Lower back pain is one of the most common reasons people visit a doctor or miss work. The Global Burden of Disease Study identifies it as the single leading cause of disability worldwide. The good news is that most episodes of lower back pain improve within a few weeks with appropriate self-care.
Types of Back Pain
Acute Back Pain
- Lasts less than 6 weeks
- Often caused by a specific event (lifting, twisting, sudden movement)
- Most cases resolve with conservative treatment
Chronic Back Pain
- Lasts longer than 12 weeks
- May or may not have a clear structural cause
- Requires a comprehensive management approach
Common Causes
Mechanical Causes (Most Common)
- Muscle or ligament strain: Overuse, awkward movements, heavy lifting
- Disc problems: Bulging or herniated discs pressing on nerves
- Degenerative changes: Normal age-related wear of the spine (spondylosis)
- Spinal stenosis: Narrowing of the spinal canal, more common in older adults
Red Flags (Less Common but Serious)
Seek immediate medical attention if back pain is accompanied by:
- Numbness or weakness in one or both legs
- Loss of bladder or bowel control
- Pain after a significant injury or fall
- Unexplained weight loss
- Fever
- Pain that is constant and does not improve with rest
- Pain that wakes you from sleep
- History of cancer, osteoporosis, or steroid use
Do You Need an X-Ray or MRI?
NICE guideline NG59 (Low back pain and sciatica in over 16s) recommends not routinely offering imaging for non-specific low back pain. This is because:
- Imaging findings (disc bulges, degenerative changes) are common in people without pain
- Imaging rarely changes the treatment plan for non-specific back pain
- Unnecessary imaging can lead to anxiety and overtreatment
Imaging is recommended when:
- Red flag symptoms are present
- Symptoms have not improved after 6–8 weeks of appropriate treatment
- Surgery or specialist intervention is being considered
Treatment
NICE-Recommended First-Line Treatments
- 1Stay active: Bed rest is not recommended. Continuing normal activities as much as possible helps recovery
- 2Exercise: The most effective long-term treatment for back pain
- Walking, swimming, and cycling are excellent options
- Core strengthening and flexibility exercises
- Your physiotherapist can design a programme for you
- 3Heat therapy: A hot water bottle or heat pack can relieve muscle pain and spasm
- 4Pain relief:
- NSAIDs (ibuprofen) - first choice for pain relief (short-term use)
- Paracetamol - NICE no longer recommends paracetamol alone for back pain as evidence for benefit is limited
- Muscle relaxants - may be prescribed for short-term relief of severe muscle spasm
- Opioids - not recommended for chronic back pain
Physiotherapy
- Manual therapy (spinal mobilisation or manipulation)
- Exercise therapy (individually tailored programmes)
- Education about pain management and self-care
- NICE recommends a group exercise programme as a first option
Psychological Approaches
For chronic back pain, NICE recommends considering:
- Cognitive behavioural therapy (CBT)
- Combined physical and psychological programmes
- These approaches help address fear of movement, catastrophising, and the emotional impact of chronic pain
When Surgery May Be Considered
- Sciatica caused by a confirmed disc herniation that has not improved after 6–12 weeks
- Spinal stenosis causing significant nerve compression
- Cauda equina syndrome (a surgical emergency)
Prevention
- Exercise regularly: Strong core and back muscles support the spine
- Maintain good posture: Especially during prolonged sitting
- Set up your workspace correctly: Chair height, screen position, and desk arrangement
- Lift correctly: Bend your knees, keep the load close to your body
- Maintain a healthy weight: Excess weight increases spinal stress
- Take regular breaks: If you sit for long periods, stand and move every 30–45 minutes
- Sleep well: Choose a supportive mattress; sleeping on your side with a pillow between your knees can reduce spinal stress
This article is for informational purposes only and does not replace professional medical advice. Always consult your doctor for personalised guidance.