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Lower back pain


Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and Physician
Next review due November 2022

Back pain is very common. Almost two out of three of us have lower back pain at some time in our lives. The cause isn’t normally serious and most of the time the pain improves within four to six weeks. But for some people, it can continue for months or even years.

You can often manage lower back pain yourself. But with some symptoms, you may need to see a physiotherapist or your GP.

Image showing a woman looking out of the window

About 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 stacked on top of one another. Below the vertebrae, at the bottom of your spine, are the bones in your sacrum and coccyx. Between the vertebrae, discs act as shock absorbers and allow your spine to bend. Your spinal cord threads through the vertebrae, carrying nerve signals between your brain and the rest of your body. The spinal cord runs as far as your lower back, then continues as a bunch of nerves. This is called the ‘cauda equina’, Latin for ‘horse’s tail’, which it’s thought to resemble. It’s usually difficult for doctors to say exactly what’s causing back pain. This is because there are so many different parts to your back and tissues that surround it. Even tests such as X-rays and MRI scans don’t help for most people.


An image showing the different parts of the spine

Symptoms of lower back pain

The symptoms of back pain can vary from person to person. It may come on suddenly, perhaps after you’ve lifted something heavy or moved in a way that’s hurt your back. Or it may come on gradually over time or for no apparent reason. The pain can be mild or severe. Some people also have pain in the buttock or down one leg, sometimes as far as the calf or the toes. This is called sciatica.

Most people with back pain symptoms have what’s called non-specific back pain. This means there’s no clear or specific cause (such as an underlying medical condition). It means that often tests can’t really help because no specific damage to the spine or muscles around it would show up on them. This might sound unsettling, but it means that there’s no serious cause for the pain.

When to get medical help and advice

Nine out of 10 people find their back pain improves within four to six weeks. You may find that you feel better sooner than this, in a few weeks. But contact your GP if the pain is severe, getting worse over time or isn’t improving after four to six weeks. Also, contact your GP urgently if you feel unwell or have a high temperature. And if you have had cancer or osteoporosis, your GP may want to check that there isn’t a more serious cause.

Seek medical attention right away if you:

  • have numbness or tingling around your bottom or genitals
  • can’t control when you pee or can’t go at all
  • lose control of your bowels
  • are unsteady when you walk, your legs feel weak or your foot is dropping or dragging

These may be signs that the nerves at the bottom of your spine are being squashed. This is called cauda equina syndrome and needs urgent treatment.

Causes of lower back pain

Non-specific back pain

This is by far the most common type of back pain. Your doctor is unlikely to be able to tell you exactly what’s causing the pain, but it’s not usually due to a serious problem. It’s mostly caused by a simple strain of the muscles, tendons or ligaments around your back, but no one knows for sure.

A specific event or movement may have started your back pain. Perhaps you were straining, twisting or lifting something heavy. Or it may have come on gradually. In some people it’s linked to repetitive tasks at work or sitting in one position for a long time. You are also more likely to have lower back pain if you are overweight. Back pain may happen as a result of the normal ‘wear and tear’ on the bones of your spine as you get older. Poor posture can put stress on the muscles around your spine. Back pain may be caused by a combination of several factors, including emotional ones.

Specific back pain

Sometimes, back pain is caused by damage to parts of your spine, including:

  • a slipped (herniated) disc – a disc bulges and presses on your spinal nerves
  • a fracture – a crack or break in one of the bones in your back, perhaps due to osteoporosis
  • inflammatory lower back pain, caused by a condition such as ankylosing spondylitis, when your immune system causes inflammation in the spinal joints and ligaments

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

Diagnosis of lower 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. You may want to go straight to see a physiotherapist if a self-refer service is available in your area. If it’s not, you can see your GP who can advise and refer you.

Usually further tests won’t help. But if you have other symptoms, your GP may recommend tests including:

  • 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

Treatment options for lower back pain

If your GP thinks there may be a specific cause for your back pain, they may refer you to a specialist to treat that specific condition. Usually, lower back pain gets better in a few days or weeks and often you can manage it yourself at home. For some advice about when to seek medical help, see our section on Symptoms.

Your physiotherapist or GP will probably encourage you to try self-help measures. They can also advise you on what exercises you can do to help your back. If the pain doesn’t improve, then your GP can help with other options or may refer you to a specialist.

Self-help for lower back pain

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.
  • Take care when lifting – avoid bending or twisting your back.
  • Doctors used to advise bed rest, but now we know this can make back pain worse. Try to avoid sitting for long periods.
  • If you need pain relief, take over-the-counter non-steroidal anti-inflammatory medicines (NSAIDs) – for example, ibuprofen. You should only take these medicines for a short time, not for long-term back pain.
  • You may want to try applying heat or cold treatments to your back. Don’t put ice directly on your skin.
  • If you sleep on your side, you may find it helps to sleep with a small cushion between your knees. If you sleep on your back, try some firm pillows under your knees.

Medicines

Your GP may recommend that you take over-the-counter non-steroidal anti-inflammatory medicines (NSAIDs) – for example, ibuprofen. These can relieve back pain and help you to stay active. Paracetamol alone doesn’t work quite so well for back pain.

If over-the-counter NSAIDs don’t help, your GP may offer you a higher dose of an NSAID (and also a medicine to protect your stomach). Or they may recommend a stronger medicine called an opioid. You should usually only take this medicine for a very short time. You may become dependent on it if you take it for a long time. Your GP may also offer you a short course of a muscle relaxant.

Antidepressant medicines are sometimes offered for lower back pain because they can work as painkillers for this condition. The latest expert guidelines don’t recommend using these medicines for lower back pain, though they may be offered for sciatica, a particular type of back pain. If your GP offers you antidepressants, they’ll explain to you why they think these medicines may be right for you.

Always read the patient information that comes with your medicine carefully. If you have any questions about your medicines or how to take them, ask your pharmacist.

Physical therapies

Your GP or specialist may recommend physiotherapy for lower back pain. This might include:

  • exercises involving physical activity, movement, muscle strengthening, controlling posture and stretching
  • ‘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 they can be helpful. Be sure to do your research before trying anything new.

Psychological therapy

It can be difficult to be optimistic when you’ve had back pain for a long time. But staying positive as well as staying active can help you recover and avoid it becoming long term.

If you find your back pain is causing you to feel upset or worried, psychological support for lower back pain can help you cope. Your doctor may suggest a talking therapy called cognitive behavioural therapy (CBT) alongside exercise. 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, such as breathing exercises useful.

Injections and other procedures

Depending on the source of your pain – for example, if you have sciatica – epidural injections may be helpful. Injections in the spine aren’t recommended for non-specific lower back pain though. If your back pain is chronic (long-term) and other treatments haven’t helped, there is a procedure called radiofrequency denervation that uses a needle to treat the pain. This is only suitable for some people and you may need to have other tests beforehand. Speak to your specialist for advice.

Surgery

This is very rarely suitable for people with lower back pain. Your surgeon will usually only offer surgery if no other treatments have helped and there is a specific cause. As with every procedure, there are risks associated with back surgery. Ask your doctor to explain how these apply to you.

You may have heard about other aids for treating lower back pain though these aren’t recommended treatments. To find out more, see our FAQ: Do special back support or insoles help back pain?

Prevention of lower back pain

If you know how to look after your back, you can greatly reduce your risk of getting back pain. It can help to do the following.

  • 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.
  • Use your legs to lift objects by bending your knees and hips, not your back.
  • Keep a good posture – if you work at a desk, make sure your chair, desk and computer screen are set up correctly. It will help if your employer assesses your work station.
  • Move regularly – don’t sit in the same position for long periods of time.

Emotional effects of lower back pain

Back pain affects everyone differently. In some situations, back pain can be become chronic, which means it lasts a long time. Some emotional factors may increase the risk of back pain becoming chronic, including:

  • believing that physical activity isn't helpful or having lots of bed rest
  • emotional problems such as feeling depressed, anxious or stressed
  • a lack of social support from family and friends
  • not wanting to 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, talk to your physiotherapist or doctor. They can reassure you that keeping mobile and being positive about managing your back pain are the keys to helping you recover. Exercise will also help to prevent back pain in future.

Medicines checklist

Our handy medicines checklist helps you see what to check for before taking a medicine.

Bupa's medicines checklist PDF opens in a new window (0.8MB)

Bupa medicines checklist

Frequently asked questions

  • You may come across a number of support aids available for people with back problems. These include back supports and insoles. Some people use back supports, corsets and braces when driving or sitting for long periods of time. You put insoles in your shoes, to improve your posture.

    There’s no evidence that back supports, braces or insoles help treat or prevent back pain so doctors don’t generally recommend them. If you wish to try them, talk to your physiotherapist first to ask if they are likely to help.

  • With the right techniques, you can reduce the chance of injuring your back when lifting and carrying. Your employer may provide training, and should take steps to make sure you’re safe. Always plan things through before moving heavy objects.

    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:

    • bend slightly from your back, hips and knees to lift
    • turn using your whole body – don’t twist or bend your back
    • carry objects close to your body
    • make a stable base for lifting - place your feet apart with one slightly forward of the other
    • avoid carrying more than you can manage
    • ask for 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.
  • Keeping active can help you to recover from back pain faster. Regular exercise may also help prevent you getting back pain in the first place.

    Staying in bed can stiffen joints and weaken muscles. This can mean it will take longer for you to recover and increase your chance of long-term problems. 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. Try walking, swimming or using an exercise bike. Start slowly and build up gradually if you haven’t done any regular physical activity for some time. Your physiotherapist will be able to advise you on the best exercises for your condition.

    If you work, try to stay at work if you can or get back as soon as possible. You and your employer may be able to make changes to your work to allow you to do this.



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Related information

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  • Reviewed by Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, November 2019
    Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and Physician
    Next review due November 2022

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