Home Care Instructions for Acute Low Back Pain at Two Weeks
Advise the patient to stay active and continue ordinary activities within the limits permitted by pain, explicitly avoiding bed rest, as staying active leads to less pain and better functional recovery than resting in bed. 1, 2
Activity and Movement
Tell the patient to remain active and avoid bed rest entirely, as bed rest causes more pain (small but measurable increase) and worse functional recovery compared to staying active 1, 3
Instruct the patient to continue work and daily activities as much as pain allows, as early return to work is associated with significantly less disability and fewer missed work days 1, 2, 4
Reassure the patient that 90% of acute low back pain episodes resolve within 6 weeks regardless of treatment, but warn that minor flare-ups may occur in the subsequent year 2
Pain Management at Home
First-Line Options
Start with acetaminophen or NSAIDs (ibuprofen, naproxen) as needed for pain, using the lowest effective dose for the shortest duration 5, 6, 2, 7
Apply heating pads or heated blankets to the painful area for short-term relief, which is effective within 4-5 days 5, 6, 8
Use ice on painful areas as an alternative or complement to heat 2
Important Medication Safety
Do NOT use NSAIDs chronically or in patients with kidney disease, heart disease, or gastrointestinal problems, as they cause significant cardiovascular, renal, and GI complications 5
Avoid systemic corticosteroids completely, as they are no more effective than placebo for low back pain 5, 6, 8
Self-Care Education
Provide written educational materials about back pain management and its natural history, as simple signposting is insufficient—patients need direct support and reinforcement 1
Direct patients to online resources, telephone helplines, or healthcare charities specializing in spinal pain for additional self-management support 1
Teach proper body mechanics and safe back exercises for injury prevention 2
Exercise and Stretching
Recommend gentle stretching exercises at home, which can be started immediately 2
Consider McKenzie exercises specifically if pain radiates below the knee, as these are particularly helpful for radicular symptoms 2
Avoid prescribing formal supervised exercise therapy at this 2-week mark, as it is not effective for acute pain but becomes beneficial after 2-6 weeks 6
When to Follow Up
Schedule a follow-up visit at 2 weeks from pain onset to assess improvement and risk stratification 1
At the 2-week follow-up, use the STarT Back tool to identify patients at low, medium, or high risk for developing persistent disabling pain, which guides appropriate resource allocation 1
Red Flags Requiring Immediate Return
Instruct the patient to return immediately or go to the emergency department if any of these develop:
Loss of bowel or bladder control (cauda equina syndrome) 6, 8, 7
Severe nighttime pain that wakes them from sleep 7
Common Pitfalls to Avoid
Never recommend prolonged bed rest, as even 2-3 days of bed rest leads to deconditioning and worse outcomes compared to staying active 1, 9, 3, 4
Do not order imaging (X-rays, MRI) at this 2-week point unless red flags are present, as routine imaging does not improve outcomes and may lead to unnecessary interventions 6, 8, 7
Avoid telling patients to "wait and see" without specific activity guidance, as direct support and frequent contact from primary care are essential given back pain's significant impact on work and lifestyle 1