What to do about lower back pain that's lasted two weeks

What we checked before giving you an answer

We reviewed the published clinical evidence on acute and subacute low back pain — including Cochrane systematic reviews, NICE clinical guidelines, and peer-reviewed trials — alongside the actual treatment guidance used by physiotherapists and general practitioners. Where institutional recommendations (such as reflexive imaging or opioid prescribing) diverge from the trial evidence, we follow the trials. We also checked what patients consistently report versus what the studies show, because those two things are sometimes different in useful ways.

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  Natural history reviewed Multiple large cohort studies confirm that approximately 90% of acute low back pain episodes resolve within six weeks without specific treatment — this is the baseline against which any intervention must be measured.
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  Bed rest evidence checked Cochrane reviews consistently find that advice to rest in bed is no more effective than advice to stay active, and in several analyses rest produces worse outcomes — this contradicts the instinct most people have.
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  Heat vs. ice evidence compared Randomised controlled trials show heat application meaningfully reduces pain and disability in acute low back pain; the evidence for ice is substantially weaker and inconclusive for this specific condition.
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  Red-flag symptom list verified Clinical guidelines from NICE (UK), the American College of Physicians, and the Royal Australian and New Zealand College of General Practitioners converge on the same set of warning signs that distinguish self-limiting back pain from conditions requiring urgent evaluation.

The approach depends on how bad it is and how patient you can be

Most people with two-week back pain have several reasonable paths — the right one depends on pain severity, your access to care, and whether self-management alone is cutting it.

What most people try first — and why it backfires

These approaches feel intuitively sensible but are either unsupported by evidence or actively counterproductive for the kind of lower back pain most people are dealing with.

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  Bed rest — Spending several days lying down is the single most common mistake. Studies consistently show it delays recovery, weakens the supporting musculature, and increases the chance of pain becoming chronic. One to two days of relative rest if the pain is truly debilitating is the maximum; after that, gentle movement is always better.
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  Rushing to get an X-ray or MRI — Imaging in the first four to six weeks of low back pain without red-flag symptoms does not improve outcomes and frequently causes harm — not because of radiation, but because scans routinely show age-related findings (disc bulges, degenerative changes) that are present in people with no pain at all, leading to unnecessary anxiety, overdiagnosis, and often unnecessary procedures. Multiple clinical guidelines explicitly advise against routine early imaging for uncomplicated low back pain.
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  Applying ice — Ice is a deeply entrenched recommendation for musculoskeletal pain, but the evidence specifically for lower back pain is weak. A 2021 systematic review found no significant benefit of ice over heat or no treatment for low back pain. Heat has the better evidence base; if in doubt, use heat.
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  Taking paracetamol (acetaminophen) as your first choice — A landmark 2014 randomised trial (the PACE trial, published in The Lancet) found paracetamol was no more effective than placebo for acute low back pain. It's still sometimes useful for people who can't take NSAIDs, but if you can tolerate ibuprofen or naproxen, those are meaningfully more effective options for this specific problem.