months your pain will be better.

Three months can feel like forever. I understand that no one wants to hear that they may be in pain for this long, but believe me it is comforting to know that, when the pain doesn’t immediately abate, time is truly a healer.

You can also expect your pain to progressively lessen and become more intermittent over this period.  However if you want to avoid this hiatus of life – next time pay attention to the warnings!  Right now the most important thing you can do is avoid becoming a prisoner of the pain.

Prisoner of pain

This stage is caused by your emotions.  When the pain is intense you worry that something serious is wrong or whether this will be how you will feel for the rest of your life.

The problem with these emotions is that it’s hard to heal when you are worried and it’s even harder to be logical when making decisions to manage the pain.  This can make the pain last even longer. Your job at this stage is to stay relaxed – despite the pain.

The key to avoiding becoming a prisoner is to know that most causes of low back pain are not serious and that the pain will end.  Education, medication and relaxation strategies such as breathing can all help. It is important to keep reminding yourself that you will get better with time.

Although it may take the full 90 days, many people will be much better within 2-3 weeks.  I often recommend you mark the days on a calendar as you can expect parole no later than 3 months, and it may be sooner for “good behavior”.

What have I hurt?

We all want to understand what is causing our pain. When we Google low back pain  it seems a diagnosis is critical to know how to get better.

This perspective can be problematic, as at the beginning of the Attack stage it can be difficult to determine exactly which structure is hurt.  The difficulty in getting an exact diagnosis can be unsettling.  You may interpret this as meaning you have something unusual or unknown, when the real reason we can’t tell you what you’ve injured is that the cause of the pain is somewhat generic.  Irrespective of whether you have herniated a disc, sprained a facet or pulled a back muscle, most back pain initially has the same cause.

Almost every injury starts with a stage that is variously referred to as nociceptive (pain), chemical or inflammatory.  These terms reflect that the pain you are experiencing is caused by the release of chemicals[1]. These chemicals irritate the surrounding tissues however they are not all bad as they also help you heal.  The most important thing to know is that as long as they are present you will be in pain.  Your rehab plan should include strategies to avoid prolonging this stage by limiting activities that provoke the tissues to release more chemicals.

Do I move or do I rest?

The pain makes you want to rest however the internet tells you to move.  Both are wrong!

Second only to whether to use ice or heat, the decision to move or rest can be one of the most confusing decisions in back pain recovery.  When we look online, our research tells us that core is essential to recovery however during the Attack-stage strengthening your core will not cure the pain. Too much movement or exercise can cause more irritation and prolong our recovery.

However don’t think this means you should take to your bed.  You need to move but you should also avoid substantial increases in pain from being too active before you’re ready. Movement is the key to flushing the chemicals out of your body by enhancing your circulation.

Determining the right level of activity

Start with gentle everyday movements like walking or light activities around the house i.e. dishes. As you transition out of this stage, exercise will become more valuable. Leave going to the gym until the basic movements are feeling better.

As you get moving it is normal to feel a mild increase in pain however the increase should not be intense nor last for longer than 30 minutes.  I find this guideline helps to determine whether you are doing too much or too little.

What about medication?

Medication can be helpful during the Attack stage.  It can make  the pain more manageable.  This allows you to move more easily and worry less.

Take what you need, but don’t make the mistake of thinking that intense pain needs intense medication.  Sometimes surprisingly low doses of over-the-counter medication can manage your pain.

See your family physician and discuss whether pain medication is right for you. Recognize that most medication for low back pain does not cure the problem.  The main purpose is to allow you to move more comfortably and to get more sleep.

What about Therapy?

In the Attack stage the primary focus is pain control and staying active as tolerated.  Gentle hands-on treatments and pain-relieving modalities (ice, heat, acupuncture, laser etc.) can help you to get through this stage.

If treatment doesn’t immediately relieve the pain, don’t despair.  Have your therapist help you to develop a treatment plan.  Discuss which home-based strategies are right for you i.e. heat, ice, etc.   Plan to come back for a review in a few weeks as the most value in winning the war of low back pain is to see your therapist for their guidance during the Resolution stage.

If you need more advice on managing your low back pain or preventing another WAR, contact us to book an appointment at or 416-925-4687.

1 One of these chemicals has the self-evident name of pain substance. Many of the other chemicals are related to inflammation.

This service pro­vides gen­eral infor­ma­tion and dis­cus­sion about therapy, health and related sub­jects. It is not meant to replace advice and/or treatment from your health care professional.