From the Guidelines
For back pain after a fall, I recommend starting with rest for 24-48 hours, applying ice for the first 48-72 hours (20 minutes on, 20 minutes off), and then switching to heat therapy. Take over-the-counter pain medications like acetaminophen (Tylenol) 650-1000mg every 6 hours (not exceeding 4000mg daily) or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours with food (not exceeding 3200mg daily) 1. Gentle stretching and movement should begin after the initial rest period to prevent stiffness. If pain is severe, worsening, accompanied by numbness, weakness, bowel/bladder problems, or if you have a history of osteoporosis or are taking blood thinners, seek immediate medical attention as these could indicate a serious injury requiring imaging and professional evaluation. Most back injuries from falls improve within a few weeks with conservative management, but persistent pain beyond 2-3 weeks warrants medical evaluation. The initial inflammation response causes pain, which is why ice and anti-inflammatories help early on, while heat later improves blood flow and muscle relaxation to promote healing.
Some key points to consider:
- Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause 1.
- Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain 1.
- Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options 1.
- For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits 1.
It's essential to note that the management of back pain after a fall should prioritize the patient's safety and well-being, and any concerns about the severity of the injury or the presence of red flags should prompt immediate medical attention.
From the Research
Initial Assessment
- The patient's complaint of back pain after a fall requires a thorough evaluation to determine the cause and appropriate treatment 2, 3, 4, 5, 6.
- A detailed history and physical examination are essential to exclude emergent or nonoperative etiologies of back pain 4.
Diagnostic Approach
- Radiographs of the thoracic and lumbar spines may be ordered, but they may not be sensitive to some bony changes associated with fractures 2.
- Computed tomography imaging may be necessary to reveal multilevel, small end-plate compression defects or other abnormalities 2.
- In the absence of red flags, routine imaging should be avoided 3.
Treatment Options
- Conventional therapies, including lifestyle modifications, nonsteroidal anti-inflammatory drugs, physical therapy, and cognitive behavioral therapy, are often used as the first line of treatment 4.
- If these options have been exhausted and pain persists for greater than 6 weeks, imaging and a specialist referral may be indicated 4.
- A multidisciplinary, logical approach to treatment is most effective for chronic back pain patients, and can include multimodal medical, psychological, physical, and interventional approaches 5.