Back Pain

What is back pain?

Back pain is extremely common and in the great majority of cases no serious cause is found. Scans often show changes that are present in people with no pain at all, so imaging is usually unhelpful early on and can lead to unnecessary worry. Staying active is the single most effective thing you can do; bed rest slows recovery.

Causes

• Non specific mechanical strain, the vast majority
• Disc problems including prolapse
• Spinal stenosis in older adults
• Osteoarthritis of the spine
• Osteoporotic fracture
• Rarely infection, cancer or inflammatory arthritis

Symptoms

• Aching or stiffness across the lower back
• Pain worse with certain movements or positions
• Muscle spasm
• Pain that eases with movement and worsens with prolonged sitting
• Pain spreading into the buttock
• Difficulty straightening up

Risk factors

• Physically demanding or sedentary work
• Obesity
• Poor physical fitness
• Previous episode of back pain
• Smoking
• Psychological stress and low mood

Diagnosis

• History and examination screening for red flags
• No imaging needed for typical pain without red flags
• MRI where red flags or persistent nerve symptoms are present
• Blood tests if inflammatory or infective cause suspected
• DXA scan if osteoporotic fracture is suspected

Treatment

• Staying active and continuing normal activity as able
• Paracetamol or a short course of anti inflammatories
• Physiotherapy and structured exercise
• Manual therapy as part of a package including exercise
• Psychological support for persistent pain
• Surgery only for specific structural problems with nerve compression

Self care

• Keep moving and return to normal activity as soon as you can
• Avoid bed rest beyond a day or two
• Use heat packs for muscle spasm
• Build up walking and gentle stretching daily
• Stay at work if possible, with adjustments if needed
• Improve sleep and manage stress, both affect pain
• Strengthen core and back muscles once acute pain settles

When to see a doctor

Book an appointment if:

• Pain not improving after six weeks
• Pain spreading down the leg below the knee
• Numbness or weakness in a leg
• Pain waking you consistently at night
• Back pain after a fall or injury
• Back pain with unexplained weight loss or feeling unwell

Some symptoms need emergency care rather than an appointment. See the warning signs listed above.

Prevention

• Stay physically active and build general fitness
• Keep to a healthy weight
• Lift with your legs and avoid twisting under load
• Vary posture and move regularly if sitting for work
• Stop smoking
• Manage stress and sleep

Outlook

Most episodes improve substantially within six weeks, and around 90 percent settle without any specific treatment. Recurrence is common, which is normal and not a sign of damage. A minority develop persistent pain, where the focus shifts from finding a structural cause to restoring function through exercise, pacing and pain management.

Related conditions

Common questions