Lower back pain

Lower back pain is pain and stiffness in the area of your back from the bottom of your ribs to the top of your legs. The cause isn’t normally serious and you can often manage lower back pain yourself. But for some people, it’s important to get advice from a physiotherapist or doctor.

About lower back pain

Lower back pain 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 33 segments of bone called vertebrae that are 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 the sacrum and coccyx. You may hear lower back pain referred to as lumbosacral pain.

Discs of cartilage sit between each vertebra, which act as shock absorbers and allow your spine to bend. Lower back pain can originate from these discs. Your spinal cord threads through the vertebrae, and carries nerve signals between your brain and the rest of your body. If nerves at the base of your spine become compressed (a pinched nerve in your lower back) or inflamed, it can cause sciatica. Sciatica is a type of pain that starts in your back or bottom (buttocks) and spreads down your leg.

It’s difficult for doctors to find the cause of back pain 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.

Lower back pain is very common – around 4 in every 5 people have pain in their lower back at some point in their life.

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

This is when you have a specific cause of your back pain, which 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 surrounding spinal nerves. It’s a common cause of sciatica.
• A crack or break (fracture) in one of your vertebrae. This can happen after trauma to your spine (such as an accident), 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 that affect 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 are much less common causes of lower back pain.

Non-specific back pain

This means no particular cause can be found for your back pain. It’s by far the most common type of back pain and is often a strain of the muscles, tendons or ligaments around your back.

While it’s not always possible to say exactly what the cause of your back pain is, certain things can increase your risk. These include if you:

• lifting heavy or awkward objects
• are obese
• are inactive
• having a demanding job, or are stressed due to work
• stand for a long time
• are depressed
• smoke

Symptoms of lower back pain

Lower back pain symptoms can vary from person to person. Lower back pain may come on suddenly, after you lift something heavy or move in a way that hurts your back, for example. 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 lower back pain.

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 might not need to seek help from a health professional to get lower back pain relief. Most people find their lower back pain improves by itself within a few weeks or so. But if there's no improvement after six weeks, or the pain is getting worse, seek advice from a GP, physiotherapist, or osteopath. It's also worth calling them if back pain stops you from doing your normal activities.

Physiotherapists can 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.

Sometimes you should see a doctor straightaway for lower back pain, for example if:

• you’ve been in a major accident, such as a traffic accident or fall
• you have numbness or tingling around your bottom or genitals
• you have sciatica pain in both legs
• you can’t control your bladder or bowels (when you pee or poo), or can’t pee
• you’re unsteady when you walk, or your legs or feet feel weak
• you have sudden, severe lower back pain
• you have osteoporosis
• there’s something that you can see is wrong with your back – you have a visible deformity
• the pain continues when you lie down or overnight, which disturbs 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 diagnose lower back pain from your symptoms and by examining you. They’ll want to rule out any underlying problem that could be causing your pain.

Your physiotherapist or GP will ask you lots of questions about your lower 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 to see how it looks. They might ask you to move around too, to see if you have any problems when you bend or extend your back.

Further tests won’t usually help. But if your symptoms indicate an underlying problem, your GP may recommend tests, which may include:

• an X-ray
• an MRI scan
• blood tests

They may also refer you to a specialist for further investigations.

Prevention of lower back pain

If you look after your back, it can help to reduce your risk of getting back pain.

• Get plenty of exercise. If you keep active and do regular exercise, it can help to prevent back pain coming back, or reduce your risk of getting it at all.
• Take care when you lift and carry heavy items. Don’t lift or carry more than you can manage, and use 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 can 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)