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Back pain

Each year, one in three of us will get back pain. Most back pain affects people’s lower back. In most cases you can manage this yourself with over-the-counter painkillers, and by keeping mobile.

It can last a few days or weeks, or continue for many months or even years. Back pain can affect your mood, your daily activities, your sleep patterns, and your ability to work.

Lower back pain is very common – about four in five people are affected at some point in their life. Back pain most often affects people between the ages of 30 and 60. It might be difficult to pinpoint the cause of your back pain. It's usually related to a strained muscle, tendon or ligament, or damage to another structure in your back.

Your back has many connected parts, including bones, joints, muscles, ligaments, nerves and tendons. Your spine supports your back. It’s made up of 24 separate bones called vertebrae, plus the bones in your sacrum and coccyx, which are at the bottom of your spine. Between the vertebrae are discs that act as shock absorbers and allow your spine to bend. Your spinal cord threads through the centre of the vertebrae. It carries nerves from your brain to the rest of your body.

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An image showing the different parts of the spine

Details

  • Symptoms Symptoms of back pain

    If you have lower back pain, you may have tension, soreness or stiffness in your lower back. You may also feel some pain in your upper legs. For most people, this is ‘non-specific pain’, meaning it’s not caused by another health problem (such as damage to your spine or a disease).

    You should contact your GP as soon as possible if, as well as back pain, you have:

    • a fever (high temperature)
    • unexplained weight loss
    • pain in your upper back or chest
    • a misshapen area of spine
    • had an accident
    • loss of bladder or bowel control (incontinence)
    • constant pain, that’s not affected by movement
    • had cancer in the past
    • had osteoporosis in the past
    • stiffness in the morning
    • pain at night

    It's important to get advice from your GP about these symptoms immediately, to make sure there’s not a serious reason for them.

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  • Diagnosis Diagnosis of back pain

    Your physiotherapist or GP will usually be able to diagnose lower back pain from your symptoms and by examining you. A physiotherapist is a healthcare professional who specialises in maintaining and improving movement and mobility. There’s often no need for further tests. But if you have other symptoms, your GP may recommend some tests. These might include:

    • an X-ray
    • an MRI scan (a test that uses magnets and radio waves to produce images of the inside of your body)
    • blood tests

    If you have long term pain that isn't improving, your GP may refer you to a doctor who specialises in treating conditions that affect the back. They may offer you injections to temporarily numb areas in your back. This can help to pinpoint the cause of your pain.

  • Treatment Treatment options for back pain

    The treatments we describe here are for non-specific back pain. If your back pain is caused by another health condition, such as a fracture, your treatment may be different from what’s described here.

    Most non-specific lower back pain gets better in a few days or weeks and often you don’t need to see your GP. If your back pain has lasted for more than six weeks, it’s important to get medical advice to help you manage your pain. When it lasts for longer than this, there are a number of treatments that may help. Your GP will suggest the treatments most suited to you and help you make choices about your options. Some treatments are designed to help you manage your pain rather than to cure it completely.

    Your GP may recommend you try self-help measures. They may also offer you medicines or refer you for other types of treatment. For example, your GP may refer you to a physiotherapist. This is a specialist in maintaining and improving movement and mobility.

    Your GP may give you advice about self-help, symptoms to watch out for and how long your symptoms are likely to last. They may advise you to return for a review if your pain has not settled after an agreed amount of time, or if you develop any other symptoms. If your GP suspects your pain has a specific cause, they may refer you to see a specialist.

    Self-help

    There are a number of things you can do to help relieve back pain.

    Stay active and continue your daily activities as normally as you can. Bed rest can make back pain worse, so try to limit the amount of time you spend resting in bed. Exercise can help back pain that has lasted six to 12 weeks.

    You may want to try applying heat or cold treatments to your back. This can give short term pain relief. Heat can help to reduce pain, improve blood flow and the ability of tissue to stretch. Cold can reduce pain and muscle spasm (cramp) and numb an area. Don’t apply heat or cold treatments directly to your skin though, as these can damage your skin. Always read the instructions that come with your treatment. This will tell you how to use it correctly.

    Medicines

    You may wish to take over-the-counter painkillers. You could try paracetamol or, if this doesn't help, anti-inflammatory medicine (such as aspirin or ibuprofen). These can relieve back pain and help you to stay active.

    Your GP may offer you stronger medicines such as codeine or another type of anti-inflammatory medicine. He or she may also offer you a muscle relaxant such as diazepam if your muscles spasm (cramp). You may be advised to take this medicine for a very short time, usually only for two to five days. These aren't suitable for everyone because they can be addictive and cause side-effects.

    Your GP might also suggest you take an antidepressant medicine. This is because some types of antidepressants also work as painkillers too. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist or GP for advice.

    Physical therapies

    A physiotherapist (a health professional who specialises in movement and mobility) or another doctor with specialist training may offer you the following treatments.

    • An exercise programme, involving physical activity, movement, muscle strengthening, controlling your posture and stretching. 
    • Acupuncture, which uses fine needles placed in the skin to help relieve pain. 
    • ‘Hands on’ (manual) therapy, such as massage or spine manipulation.

    You may wish to try complementary therapies such as chiropractic treatment or osteopathy. These treatments aren't usually funded by the NHS, but some people find therapies such as chiropractic treatment helpful. Be sure to do your research before trying anything new.

    Psychological therapy

    As well as being physically active, having a positive outlook can also help. Some scientific studies show that pain can be linked to your emotions and thoughts. If you find your back pain is causing you to feel upset or worried, psychological therapies can help you cope with your emotions. Your doctor may suggest a talking therapy called cognitive behavioural therapy (CBT). This can help you to understand your thoughts, feelings and actions, and change the way you react to and cope with pain. You may also find relaxation techniques useful. These may include simple techniques such as breathing exercises.

    For more information on how psychology and physical therapy can be combined, see our article on psychology and back pain.

    Your treatment may last for up to 12 weeks. After your treatment has finished, you’ll see your doctor to have a chat about how things are going. After your treatment is finished and your pain has resolved, you won’t need to see your GP. You only need to see your GP if you have any ongoing concerns or your treatment hasn't helped to improve your pain. If your pain still hasn't improved, your GP will refer you to a specialist back clinic where your pain can be looked into further.

    Surgery

    Surgery is very rarely suitable for people with lower back pain. You’ll usually only be offered surgery for back pain if no other treatments have helped, a specific cause has been identified, and you’re finding the pain difficult to cope with. As with every procedure, there are some risks associated with back surgery. We have not included the chances of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

  • Physiotherapy

    At our Bupa Health Centres, we offer self-pay health services for a wide range of conditions, including physiotherapy.

  • Causes Causes of back pain

    Non-specific back pain

    There are a number of factors that can increase your risk of developing lower back pain, or make it worse once you have it. These include:

    • staying in the same position for long periods of time
    • bending, twisting and lifting (especially heavy objects)
    • being obese
    • vibration of the whole body (e.g. from driving heavy machinery)
    • an accident or injury, such as a car accident or fall

    Specific back pain

    Sometimes, damage to parts of your spine can be the cause of back pain. Examples of this are:

    • a slipped (herniated) disc – when a disc bulges and puts pressure on your spinal nerves
    • a fracture – a crack or break in one of the bones in your back
    • cauda equina, when nerves in your back become squashed

    Back pain can also be caused by a serious condition such as an infection or cancer, but this is very uncommon.

  • Prevention Prevention of back pain

    If you look after your back, you can greatly reduce your risk of getting back pain. The following things can help:

    • Exercise regularly. Walking, swimming or using an exercise bike are all things you can do even if your back feels a bit sore. Take time to build up your fitness if you’re trying new activities.
    • When lifting objects, bend your knees and hips, not your back.
    • Keep a good posture. If you work at a desk/computer, make sure your chair, desk and computer screen are set up correctly. You may be able to have your work station assessed by your employer.
    • Don’t stay in the same position for long periods of time.
  • Emotional effects Emotional effects of back pain

    Back pain affects everyone differently. In some situations, back pain can be become chronic, which means it lasts a long time (more than 12 weeks). Some emotional factors may increase the risk of your back pain becoming chronic. These include:

    • certain behaviours, such as believing that physical activity isn't helpful or having lots of bed rest
    • emotional problems, such as feeling depressed or anxious
    • a lack of social support, for example from your family
    • not wanting to take part or play an active role in your treatment

    Although you may think your pain is a warning sign to stop you doing certain activities, it’s important that you keep active to overcome it. If you have any questions about keeping active, contact your physiotherapist or doctor. A physiotherapist is a healthcare professional who specialises in maintaining and improving movement and mobility.

  • Exercises for lower back pain Exercises for lower back pain

    Lower back exercises

    Click to open full-size image (83.3 KB)

  • FAQs FAQs

    Do special mattresses, back supports or insoles help back pain?

    Answer

    There are a number of support aids available for people with back problems, including back supports and insoles. For many of these, there isn’t much proof that they help your back pain.

    Explanation

    The following are examples of different support aids available.

    • Supportive mattresses. Ideally, your mattress should provide support for you, so that your spine is not bent when you sleep. A small amount of proof suggests that if you have long term lower back pain, swapping to a new medium or firm mattress may be helpful. Medium to firm mattresses may help to reduce your pain, letting you get on with your usual daily activities.
    • Back supports, corsets and braces. Some people use these when driving or sitting for long periods of time. These might not provide any benefit to people with long term lower back pain though.
    • Insoles. These are placed in your shoes to help with your posture. There isn’t much proof that insoles will prevent or treat back pain.

    Talk to your physiotherapist before trying support products to treat your back pain. A physiotherapist is a healthcare professional who specialises in maintaining and improving movement and mobility.

    I do a lot of lifting and carrying at work. How can I prevent back injury?

    Answer

    By using the right techniques, you can reduce the chance you’ll injure your back from lifting and carrying. Always try to think and plan things through before you start moving heavy objects.

    Explanation

    A lot of injures are caused by lifting and carrying. You can injure your back by stooping, twisting and reaching, picking up and carrying difficult loads, and doing repetitive tasks.

    As a general rule, it's best to lift with care and not to lift more than you can easily handle. Think before lifting anything and use mechanical handling equipment when you can.

    When you do need to lift or carry objects, it may be helpful to do the things below.

    • Bend slightly from your back, hips and knees to lift.
    • Turn using your whole body − don't twist or lean your back.
    • Carry objects close to your body.
    • Make a stable base for lifting by placing your feet apart and one slightly forward of the other.
    • Don’t carry too many things at once or more than you can manage.
    • Ask someone to help when you need it.

    Your employer has a duty to reduce the need for manual handling as much as possible in the workplace and to minimise your risks..

    Why is it important to keep active when you have back pain?

    Answer

    Keeping active can help you to recover from back pain faster. Regular exercise can also help prevent you getting back pain in the first place.

    Explanation

    Staying in bed can cause your joints to stiffen and your muscles to lose strength. This can mean it will take longer for you to recover. So, it’s best to get back to being active as soon as possible if you have non-specific lower back pain.

    There are many physical activities you can take part in to keep your back healthy. Exercise can help if you have back pain that lasts for longer than six to 12 weeks. For example, you could try walking, swimming, or using an exercise bike. Speak to your GP or physiotherapist before starting a new training programme, especially if you haven’t done any regular physical activity for some time. A physiotherapist is a healthcare professional who specialises in maintaining and improving movement and mobility.

    You don’t need to wait until the pain has completely gone before going back to work. You and your employer may be able to make changes to your work to allow you to return gradually, over time.

  • Resources Resources

    Further information

    Sources

    • The Map of Medicine and the British Pain Society. Low back and radicular pain. England View. London: Map of Medicine; November 2012
    • Low back pain: early management of persistent non-specific low back pain. National Institute for Health and Care Excellence (NICE), 2009. www.nice.org.uk
    • Low back pain: early management of persistent non-specific low back pain: patient information. National Institute for Health and Care Excellence (NICE), 2009. www.nice.org.uk
    • Strandring, S. Gray’s anatomy: The anatomical basis of clinical practice, expert consult (online version). 40th ed. Spain: Elsevier; 2008: 1281−82, 1289−92, 1304−25, 1336−59
    • Rehabilitative measures for treatment of pain and inflammation. The Merck Manuals. www.merckmanuals.com, published September 2013
    • Roland M, Waddell G, Moffett JK. The back book (online version). www.thestationeryoffice.com, accessed April 2015
    • Psychotherapy. Oxford handbook of psychiatry (online). Oxford Medicine Online. www.oxfordmedicine.com, published March 2013 
    • Herniated nucleus pulposus: herniation. Medscape. www.emedicine.medscape.com, published April 2014
    • Mechanical low back pain. Medscape. www.emedicine.medscape.com, updated August 2014
    • Are you sitting comfortably? UNISON. www.unison.org.uk, accessed April 2015
    • Manual handling at work: a brief guide. Health and Safety Executive. www.hse.gov.uk, published 2012
    • van Duijvenbode I, Jellema P, van Poppel M, et al. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. doi: 10.1002/14651858.CD001823.pub3
    • Chuter V, Spink M, Searle A, et al. The effectiveness of shoe insoles for the prevention and treatment of low back pain: a systematic review and meta-analysis of randomised controlled trials. BMC Musculoskelet Disord 2014; 15:140. doi:10.1186/1471-2474-15-140
    • Mind your posture: buying a bed. British Chiropractic Association. www.chiropractic-uk.co.uk, published 2013
    • Kovacs FM, Abraira, V, Peña A, et al. Effect of firmness of mattress on chronic non-specific low-back pain: randomised, double-blind, controlled, multicentre trial. The Lancet 2003; 362:1599–1604. doi: 10.1016/S0140-6736(03)14792-7
    • Low back pain and sciatica. Patient Plus. www.patient.co.uk/patientplus.asp, reviewed 4 May 2013
    • Back pain – low. Without radiculopathy. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published June 2014
    • Linton SJ, Shaw, WS. Impact of psychological factors in the experience of pain. Phys Ther 2011; 91:700–11. doi:10.2522/ptj.20100330
    • How to manage stress. MIND. www.mind.org.uk, accessed 7 April 2015
    • Acute low back pain. BMJ Best practice. www.bestpractice.bmj.com, published 9 May 2011
    • European guidelines for the prevention of back pain. COST B13 working group on guidelines for prevention in low back pain. www.backpaineurope.org, 2004
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