Lower Back Pain: A Physio’s Plan for the First Two Weeks

You bent to pick something up and your back seized. Or you woke up unable to straighten. The first two weeks are when most people either recover well or accidentally make things harder for themselves.

Here’s what the first fortnight usually looks like, and what to do in each part of it.

First: rule out the serious stuff

Go to A&E now if you have numbness around your groin or buttocks, trouble passing or controlling urine, or weakness in both legs.

See a doctor in the next day or two if the pain followed a significant fall, you have a fever, unexplained weight loss, a history of cancer, you’re over 50 with new back pain, or you’re on long-term steroids. Sudden severe pain after something minor, in someone with thin bones, has its own page: osteoporosis and spinal compression fractures.

Everything else is almost certainly the ordinary kind, which settles. More on the distinction: when a heating pad helps back pain, and when it won’t. Pain on one side only has its own list: lower back pain on the left side.

Days 1–3: keep it moving, take the edge off

• Don’t go to bed. Bed rest for back pain makes recovery slower. Stay up, potter about, change position often.
• Heat, 15–20 minutes, a few times a day. Most acute back pain has no swelling, just muscle guarding, so heat helps from day one. See heating pad for lower back pain, on the lowest setting that feels clearly warm.
• Short walks. Five or ten minutes, several times a day, even if slow and awkward.
• Pain relief. Ask a pharmacist what suits you, and take it regularly for the first few days rather than waiting for peaks.
• Find your easier positions. Lying on your side with knees bent and a pillow between them suits most people. So does lying on your back with a pillow under the knees. If the spasm is worst at night, see back spasm at night.

Expect this to be the worst part. Spasm can be severe, and severe pain doesn’t mean severe damage.

Days 4–7: start adding back

• Longer walks. Build from 10 minutes towards 20 or 30.
• Gentle movements after heat. Knee rocks, pelvic tilts, knees to chest. Ten of each, slowly, twice a day. The sequence matters: heat first, then the movement.
• Back to work if you can. Modified duties beat staying home. Break up sitting every 30 minutes; see sitting back pain.
• Resume light household tasks. Bend at the knees, keep loads close, avoid twisting while lifting for now. See back pain after gardening and housework.

Week 2: back towards normal

• Return to your usual activity, building up rather than jumping straight back to your heaviest session. Lifting again: heat and weight training.
• Use heat as a warm-up before exercise rather than as the main event.
• Expect good days and bad days. Recovery isn’t a straight line, and a flare doesn’t undo your progress.
• Start thinking about why. A one-off awkward lift, or months of a bad chair and no exercise? Shift work is its own pattern: shift worker back pain.

What not to do

• Don’t rest it for a week. The single most common mistake.
• Don’t rush for a scan. Most people with no red flags don’t need imaging in the first six weeks, and scans often show age-related changes that have nothing to do with today’s pain. See slipped disc and heat.
• Don’t let someone forcefully crack your back while it’s in acute spasm, unless they’re a qualified clinician who has assessed you.
• Don’t stretch hard into pain. A guarded muscle tightens further.

See a physio if…

• You’re not clearly improving by the end of week two
• Pain or numbness is travelling down a leg. See sciatica: can a heating pad help?
• This is your third or fourth episode, which is the point to address the cause rather than each flare. A flare plan helps if they keep coming.
• You’re worried about going back to lifting, sport or work

Clinically reviewed by: Nigel Chua (Hand Occupational Therapist) & Louise Yow (Physiotherapist). This article is general information, not a diagnosis. electricheatpad.com sells electric heat pads.