Lower back pain
Your health expert: Dr Sundeept Bhalara, Consultant Rheumatologist and Physician
Content editor review by Pippa Coulter, April 2022
Next review due April 2022
Lower back pain is very common. Almost 2 in every 3 people have pain in their lower back at some point. The cause isn’t normally serious and you can often manage the pain yourself. But for some people, getting advice from a physiotherapist or doctor is important.
About lower back pain
Lower back pain is pain in the area of your back from the bottom of your ribs to the top of your legs. It can come from any of the many structures that make up your back. These include 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. The lower section of your spine is called the lumbar spine. Below the vertebrae, at the bottom of your spine, are bones called your sacrum and coccyx. You may hear lower back pain referred to as lumbosacral pain.
Discs of cartilage sit between each vertebra, acting as shock absorbers and allowing your spine to bend. Some lower back pain originates from these discs. Your spinal cord threads through the vertebrae, carrying nerve signals between your brain and the rest of your body. If nerves at the base of your spine become compressed or inflamed, it can cause sciatica. Sciatica is a type of pain that starts in your back or buttocks and spreads down your leg.
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 magnetic resonance imaging (MRI) scans aren’t helpful for most people.
Causes of lower back pain
Lower back pain can be classed in two different ways: specific back pain and non-specific back pain.
Specific back pain
Sometimes, there may be a specific cause of your back pain. These can include the following.
- A slipped (herniated) disc. This means one of the discs between your vertebrae bulges out of shape and presses on the spinal nerves surrounding it. It’s a common cause of sciatica.
- A fracture – a crack or break in one of your vertebrae. This can happen after trauma to your spine, or if you have osteoporosis (a condition that weakens your bones).
- Facet joint pain. This is pain in one of the joints that link the bones in your spine together.
- Inflammatory lower back pain. This can be caused by a condition such as ankylosing spondylitis, which causes inflammation in your spinal joints and ligaments.
Sometimes, you may feel problems affecting other organs in your body, such as your kidneys, pancreas or bowel, as back pain. And occasionally, a more serious condition, such as an infection or cancer, can cause pain in your lower back. These things are much less common causes of lower back pain.
Non-specific back pain
This means that no particular cause can be found for your back pain. It’s by far the most common type of back pain. It’s often a result of a simple strain of the muscles, tendons or ligaments around your back. But it can be hard to tell for sure.
It might not always be possible to say exactly what’s caused your back pain. But there are certain things that can increase your risk. These can include:
- lifting heavy or awkward objects
- being obese
- being inactive
- having a demanding job, or being stressed due to work
- standing for a long time
- being depressed
Symptoms of lower back pain
The symptoms of lower 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 clear reason. Some people get a dull pain in their back, while others describe it as more of a tearing or burning pain. You may find certain things make the pain worse, and other things help to relieve it. The pain can range from mild to severe.
If you have sciatica, pain can spread from your back or buttock down your leg, sometimes as far as your foot or toes.
Seeking help for lower back pain
You may not need to seek help from a health professional for lower back pain. Most people find their lower back pain improves by itself within a few weeks. But if there's no improvement after two to three weeks or the pain is getting worse, seek advice from a GP or physiotherapist. It's also worth seeking help if your back pain is stopping you from doing normal activities, or if it goes on longer than six weeks.
Physiotherapists are often best placed to help with back pain. In some areas, you may be able to self-refer to a physiotherapist on the NHS, whereas in others you need a referral through your GP. You can also choose to pay for private physiotherapy.
There are some circumstances when you should always see a doctor straightaway for back pain though. These include if:
- you have numbness or tingling around your bottom or genitals
- you can’t control your bladder or bowels (when you pee or poo)
- you’re unsteady when you walk, or your legs or feet feel weak, you have sudden, severe lower back pain
- you’ve been in a major accident, such as a traffic collision or fall
- you have osteoporosis
- there’s a visible deformity in your back
- the pain continues when you’re lying down or overnight, disturbing your sleep
- you have a history of cancer or have had a recent bacterial infection
- you also have a fever, chills or unexplained weight loss
These can be signs of more serious problems.
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. They’ll want to rule out whether there’s any underlying problem that could be causing your pain.
Your physiotherapist or GP will ask you lots of questions about your back pain. These may include when it started, how bad it is and if there’s anything that makes it better or worse. They may press against your back to see if there’s any tenderness and check for any deformities. They might ask you to move around too, to see if you have problems bending or extending your back.
Usually, further tests won’t help. But if your symptoms indicate an underlying problem, your GP may recommend tests including:
- an X-ray
- an MRI scan
- blood tests
They may also refer you to a specialist for further investigations.
Self-help for lower back pain
There are lots of things you can do yourself to help relieve your back pain and recover faster. The most important things are to keep active and to try to stay positive about managing your pain.
Keeping active
You might feel as though you shouldn’t do too much if you’ve got back pain, or that exercise might make it worse. But actually, keeping active will help you to recover faster from back pain. Too much rest can stiffen your joints and weaken your muscles, which can increase your risk of long-term problems. Keeping active will keep the muscles around your spine strong and your back mobile. Regular exercise can release chemicals called endorphins, which can make you feel better too.
You don’t need to wait until you’re pain-free to get moving. You might get a bit of pain at first when you’re moving around, but that doesn’t mean it’s harmful. If you start gently and can manage to put up with any pain, you should find it starts to get better. It doesn’t really matter what you do, as long as you’re being active. It’s best just to choose an exercise that you enjoy. Good examples include walking, swimming and yoga. If you develop severe pain (that you can’t cope with) when you exercise, you should stop and seek advice from a doctor. You should always see a doctor if you have symptoms, such as numbness or weakness in your legs.
Pain relief
If you need pain relief, take over-the-counter non-steroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen. Paracetamol on its own has not been found to be helpful for lower back pain. You may find that it helps you to keep active if you take painkillers before doing any exercise. You should only take NSAIDs for a short period of time. Make sure you follow the guidance on the patient information leaflet.
You could also try applying heat or cold treatments to your back to relieve pain. Make sure you protect your skin properly if you do.
Staying positive
Recovery from low back pain is strongly linked to how you feel emotionally, and how you cope with the pain. Some emotional factors can increase the risk of your back pain becoming chronic (long-term). These include:
- worrying that physical activity and pain is causing you harm
- having emotional problems, such as feeling depressed, anxious or stressed
- a lack of social support from family and friends
- feeling unmotivated to try treatments for your pain
Having lower back pain can be frustrating, but trying to stay positive in how you manage it can help you to recover faster. Try to keep up with your normal routines and social activities as much as possible. Getting out and spending time with friends or doing an activity can really help.
Stress can make back pain worse. If this is a factor for you, think about what you can do to manage your stress. Make sure you’re getting enough sleep, as this can make a difference too.
Treatment options for lower back pain
If you see a physiotherapist or GP for lower back pain, they will probably encourage you to try the self-help measures outlined above first. They can also advise you on what exercises you can do to help your back, or may refer you to a group exercise programme. But if your pain doesn’t improve, they may be able to recommend other options you can try. They can also refer you to a specialist if necessary.
Medicines
If over-the-counter NSAIDs don’t help, your GP may offer you different medicines for pain relief. These may include a medicine called codeine, either on its own or with paracetamol. You should usually only take this medicine for a very short time, as you may become dependent on it. Your GP may also offer you a short course of a muscle relaxant.
Sometimes, your doctor may offer you antidepressant medicines for lower back pain because they can work as painkillers for this type of pain. They can also help to improve sleep, which can help with your pain. If your GP offers you antidepressants, they’ll talk to you about how these medicines might be able to help 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 may refer you for physiotherapy for lower back pain, or you may be able to self-refer (see the When to seek help section above). A physiotherapist can help in lots of ways with lower back pain. These may include:
- advising on lower back exercises to improve your movement, muscle strength, posture and flexibility
- helping with pain management, using various therapies, such as ice, heat and ultrasound
- providing ‘hands on’ (manual) therapy, such as massage or spine manipulation
You may also wish to try other options such as chiropractic treatment or osteopathy for back pain. These treatments aren’t usually available on the NHS. Be sure to do your research before trying anything new and find a registered practitioner.
Psychological therapy
It can be difficult to stay positive when you’ve had back pain for a long time. But staying positive as well as keeping active can help you recover and avoid back pain becoming long term.
If negative feelings are hampering your recovery, you may benefit from some psychological support for lower back pain. Your doctor may suggest a talking therapy called cognitive behavioural therapy (CBT) alongside exercise. This can help you to understand 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
If you have severe sciatica, your doctor may suggest an epidural injection. Epidural injections contain a local anaesthetic and steroid to relieve pain and reduce inflammation. They’re only recommended for sciatica and not non-specific lower back pain.
If your back pain is chronic (long-term) and other treatments haven’t helped, your doctor may suggest a procedure called radiofrequency denervation. It’s only suitable for certain types of back pain. Your doctor will refer you to a specialist to assess whether it would help you.
Surgery
Back surgery is very rarely suitable for people with lower back pain. Your surgeon will usually only recommend it for certain types of back pain and if no other treatments have helped. As with every procedure, there are risks associated with back surgery. Your doctor will explain how these apply to you.
Prevention of lower back pain
Looking after your back can help to reduce your risk of getting back pain. It can help to do the following.
- Get plenty of exercise. Keeping active with regular exercise can help to prevent back pain coming back, or reduce your risk of getting it in the first place.
- Take care with lifting and carrying heavy items. Don’t lift or carry more than you can manage, and make sure you’re using the right technique. This means slightly bending your back, knees and hips when lifting, rather than stooping from your back.
- Keep a good posture. If you work at a desk, make sure your chair, desk and computer screen are set up correctly. Your employer should be able to assess your workstation.
- Move regularly – don’t sit in the same position for long periods of time.
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)
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Lower back pain is often caused by straining muscles, tendons or ligaments in your back. But it’s often not possible to say for sure what’s caused it. Sometimes there is a specific cause, such as a slipped disc, fracture or inflammation. See our section on Causes of lower back pain for more information.
Physiotherapy for lower back pain
Chiropractic for lower back pain
Chiropractic is a healthcare profession focusing on diagnosing and treating disorders that affect your bones, muscles and joints.
Osteopathy for lower back pain
Osteopathy is a system of diagnosing and treating medical conditions that focuses on the structure and functioning of your whole body.
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