What is acute/low mechanical back pain?

Acute low/mechanical back pain is a common medical problem. Acute pain is pain that has been present less than four to six weeks. Mechanical means the source of the pain may be in the spinal joints, discs, vertebrae or soft tissues. Acute mechanical back pain may also be called acute low back pain, lumbago, idiopathic low back pain, lumbosacral strain or sprain, or lumbar syndrome.

What causes low/mechanical back pain?

A precise cause of low/mechanical back pain can be identified 20 percent of the time. Sometimes, a specific trauma to the back or strenuous activity may cause the pain. However, 80 percent of the time, the specific source of pain is not found.

It implies the source of the back pain is in the spine and/or its supporting structure. The surrounding muscles and ligaments may become inflamed and irritated.

Less than one percent of people who develop acute low back pain have a serious cause, such as cancer or infection, to explain their pain.

What are the symptoms of low/mechanical back pain?

Most people experience pain primarily in the lower back. The pain may spread (radiate) to the buttocks, thighs or knees. Many people may also experience spasms with mechanical back pain. The symptoms of low/mechanical back pain are generally more noticeable with flexion of the back and when lifting heavy objects.

Back pain is usually more severe than leg pain (sciatica). Sciatica is usually the result of a pinched nerve, when a protruding disc is putting pressure on a spinal nerve. With sciatica, the pain frequently extends below the level of the knee.

How is back pain diagnosed?

A careful evaluation of your medical history and a physical examination will help your health care providers determine if you have mechanical back pain. Then, they will work with you to create an appropriate treatment plan for dealing with the pain.

If your health care provider has determined your back pain is mechanical, additional testing is not usually necessary. If your symptoms or examination suggest the possibility of infection, malignancy or a pinched nerve, additional tests may be necessary. Additional testing may include blood tests, X-rays, computed tomography (CT) scan, magnetic resonance imaging (MRI), and/or nerve conduction studies.

How is back pain treated?

Non-surgical treatment with limited rest, pain medication, and a supervised therapy program is the recommended treatment for mechanical back pain.

Bed Rest

Short-term bed red is recommended for patients with severe back pain and muscle spasms. Bed rest greater than 48 hours is rarely recommended. If you have rested in bed for 48 hours, we recommend that you get up and move about.

Physical Activity

We recommend early physical activity to promote rapid recovery from back pain. For moderate to mild back pain, the Center for Spine Health recommends maintaining a near-normal schedule from the onset.

Ice and Heat Application

Applying heat and ice alternately to the back is helpful to relax the muscles and decrease muscle inflammation. We generally recommend that you apply heat for 20 minutes. Next time, apply ice for 20 minutes. If you find that one application is more helpful than the other, then use only that application. Generally, heat and/or ice should be applied two to three times per day.


If there is a muscle spasm, a muscle relaxant may be prescribed for a short time (3 to 4 days).

Non-steroidal antiinflammatory drugs (NSAIDs) such as ibuprofen or naproxen are frequently prescribed. They serve as analgesics (pain relievers) and as anti-inflammatories (to decrease muscle inflammation).

Occasionally, if the back pain is severe, you will be given an analgesic that can be taken with the NSAIDs and/or muscle relaxant.

Physical Therapy

In many cases, physical therapy is an essential part of acute back pain rehabilitation. It is important that you work with a physical therapist trained in the exercise approach to promote rapid healing.

The Center for Spine Health encourages active physical therapy to shorten recovery time and return you to work and leisure activities as quickly as possible. Active physical therapy is an exercise program that may require home exercises as frequently as every two hours while you are awake. The exercises generally take about 5 minutes to do and do not require special equipment, nor do you need to go to a gym to do them.

Passive physical therapy methods may be recommended for short-term use only. Passive methods produce short-term symptom relief, but no lasting improvement occurs. Passive therapy procedures include massage, ultrasound, diathermy, heat and traction. Some patients may also benefit from manipulation.

When can I return to work?

We usually recommend that you return to work promptly. If you can not do your regular job initially, it is in your best interest to return to some kind of modified duty (light or restricted duty). Your health care provider can give you a prescription for a limited period of modified work duty.

It is very common to be afraid to promptly return to work and other activities due to fear of re-injury. The Center for Spine Health specialists know from experience that with proper treatment, the risk of re-injury is very low. It is in your best interest to return to a normal lifestyle promptly. Early mobility has been found to directly result in a more rapid recovery. Maintaining a positive mental attitude is also imperative to a quick recovery.

What is the outlook for people with back pain?

The prognosis for complete recovery is excellent. Most people with acute mechanical back pain respond very rapidly to treatment; 90 percent of people with acute low back pain are symptom-free in one to two weeks. Many of the remaining 10% recover within three months. It is important that you maintain a positive mental attitude, continue to engage in regular daily activities, and return to work promptly.

Recurrences of back pain are common. Continuing your home exercise program may help reduce your risk of another episode of pain.

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