Management of Acute Low Back Pain

As we discussed in our last blog post, there are a number of reasons that people can experience low back pain. These problems can be acute, meaning they have occurred recently (<1 month), to chronic, meaning they have been present for a longer period of time (>3 months). This post focuses on the physical therapy approach to managing acute low back pain. Proper early management of an episode of acute low back pain can set the stage for a successful long term recovery.

Assessment of Acute Low Back Pain

As with any assessment, it is critical to rule out serious pathology, especially when it comes to a new onset of low back pain. This includes systemic issues (cancer, infection, rheumatologic diseases, etc.), presence of a fracture, or potentially severe neurological deficits. A good subjective history of the onset and behavior of pain along with a physical assessment can help us identify whether your issue is a musculoskeletal problem that we can treat and help you manage. Our physical assessment will include but is not limited to:

  • Range of motion testing for mobility restrictions
    • Motion of specific joints and overall functional motion patterns
  • Strength testing 
  • Neurological testing
  • Observation of Activities of Daily Living
    • Lifting/carrying objects
    • Ergonomic work setup
    • Recreational activities
  • Palpation
    • Assessment of restricted or painful soft tissue and bony structures

Physical Therapy Management of Acute Low Back Pain

We know that a new episode of back pain can be EXCRUCIATING! In this phase of your injury, there may be a lot of inflammation and muscle guarding/spasms. Something as simple as rolling over and getting up out of bed can set off your pain. You may not be able to tolerate sitting or standing for long periods of time without agony, let alone lifting objects or resuming normal recreational activities. Here are some of the things you can expect in the acute phase of treatment for your low back pain:

  • Gentle range of motion/stretching exercises
    • Individually selected to promote continued movement and prevent joint/muscular stiffness without worsening pain
  • Gentle strengthening/stabilization exercises
    • In this phase we may introduce some low level strengthening exercises to prevent disuse/inhibition of the muscles of the low back and core
    • We proceed carefully to avoid exercises that would produce discomfort
  • Manual Therapy Techniques
    • Soft tissue mobilization may be used to desensitize and increase blood flow to the area allowing relaxation of the muscle
    • Joint mobilization techniques are used at specific joints in order to decrease pain, provide nutrition to joint surfaces, increase blood flow to the area, and cause stretching to soft tissue around the joint
    • Traction is used to decompress joint surfaces as well as possible “pinched” nerves in the spine to decrease pain to the affected area
    • Joint manipulation techniques may be used for specific joints showing reduced mobility. These can be helpful in reducing pain and increasing range of motion to restricted joints
  • Use of modalities
    • Ice or heat may be used depending on your specific presentation in order to reduce pain and inflammation in this stage
    • Heat is used to increase circulation and relax sore/spastic muscles. This can be applied generally to the affected area with a wet towel or hot water bottle, as well as via a shower or bath. This can be done for 15–20 minutes
    • Ice can also provide pain relief to an irritated area and may relieve small muscle spasms or “knots”. This can be done by using crushed ice in a plastic bag, a gel cold compress, and direct application to the affected area. This should be done for 15–20 minutes
    • Electrical stimulation and therapeutic ultrasound may also be incorporated in order to reduce inflammation, and provide heat to deep tissue to promote relaxation of spastic muscles
  • Guidance and modification of activity and postures 
    • While complete bed rest is rarely indicated for acute low back pain, it will be important to avoid certain movements and activities in the short term to allow proper healing of the injured tissues 
    • We have some instructions for basic activity modifications for acute low back pain
  • Gradual progression of exercises and return to normal activities
    • While we may advise avoiding certain movements and activities in the short term, you can expect a gradual progression and reintroduction to normal movements and activities 
    • We will address possible limitations in strength and mobility that predisposed you to injury in order to put you in the best position to avoid a recurrence of injury

If you’re suffering from acute low back pain, don’t hesitate to schedule a consultation with one of our physical therapists. We will assess your specific situation and tailor a treatment plan that can help get you moving again.


The information in this article is intended for informational and educational purposes only and should not be taken to be the provision or practice of Physical Therapy services. It is not intended to delay or substitute diagnosis or care from a Physical Therapist or other healthcare professional.