Overview
Low back pain is pain felt between the lower edge of the ribs and the buttocks. It is one of the commonest reasons people see a doctor.
In most people no disease or structural problem is found, and the pain is then called non-specific. It is called chronic once it has carried on beyond twelve weeks.
Symptoms
The pain may be a dull ache, a stiff feeling or a sharp catch with a particular movement. It can start suddenly after lifting or twisting, or build up over days with no clear trigger.
Stiffness is often worst in the morning or after sitting still. The pain can spread into the buttock or down the leg, and some people notice numbness, tingling or weakness in the leg.
When to see a doctor
See a doctor within the next few days if the pain has not started to settle after a few weeks, if it stops ordinary activities, if it is worse at night, if there is weight loss that has not been explained, or if there is a new swelling or change in the shape of the back.
Causes
Most low back pain comes from the muscles, ligaments and joints of the spine rather than from one injury. A strain or an awkward movement is a common trigger, and often there is no trigger at all.
Named causes include a slipped disc pressing on a nerve, narrowing of the spinal canal, and inflammatory conditions such as ankylosing spondylitis. Rarely, back pain is the first sign of a fracture, an infection or a cancer.
Risk factors
- Doing little physical activity
- Work with heavy lifting or repeated bending
- Being overweight
- Smoking
- Long hours of sitting without support for the lower back
- Older age, as the discs and joints of the spine change
- Stress, worry or low mood, which make pain harder to settle
Complications
Most episodes settle. When pain lasts for months it can disturb sleep, work and mood, and the inactivity that follows weakens the muscles that support the spine.
If a nerve stays squeezed there can be lasting numbness or weakness in the leg. Loss of bladder or bowel control is rare, but it is an emergency, because delay can leave the damage permanent.
Prevention
- Staying physically active, with exercises that strengthen the stomach, back and hip muscles
- Keeping to a healthy weight
- Lifting with the knees bent and the load held close to the body
- Breaking up long periods of sitting
- Not smoking
- Sleeping well and finding ways to manage stress
Diagnosis
A doctor asks how the pain started, where it spreads and what makes it worse, then examines the back and tests power, sensation and reflexes in the legs.
Most people need no further testing. An X-ray, MRI or is used when the history or examination points to a specific cause, or when severe pain is not settling.
Treatment
The main advice is to keep moving. Carrying on with ordinary activity, and returning to work as soon as it is comfortable, helps more than resting in bed. Heat or ice packs help many people.
Pain relief such as paracetamol, or an anti-inflammatory medicine such as ibuprofen, may be used for a short time. Anti-inflammatory medicines do not suit everyone, so a pharmacist or doctor should be asked first.
For pain that does not settle, treatment may include physiotherapy, a supervised exercise programme, manual therapy alongside exercise, and talking therapy. Injections and surgery are considered for a small number of people, once a specific problem has been found.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“The best thing for a bad back is to lie down and rest until the pain goes.”What is true?
Fact
Staying in bed for more than a day or two can make back pain worse. Keeping gently active, moving within comfort and carrying on with ordinary daily life is the advice that helps most people recover.
Myth“If my back hurts this much, something inside must be damaged.”What is true?
Fact
In most people with back pain no disease or structural damage is found. Pain can be severe and still come from the muscles, ligaments and joints of a back that is basically healthy, and severity does not measure damage.
Myth“You cannot treat back pain properly without an X-ray or MRI first.”What is true?
Fact
Most people with back pain do not need any scan. The diagnosis comes from the history and the examination, and imaging is used when those point to something specific, such as a nerve being pressed, a fracture, an infection or a cancer.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How long will my back pain take to get better?
Most episodes improve over days to weeks. Some settle more slowly, and back pain often comes back at some point. Pain that is still there after twelve weeks is called chronic, and it is worth seeing a doctor so a plan can be made rather than waiting it out.
Should I wear a lumbar belt?
A belt may feel supportive for a short while during heavy work, but it is not a treatment. Relying on one for weeks can let the muscles that hold the spine weaken. Exercise that strengthens the trunk is more useful in the long run, and a physiotherapist can show which exercises suit you.
Is it safe to exercise while my back still hurts?
Usually yes. Gentle movement, walking, swimming and stretching are encouraged, building up as the pain allows. Stop and get advice if an activity causes sharp pain down the leg, or any numbness or weakness, and get emergency care if the warning signs above appear.
My MRI report mentions disc bulges. Does that explain my pain?
Not always. In most people with back pain no structural problem explains the symptoms, and a scan is used to confirm or rule out a specific cause rather than to label the pain. A doctor reads the report alongside the history and the examination before deciding what is causing the pain.
