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Lower back pain


Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and Physician
Next review due April 2020

Back pain is very common, with around one in three of us getting it every year. It’s usually the lower back that’s affected. Lower back pain doesn’t normally have a serious cause and in most cases the pain will improve within four to six weeks. However, for some back pain can continue for many months or even years.

In most cases you can manage lower back yourself by keeping mobile and perhaps taking over-the-counter painkillers. See our self-help section below for more information. Back pain usually gets better on its own, but please see our symptoms section below for advice on when to contact your GP.

Lady with back pain

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 these are 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 vertebrae. It carries nerve signals between your brain and the rest of your body. The spinal cord ends in your lower back, and 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. See our causes section below for more information.


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. Back pain may come on suddenly, perhaps after you’ve lifted something heavy, or it may come on gradually over time. The pain may feel really bad, or may be milder. Some people with back pain also have pain down one leg, or into the buttock or groin. This is sometimes called sciatica.

You’ll probably find that the pain is worse when you move, and better when you lie down. This may make it hard for you to carry out your usual day-to-day activities, and you may find it difficult to sleep well. Your back pain may come and go, and you may find that you have good days and some less good days.

When symptoms of back pain don’t have a specific cause such as an underlying medical condition or injury, they are known as ‘non-specific back pain’.

Most people find their back pain symptoms improve within four to six weeks. Contact your GP if the pain is severe or gets worse over time, or if it doesn’t start to improve after a few weeks. It’s also best to contact your GP if you feel unwell, have a high temperature or have had cancer or osteoporosis in the past. Your GP may want to check that your back pain doesn’t have a more serious cause.

You should seek medical attention right away if you:

  • have numbness or tingling around your bottom or genitals
  • have sudden difficulty passing urine
  • 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 pressed on. This is called cauda equina syndrome and needs urgent treatment.

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. 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.

Self-help for lower back pain

Usually, lower back pain gets better in a few days or weeks and often you don’t need to see your GP. See our section on symptoms above for some advice about when to seek medical 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. However, remember to take care when lifting or twisting your back. Doctors used to advise bed rest, but now we know it can make back pain worse. Try to avoid sitting for long periods.
  • Do exercises and stretches – see our section on exercises for lower back pain below.
  • Take over-the-counter non-steroidal anti-inflammatory medicines (NSAIDs, for example ibuprofen) if you need pain relief. Paracetamol alone probably doesn’t work well for back pain. You should only take these medicines for a short time, not for long-term back pain. See our section on treatment below for more information about painkillers.
  • You may want to try applying heat or cold treatments to your back. Remember not to apply ice directly to your skin.
  • You may find it helps to sleep with a small cushion between your knees, if you sleep on your side. Or with some firm pillows under your knees, if sleeping on your back.

For more information click on the ‘Self-help tips for back pain’ infographic.

An image showing self-help tips for back pain

Treatment options for lower back pain

Your GP will probably encourage you to try self-help measures – see our section on self-help above. They may give you advice about symptoms to watch out for and how long your symptoms are likely to last. You may be advised to come back if your pain hasn’t settled after an agreed amount of time, or if you develop any other symptoms.

Depending on your symptoms and how they’re affecting you, your GP may also offer you medicines or refer you for other types of treatment. For example, your GP may refer you to a physiotherapist. If your GP suspects your pain has a specific cause, they may refer you to see a specialist.

Some treatments are designed to help you manage your pain rather than to cure it completely.

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 probably doesn’t work well for back pain.

If over-the-counter NSAIDs don’t help, your GP may offer you a higher dose of an NSAID. Or they may recommend a stronger medicine called an opioid. You may be advised to take this medicine only for a very short time. This is because you may become dependent on them if you take them for a long time. Your GP may also offer you a short course of a muscle relaxing medicine.

Antidepressant medicines are sometimes offered for low back pain, in the belief that they can work as painkillers for this condition. The latest expert guidelines do not recommend using these medicines for low back pain. If your GP offers you antidepressants, they’ll explain to you why they think these may work in your particular circumstances.

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

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.
  • ‘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

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 therapies can help you cope with your emotions. Your doctor may suggest a talking therapy called cognitive behavioural therapy (CBT) alongside your exercise programme. 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.

Surgery

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

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 probably often caused by a simple strain of the muscles, tendons or ligaments around your back, but no one knows for sure.

There may be a specific event or movement that started your back pain. Perhaps you were straining, twisting or lifting something heavy. Or back pain 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. Back pain may happen as a result of the normal ‘wear and tear’ on the bones of your spine as you get older. Or poor posture may have put stress on the muscles around your spine. It may be caused by a combination of several factors, including emotional.

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, perhaps due to osteoporosis
  • inflammatory low back pain – caused by a condition such as ankylosing spondylitis. In this condition 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.

Prevention of lower 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 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 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, 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 yourself recover.

Exercises for lower back pain

If you have low back pain, it’s important to stay physically active. Not only is exercise great for your overall health, it may help to reduce back pain and prevent it coming back.

Click on the image to open our infographic of exercises for low back pain (PDF 83.3KB).

Exercises for low back pain by Bupa UK 

Frequently asked questions

  • You may come across a number of support aids available for people with back problems, including back supports and insoles. Some people use back supports, corsets and braces when driving or sitting for long periods of time. Insoles are designed to be placed in your shoes to help with your posture.

    Medical experts don’t think that these really help back pain so they don’t generally recommend them. If you wish to try them it’s worth talking to your physiotherapist first to ask whether they may help in your particular circumstances.

    Supports and braces may help protect against certain activities that may otherwise strain the back. However, they should not regularly be worn for long periods as they may weaken your back muscles.

  • By using the right techniques, you can reduce the chance you’ll injure your back from lifting and carrying. Your employer may provide training for you, and should take steps to make sure you’re safe. Always try to think and plan things through before you start 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 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.

  • 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 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. For example, you could 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 what exercises might be best in your particular circumstances.

    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.

    Remember, being inactive and resting in bed increase your chance of long term problems with back pain.


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    • Personal communication, Dr Sundeept Bhalara, Consultant Rheumatologist and Physician, 7 May 2017
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, April 2017
    Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and Physician
    Next review due April 2020



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