Back pain

The pain usually gets better by itself within a few weeks. However, once you’ve had a back problem, you’re more likely to have it again at some point. It’s best to stay active and use over-the-counter painkillers if you need to. If your pain is chronic (long-term) or severe, then you may need treatment.

In most cases, there’s no obvious reason for back pain (non-specific back pain) and it's very rarely anything serious. 

It’s often due to a sprain or strain to a muscle, tendon or ligament, which can be caused by: 

• A sudden awkward movement eg twisting awkwardly
• Lifting something too heavy for you 
• Poor posture or being in poor condition physically — this can put constant strain on your back, which may cause painful muscle spasms

Other causes of back pain include the following medical conditions:

• A slipped disc — also called a herniated or prolapsed disc, where one of the soft cushions (intervertebral discs) that sit between your spinal bones (vertebrae) bulges out and pushes against a nerve; however, you may have a slipped disc without back pain and only realise it when you incidentally have a spinal X-ray for another reason
• Osteoporosis — a condition that causes your bones to become weaker (brittle) and more likely to fracture; this can cause painful spinal fractures
• Sciatica — irritation of the sciatic nerve which runs from your pelvis to your feet; this is often caused by a slipped disc

These medical conditions often cause other symptoms in addition to back pain, such as numbness, a tingling sensation and/or weakness. They are also treated differently to non-specific back pain.

Some people are at greater risk of back pain

You can develop back pain at any age; even children and teenagers can have back pain. However, the following factors put you at greater risk of back pain:

• Age — your risk of back pain increases as you get older; back pain usually starts between ages 30-40
• Being overweight — this puts extra strain on your back
• Certain medical conditions eg arthritis and cancer
• Lack of exercise — this can cause weak abdominal and back muscles, which can lead to back pain
• Lifting objects incorrectly — bending your back to lift heavy objects can cause back pain; you should instead bend your knees and allow your legs to take the strain
• Smoking — back pain is more common among smokers; smoking makes you cough more and this may increase your risk of a slipped disc; smoking also decreases blood flow to your spine and increases your risk of osteoporosis

Depression and anxiety also increase your risk of back pain. 

• Cauda equina syndrome — pressure on the nerves at the base of your spine causing back pain and bowel and bladder problems; symptoms come on and progress quickly, and need urgent medical treatment
• Sciatica — symptoms include lower back pain, leg pain, and sometimes also tingling and numbness from your lower back and buttocks down your legs and feet
• Slipped disc — one of the fluid-filled cushions that sit between the vertebrae of your spine bulges out, pressing on a nerve and causing sudden and severe lower back pain
• Spinal stenosis — nerve tissue is compressed as your spinal canal narrows, causing pain, numbness and weakness in your back and legs

Other less common conditions that can cause back pain include:

• Arthritis, including osteoarthritis, rheumatoid arthritis and ankylosing spondylitis — all of these can cause back pain and stiffness due to inflammation of joints in your spine; osteoarthritis can cause lower back pain; arthritis can also cause spinal stenosis
• Infection
• Pressure from structures that are near the spine
• Tumours

If you’re worried that your symptoms aren’t improving, or they’re affecting your everyday life, you should see your GP.

In most cases, you won’t need any tests. Your doctor can diagnose the most common type of back pain — non-specific back pain — from your description and a brief examination. However, if your doctor thinks there could be a serious reason or underlying condition for your pain, they may refer you to a consultant or arrange for you to have further tests, such as an X-ray, MRI scan or blood tests.

How do I know if my back pain is serious?

You should see your GP about your back pain if: 

• It causes numbness, tingling or weakness in one or both legs
• It doesn't begin improving after a few weeks
• It is very severe or getting worse
• It spreads down one or both legs, particularly if it spreads below your knees
• It stops you from carrying out your everyday activities

You should also see your GP if you are worried about your back pain or are finding it difficult to cope. 

They will ask you about your symptoms, perform a physical examination of your back and discuss possible treatments.

Contact your GP immediately if you have back pain and any of the following symptoms:

• A high temperature
• A swelling or a deformity in your back
• Chest pain
• Difficulty urinating or controlling when you urinate or pass a stool
• Numbness or tingling around your buttocks or genitals
• Unintentional weight loss

You should also urgently contact your GP if your back pain:

• Comes from your upper back, between your shoulders, instead of your lower back
• Doesn't improve after rest or worsens at night
• Is preventing you from sleeping well
• Is worse when you cough, pass a stool or sneeze
• Started after a serious accident, blow to your back, fall or other injury

These symptoms could be a sign of a more serious problem that needs treatment.

What can I do to relieve my back pain?

You can often do things at home to help relieve your back pain and speed up your recovery, such as:

• Applying hot or cold packs to the painful part of your back — this can provide temporary pain relief;  you can buy special hot or cold packs from a pharmacy or use a hot water bottle or wrap a bag of frozen vegetables in a cloth
• Staying active and continuing your usual daily activities as much as possible — long periods of rest can make your back pain worse
• Taking anti-inflammatory painkillers eg ibuprofen — check these medications are safe for you to use; if you aren't sure, ask your pharmacist
• Taking a warm bath
• Trying gentle exercises and stretches for back pain — this can include activities such as Pilates, swimming, walking and yoga 

Try to stay positive and remember that your back pain will most likely improve — this mental attitude is shown to speed up recovery.

How to prevent back pain

It is difficult to prevent back pain but there are some things you can do to reduce your risk, including: 

• Avoiding movements that twist or strain your back and avoiding sitting for long periods of time
• Lifting properly — do not bend your back to lift objects, bend your knees and hold heavy objects close to you
• Losing excess weight through regular exercise and a healthy diet
• Performing regular back exercises and stretches — your GP or a physiotherapist can advise you about good exercises to try
• Sleeping on a supportive mattress
• Staying active — regular exercise will help your back muscles stay strong; it is recommended that adults do at least two and a half hours of exercise every week

It is also important to be aware of your posture. It is easy to have bad posture especially when lifting objects, sitting, using digital devices or watching television. Make sure you: 

• Avoid heavy lifting whenever possible but if you have to lift a heavy object, let your legs take the strain — when lifting, keep your back straight and do not twist it, bend at your knees and hold the object close to your body; if the object is very heavy or an awkward shape, ask for help
• Do not slouch when standing — keep your pelvis in a neutral position and if you have to stand for a long time, place one foot on a low stool to take some of the strain off your back and then swap to place the other foot on the stool 
• Sit on seats with good lower back support, armrests and a swivel base, whenever possible — keep your knees and hips level and try placing a pillow or rolled towel at the base of your spine to maintain its normal curve; change your position at least every 30 minutes

Specialist back pain treatments

If your back pain doesn’t improve, your doctor may suggest you see a specialist, such as a physiotherapist, chiropractor or osteopath, who may carry out manual therapy. Manual therapy should only be used alongside other treatments such as exercise. 

They may also suggest attending group exercise classes led by a qualified instructor to reduce your back pain. There is some evidence that the Alexander technique — a technique that focuses on being more aware of your posture and movements — may help. However, the National Institute for Health and Care Excellence (NICE) doesn't currently recommend this technique. 

Psychological therapies eg cognitive behavioural therapy (CBT) may help you cope better with your back pain by changing the way you think about it. Having a more positive attitude can improve your back pain. 

If your back pain is caused by a specific medical condition, your GP may refer you to an orthopaedic consultant or neurosurgeon for further advice and possible treatment, including:

• Back surgery to strengthen or repair your back
• Facet joint injections to reduce inflammation and relieve pain
• Radiofrequency denervation — this involves inserting needles into the nerves that are sending pain signals from the affected area of your body; radio waves are sent through the needles to heat up the nerves, which stops them sending pain signals
• Spinal fusion surgery to fuse two vertebrae together — this strengthens your back and can reduce pain caused by a damaged vertebra pressing against a nerve

Other treatments used to treat non-specific back pain are not recommended by NICE as there is not enough evidence to show they work. These treatments include: 

• Acupuncture — inserting fine needles at different points along your body
• Belts, corsets, foot orthotics and shoes with 'rocker' soles
• Electrical nerve stimulation — this includes: 
• Percutaneous electrical nerve stimulation (PENS) — delivering small electrical pulses via needles inserted near the nerves in your back
• Transcutaneous electrical nerve stimulation (TENS) — using a machine with small sticky patches (electrodes) attached to your skin to deliver small electrical pulses into your back
• Interferential therapy (IFT) — passing an electrical current through your back to speed up healing
• Therapeutic ultrasound — directing sounds waves onto your back to promote healing
• Traction — using pulleys, ropes and weights to apply force on the tissues around your spine

Painkilling spinal injections have also been used to treat non-specific back pain but there is insufficient evidence to prove this is effective. However, it is known to work for sciatica.