The first 48 hours.
What to do, and what to expect.
Acute back pain can be overwhelming, and yet in most cases there is no reason to panic. This page walks with you from the first hours to the first weeks: what to do, what to skip, and what to expect. Everything here can be checked against the sources given.
Hour by hour, day by day
Four steps from the first hours to the first weeks. Pick where you are right now.
How long have you had the pain?
The first hours
The pain is at its worst right now, and that says little about damage: in 9 out of 10 people with back pain no physical cause can be found (NHG Standard). Find a position that eases it, for example on your side with a pillow between your knees. Heat is fine, and so is a painkiller if you need one. Lying down for a while is okay, but spending the day in bed slows recovery (Cochrane 2010).
Which painkiller?Today
Get moving every hour or two, even if it is only a lap around the house, and do the three movements below. Carrying on with your everyday activities is the first step the WHO and every major guideline recommend. Go to work if you can, or talk about adjusted tasks.
Back pain and workTomorrow
Extend: a walk of 10 to 15 minutes and picking up the ordinary things again, from groceries to cooking. Some pain while moving is normal and does not mean you are causing damage. Sharp, sudden pain, increasing radiation into your leg or numbness is the signal to stop.
All exercises and the walking scheduleAfter that
In most people the pain eases substantially in the first six weeks, without any specific treatment (Wallwork et al., CMAJ 2024). Build up the movement and keep it going. Not improving after 4 to 6 weeks? Then a physiotherapist or your GP is the next step.
How the care pathway worksOne thing to be open about: that movement, heat and a short course of painkillers help comes from research. Which hour or day you do what is practical guidance, put together from the guidelines, and not a trial outcome. Use it as a starting point and adjust to what your back allows.
Three movements for now
Not to train, but to let your body notice that moving is safe. Calmly, within your pain limits, a few minutes every couple of hours.
Knees to chest
On your back, gently pull one knee toward your chest, then switch.
every few hours · gentlyPelvic tilt
Knees bent, press your lower back softly into the floor and let go again.
every few hours · gentlySupine rotation
Let both knees drop to one side, shoulders stay down, then switch.
every few hours · gentlyWhat to expect
Wallwork et al., CMAJ 2024The largest summary of how back pain runs its course (Wallwork et al., CMAJ 2024) pooled 95 studies. In people whose back pain had lasted less than six weeks, average pain at the start was 56 on a scale of 0 to 100. Six weeks later it was 26. After that little changed: 22 after six months and 21 after a year.
- At the start56
- 6 weeks26
- 6 months22
- 1 year21
These are averages. One person is pain-free after two weeks, another still has real pain after six, and on average the pain does not drop to zero. Fear and catastrophising (thinking the worst) are proven risk factors for pain that lingers. Try to see the pain as a temporary protective signal, not as evidence of serious damage. Your back is strong and resilient.
Back pain often comes back
Among 250 people who had recovered from an episode, 69% had back pain again within a year, and for 40% that episode limited their daily life (da Silva et al., 2019). What helps against that, exercise above all, is on Preventing back pain.
Do and skip
The core of the first days in one place, with the source next to each line.
Do
- Keep moving. Bed rest slows recovery (Cochrane 2010). Doing your ordinary things is enough; it does not have to be intense.
- Heat if it feels good. A Cochrane review found a small, short-lived improvement in recently started back pain, mostly with a heat wrap worn for hours and combined with movement. A hot water bottle or warm shower is safe; not on inflamed or swollen areas. On cold there is too little research to say anything.
- A short course of painkillers if you need it. Ibuprofen (400 mg, at most 3 times a day) or naproxen (250 to 500 mg, at most 2 times a day) have the best evidence (WHO 2023, NICE, Cashin 2025), though the effect is small. With food, for at most 7 to 14 days. Check with your GP if you have stomach problems, kidney disease or use blood thinners.
- Sleep in whatever position is comfortable. See the sleep tips below. A comfortable position is the only thing you need to do.
Better not
- Staying in bed. Lying down for a while is fine, spending the day in bed is not: it slows recovery (Cochrane 2010).
- Waiting for a scan. Wear and tear shows up on scans of people without pain too: among 40-year-olds without back pain, 68% have disc degeneration and 50% a bulge on MRI (Brinjikji 2015). Without warning signs your GP therefore orders no imaging (NHG Standard).
- Buying a back belt or corset. NICE advises against belts and corsets for back pain with or without sciatica: in the trials they did not deliver enough to be worth it.
- Expecting paracetamol to fix it. In the PACE trial paracetamol did no better than a placebo. Your GP still suggests it first because it has the fewest side effects (Thuisarts.nl).
Sleeping with back pain
Sleep on your side with a pillow between your knees, or on your back with a pillow under your knees. This reduces pressure on the spine. On mattresses: medium-firm came out better than firm in a double-blind trial (Kovacs et al., Lancet 2003), but the evidence is thin and buying a new mattress is rarely necessary. Sleeping poorly because of pain is normal and usually settles by itself; don’t force it.
Can I work?
Usually, yes. The advice to carry on with your ordinary activities (WHO 2023) applies to work too. If your usual work is not possible yet, talk to your employer about adjusted tasks or shorter days. If the back pain affects your work for longer, the occupational physician can help with workplace adjustments and a return-to-work plan; your employer arranges that contact.
Back pain and workFrequently asked questions
Key message
Acute back pain is unpleasant but usually harmless. Keep moving, use heat if it feels good and a short course of painkillers if you need one, and pick up your normal life again within a few days, work included. Honest about movement: in the first weeks it has not been shown to reduce pain more than a placebo does, but it is safe, it stops you stiffening up, and every guideline recommends it. Not improving after 4 to 6 weeks? Then a physiotherapist or your GP is the next step.
When to contact your GP after all
Most back pain does not need a doctor. Do get in touch the same day if you have:
- Weakness or loss of function in a leg
- Problems with urinating
- Numbness in the saddle area (between the legs)
- Fever combined with back pain
Outside office hours, call your own GP; you are put through to the out-of-hours service. All warning signs are on When to see a doctor. Not sure what is going on? Take the self-assessment.
Next step