A sudden attack of pain sends the muscles into a debilitating spasm (persistent uncontrollable muscle contractions)—which is actually a protective defense mechanism to prevent further damage from continued use. When immobilized by muscle spasms, the obvious course of action is to lie down and rest for a while, which reduces pressure on the affected areas and permits inflamed tissue to settle down. Some people find that lying on one side with legs bent and a pillow between the knees provides optimal relief.
Either or both may provide temporary relief, although the evidence is better for heat than for ice. You should wait at least 48 hours after an acute injury before applying heat, but otherwise, hot packs, hot water bottles or heating pads are advisable. Likewise, sitting in a whirlpool or hot tub (hydrotherapy) can be soothing and therapeutic. Heat dilates the blood vessels, improving the flow of nutrient- and oxygen-rich blood to the affected tissues. Heat also alters the sensation of pain and can ease muscle spasms. Cold is known to reduce inflammation. Although cold may feel painful against the skin, it numbs deep tissue pain.
Choose an over-the-counter (OTC) pain reliever such as acetaminophen, naproxen, ibuprofen or aspirin. (Acetaminophen has a lower risk of side effects than the others, as long as it is not combined with alcohol.) These medications help you get through the worst of the back attack, until you can return to your normal activities.
Short-term bed rest is fine (and often unavoidable), but numerous studies have shown that too much bed rest actually makes matters worse. If your pain keeps you from moving, it’s all right to stay in bed, but it’s important to get up and start moving around as soon as possible. Adjust what you do and how much you do to your symptoms, but be as active as you can. Resume walking and other activities as soon as possible, usually after a day or two, at least to some degree.
Aquatic therapy—essentially physical therapy conducted in the water—is used to manage various musculoskeletal conditions, including low back pain. Water provides natural resistance when you move. Exercising against this resistance, with the correct pushing or pulling motions, gently develops muscle strength in your back, abdomen and hips. When you target these core muscles, you help stabilize your posture and support your lower back. Water's buoyancy also minimizes pressure on your spine. Warm water particularly relaxes your back muscles and eases pain.
The intensity of back pain is not a reliable indicator of the seriousness of the underlying problem. Some serious diseases may produce only dull pain, whereas a simple muscle spasm can be excruciating. In any case, you should see a doctor right away if back pain is accompanied by changes in bowel or bladder control, diminished sexual function or numbness in the genital region, or pain, numbness or tingling that radiates into the limbs. Likewise, sudden back pain accompanied by fever or vomiting merits prompt medical attention.