What should I know about back pain?

Back pain is a very common problem and will affect many of us at some point during our lives.

The good news is that in most cases it isn’t a serious problem, and it might just be caused by a simple strain to a muscle or ligament.

As far as possible, it’s best to continue with your normal everyday activities as soon as you can and to keep moving.

Being active and exercising won’t make your back pain worse, even if you have a bit of pain and discomfort at first. Staying active will help you get better. Taking painkillers can help you do this.

How your back works

The spine, which is also called the backbone or spinal column, is one of the strongest parts of the body and gives us a great deal of flexibility and strength.

It’s made up of 24 bones, known as vertebrae, one sitting on top of the other. These bones have discs in between and lots of strong ligaments and muscles around them for support. There are also the bones in the tailbone at the bottom of the back, which are fused together and have no discs in between.

On either side of the spine, running from top to bottom, are many small joints called the facet joints.

The spinal cord passes inside the vertebrae, which protect it.

The spinal cord connects to the brain through the base of the skull and to the rest of the body by nerves that pass through spaces between the bones of the spine. These nerves are also known as nerve roots.

As you grow older, the structures of your spine, such as the joints, discs and ligaments, age as well. The structures remain strong but it’s usual for your back to get stiffer as you get older.

Causes

Often back pain doesn’t have one simple cause but may be due to one or more of the following:

  • poor posture
  • lack of exercise resulting in stiffening of the spine and weak muscles
  • muscle strains or sprains.

As well as the things listed above, there are also specific conditions which are linked with pain felt in the back. It’s important to remember that severe pain doesn’t necessarily mean there’s a serious problem. Some common conditions are listed below.

Spondylosis

As we grow older, the bones, discs and ligaments in the spine can naturally weaken as they age. This happens to all of us to some degree as part of the ageing process, but it doesn’t have to be a problem and not everyone will have pain from this.

As we grow older the discs in the spine become thinner and the spaces between the vertebrae become narrower. Little pieces of bone, known as osteophytes, may form at the edges of the vertebrae and facet joints.

The medical term for this is spondylosis and is very similar to the changes caused by osteoarthritis in other joints.

Keeping the spine supple and the muscles around the spine and pelvis strong, will reduce the impact of spondylosis.

Sciatica

Back pain is sometimes linked with pain in the legs, and there may be numbness or a tingling feeling. This is called sciatica.

This is due to a nerve in the spine being pressed on or squeezed. For most people with sciatica, the leg pain can be the worst part and occasionally they may have little or no back pain at all.

In most cases sciatica is caused by a bulging disc pressing on the nerve. Discs are designed to bulge so we can move our spines about easily, but sometimes a bulge can ‘catch’ a nerve root and cause pain that travels all the way down the leg and foot.

Most people recover fairly quickly, although in some cases it might take a number of months.

Starting gentle exercise as soon as you can will greatly help with sciatica. It is also a very good idea to see a physiotherapist.

Spinal stenosis

Sometimes back pain is linked with pain in the legs which starts after you start walking for a few minutes, and then tends to get better very quickly when you sit down. This is known as spinal stenosis.

This can happen from birth or can develop as we get older.

Problems are caused when something presses on the small space in the middle of the spine, where the nerves are. This space, which is called the spinal canal or nerve root canal, can be squeezed by bone or ligament.

Symptoms often affect both legs, but one may be worse than the other. The pain usually gets better when you sit down and rest, and some people find they have less pain if they walk a little stooped. Like sciatica, the main problem tends to be leg pain more than the back pain.

In most cases, neither sciatica nor spinal stenosis are serious problems. However, if the symptoms cause you a lot of trouble and greatly affect your quality of life then you should see your doctor for further advice and to discuss what else can be done.

Other causes

Other rarer causes of back pain include:

  • bone problems such as a fracture – often linked to thinning of the bones, which is known as osteoporosis
  • an infection
  • a tumour
  • inflammation, for example in the condition ankylosing spondylitis.

When to see a doctor

Even though it's common, most cases of back pain tend to clear up without the need to see a doctor.

You should see your doctor if your pain:

  • is really bad
  • lasts for a long time
  • stops you from working or doing the things you enjoy
  • affects your everyday activities
  • gets worse.

You should also see your doctor if you have any changes in sexual function, for example, being unable to get an erection.

If the pain is causing you significant problems and stops you from getting on with normal life and work activities, your doctor will examine you and ask you questions.

These questions will help predict how likely it is that you need further help with your back pain. If you do need further support, your doctor will make a referral to physiotherapy so that you can have treatment early, to help with the pain and return to normal activities.

It’s natural to want to know what has caused your back pain. However, specialists may not be able to tell you for certain what has caused your back pain, even after carefully assessing you.

If you’re concerned about the cause of your back pain, it can help to talk openly about any worries with a healthcare professional, as reducing any fear may help speed up your recovery.

What are the warning signs of a serious problem?

Very rarely back pain or pain that travels down the leg is a sign of a serious problem.

If you have any of the following symptoms, you should seek urgent medical attention:

  • difficulty controlling or passing urine
  • loss of control of your bowels
  • numbness around your back passage or your genitals
  • serious weakness in your legs so you find standing really difficult
  • severe and ongoing back pain that gets worse over several weeks.

The above symptoms could potentially be linked to a rare but serious condition that needs urgent medical attention.

Diagnosis

National guidelines suggest that doctors should use a common-sense ‘wait and see’ approach when diagnosing back pain before deciding if you need further treatment, especially as most cases of back pain improve by themselves. As a patient this approach can sometimes be frustrating, but you may find that if you keep up your self-help measures, you won’t need further treatment anyway.

Should you need further treatment, your GP will be able to assess your back pain by discussing your symptoms with you. Most problems can be diagnosed after a simple examination, and it’s unlikely that any special tests will be needed.

Tests

You may be sent for tests if:

  • you’ve had an injury to your back, for example a bad fall
  • your doctor suspects that there may be an underlying cause for your pain
  • the pain has lasted for an unusually long time.

In this case a magnetic resonance imaging (MRI) scan or computerised tomography (CT) scan may be needed.

X-rays are much less commonly used because back pain is often caused by problems with soft tissues, such as ligaments and muscles, which can’t be seen on x-rays.

Changes to the spine as a result of spondylosis can show up on x-rays. These common changes that happen to us all, can appear on x-rays without people having any pain or problems. Because of this, x-rays aren’t particularly helpful.

Remember that sometimes even after a thorough investigation it might not be possible to say for certain what is causing back pain.

Managing your symptoms

The most important things to do to treat back pain is to keep moving, continue with everyday activities and have a healthy lifestyle.

Some people worry that if they have back pain, doing certain activities such as lifting things, twisting and turning might make their back pain worse. It’s important to remember that our backs and our spines are very strong and are designed to move.

In fact, too much rest can make back pain worse.

Being active and continuing with your everyday activities as soon as possible, and as much as possible, will speed up your recovery.

There’s also evidence to suggest that how you respond emotionally to having back pain has an important impact on how quickly you get better. The more positive you are, the more active you are, the quicker your back will get better.

Remember, if you’re ever struggling don’t suffer in silence, talk to a healthcare professional.

Keep moving

Staying active is the most important way you can help yourself if you have back pain.

Keeping the muscles around the spine strong, will provide more support to the bones and joints and take pressure off them. The more you move, the more the back will keep its natural range of movement.

If you stop being active for a long time, the muscles in your back become weak and you become less fit, and this can make your back pain worse. Not moving can make your back more stiff and painful.

Regular exercise leads to shorter and less frequent episodes of back pain. It also releases chemicals called endorphins, which are the body’s natural painkillers. These improve pain and make you feel happier.

Exercise might make your back feel a bit sore at first but it doesn’t cause any harm – so don’t let it put you off. If you're getting back to exercise, start off gently and gradually increase the amount of exercise you do. Regular and small episodes of exercise is a good way to start and then each day try to do a little bit more.

Try taking some painkillers beforehand too. Over time, your back will get stronger and more flexible, and this should reduce pain.

Types of exercise for back pain

It’s better to choose a form of exercise that you enjoy as you’re more likely to stick to it. There are many forms of exercise that have helped people with back pain. Examples include:

  • swimming
  • walking
  • yoga
  • Pilates
  • going to the gym.

Research has found that a specially developed 12-week yoga programme can help people with low back pain lead more active lives and manage their condition more effectively. Many of the people who took part in the study also found that they had the knowledge to prevent further attacks if they felt an episode of back pain coming on.

You can find more information about the 12-week programme at www.yogaforbacks.co.uk

Many community and sports centres also run yoga classes if you’re interested in trying it. Make sure you speak to the yoga instructor before you start so they’re aware that you have back pain.

Pain during exercise

You may feel some discomfort and sometimes pain when you exercise. This feeling is normal and should calm down a few minutes after you finish. It’s not a sign that you're hurting yourself. Exercise will help reduce pain and can help you manage your back pain better. 

While you can push yourself and do strenuous exercise, it’s important not to overdo it. If you are in pain that you can’t cope with during or after your activity, you will need to see a doctor. The key is to start off gently and to gradually increase the amount you do.

Often people stop exercising once their back pain has cleared up. But if you stop exercising all the improvements you’ve made will disappear within a few weeks. So, it’s important that you continue to exercise regularly and don’t stop when the pain is gone and you’re feeling better.

If you’re ever having any trouble exercising, it can be a good idea to see a GP or ask for a referral to a physiotherapist for tailored exercise advice. If you're a member of a gym, there may well be personal trainers there who can give you expert advice. Make sure you tell them about your condition.

Treatment

Taking some painkillers, staying active and doing some specific exercises are generally the most helpful treatments for people with back pain. However, some people will need further medical treatment.

Therapies

Physiotherapy

Physiotherapy can be useful to improve your strength and flexibility. Exercise is one of the most effective treatments for back pain. A physiotherapist can help oversee your exercise programme and recommend specific exercises to help.

Manual therapies, which are sometimes called ‘hands-on’ treatments, such as manipulation and mobilisation of the spinal joints, can help to clear up a spell of back pain along with exercises. These manual therapy techniques are usually carried out by osteopaths, chiropractors and physiotherapists.

These therapies might not be suitable for all back conditions. Talk to your doctor if you’re thinking of trying one of these. And make sure you explain to the therapist what condition you have.

Read more about physiotherapy.

Occupational therapy

If your back pain is causing problems with daily activities such as dressing, washing and driving, you may find it useful to see an occupational therapist. They may suggest different ways of doing things to reduce the strain or recommend aids or gadgets that will help you. However, it’s important that you don’t come to rely on aids or gadgets instead of trying to get back to your daily activities.

Find out more about occupational therapy.

Talking therapies

Back pain, especially if it lasts for a long time, can affect people’s mood. If you are feeling really low or anxious, it’s important to talk to someone such as a partner, relative, friend or a doctor. ‘Talking therapies’ can be useful.

For example, cognitive behaviour therapy (CBT) can help people with back pain. The aim is to help people to deal with problems in a more positive way, by breaking them down into smaller parts. Your doctor may be able to refer you for CBT, or you might like to consider going private.

Keeping socially and physically active is an important part of helping with low mood and anxiety, and it also helps with pain. Simple things, such as joining a local leisure centre, sports club, walking group, gardening group, or just getting out and seeing friends for a coffee on a regular basis might really help you.

Working with back pain

Getting back to work sooner rather than later will help most people with back pain.

This will help your back pain itself, as staying active and keeping the back muscles moving will help you get better sooner. It'll also make you feel better about yourself as time off work has been shown to affect people’s mood.

In the past, people were advised to rest up in bed and we now realise that it does more harm than good and that it's better to keep moving, even if you need to take some simple painkillers to allow you to do so.

Most people are able to return within 2-3 days, although the length of time off work varies with the individual and the type of job you do.

You don’t need to wait until your back problem has completely gone. In many cases, the longer you’re off work the more likely you are to develop longer-term problems and the less likely you are to return to work.

Getting support from your employer

It’s important to keep in contact with your employer and discuss what can be done to help you return to work. If your work involves heavy lifting or other physically demanding tasks, you may need to do lighter duties and less hours for a while.

If you have an occupational health advisor through your job, they can help advise what work you are fit to do and arrange any simple adjustments to your work or workplace to help you to cope and stay at work.

Getting other support

If you're having difficulties travelling to or from work or need an item of equipment, the Government’s Access To Work scheme might be able to help.

If you're unable to get back to work after two weeks of absence because of your back pain, you should talk to your GP and employer about getting physiotherapy or other treatment to get you moving again.

You can get further advice through your local Jobcentre Plus and the Government’s Fit for Work guidance.

Research and new developments

Research continues in the field of low back pain, sciatica, and spinal stenosis. Currently there are three main ongoing studies:

  • One is looking to confirm the results of a previous study as to whether antibiotics are useful for a small number of people with prolonged and severe back pain and specific findings on MRI scan.
  • The second study is investigating whether a model of care, called stratified care, for people with sciatica can lead to better outcomes compared to current non-stratified care. In this study, patients with sciatica receive different levels of care depending on how likely it is that they will do well or they will need tests and a specialist opinion. Those who are likely to need a specialist assessment are referred early on, those who are likely to do well receive advice and self-help support, and those with more troublesome pain are referred to physiotherapy.
  • The third study is investigating two different types of physiotherapy treatment for spinal stenosis, to find out which one is more effective.

Exercises to manage back pain

Back pain is common but most cases aren’t caused by a serious problem. Most cases of back pain get better on their own within a few weeks.

Knees to chest

Lie on your back, knees bent. Bring one knee up and pull it gently into your chest for 5 seconds. Repeat up to 5 times on each side.

Back stretch

Lie on your back, hands above your head. Bend your knees and roll them slowly to one side, keeping your feet on the floor. Hold for 10 seconds. Repeat 3 times on each side.

Pelvic tilt

Lie down with your knees bent. Tighten your stomach muscles flattening your back against the floor. Hold for 5 seconds. Repeat 5 times.

One-leg stand

Holding onto something for support if needed, bend one leg up behind you. Hold for 5 seconds. Repeat 3 times on each side.

Deep lunge

Kneel on one knee, the other foot in front. Facing forwards, lift the back knee up. Hold for 5 seconds. Repeat 3 times on each side.

Summary

  • Back pain is common but most cases aren't caused by a serious problem.
  • Most cases of back pain get better on their own within a few weeks.
  • Stay active. Bed rest for more than a couple of days makes it harder to get going. Gradually increase your normal activities and do regular exercise.
  • Take painkillers if needed so you can stay active.

Your pain should ease within 2 weeks and you should recover over approximately a 4-6 week period.

You should carry on with the exercises for at least 6-8 weeks to help prevent another injury.

If the pain is severe or not improving after a week or so, contact your doctor.

Exercise is the most important way that you can help yourself if you have back pain. Research shows that bed rest for more than a couple of days doesn’t help back pain and in the long term actually makes it worse as the muscles in your back become weak and you become less fit.

Exercise also releases endorphins – your body's natural painkillers.

Exercise might make your back feel a bit sore at first but it doesn’t cause any harm. Start off slowly and gradually increase the amount of exercise you do. You can also try taking some painkillers beforehand. Over time, your back will get stronger and more flexible and this should reduce pain.

It’s better to choose a form of exercise that you enjoy as you’re more likely to stick to it. Any regular exercise that helps to make you flexible, stronger and increases your stamina is good, for example:

Exercises that may help include:

  • swimming
  • walking
  • yoga or Pilates
  • going to the gym.

You can also download a selection of exercises (PDF 632 KB) that are designed to stretch, strengthen and stabilise the structures that support your back. They may not be suitable for all types of back pain, so it’s a good idea to get advice from your doctor or physiotherapist about specific exercises before you begin. It’s also important to keep exercising even once your back pain has cleared up.

Staying active is the most important way you can help yourself if you have back pain.

Keeping the muscles around the spine strong, will provide more support to the bones and joints and take pressure off them.

If you stop being active for a long time, the muscles in your back become weak and you become less fit. This can make your pain worse.

Regular exercise leads to shorter and less frequent episodes of back pain. Exercise also releases chemicals called endorphins. These can improve pain and make you feel happier.

Research has found that a specially developed 12-week yoga programme can help people with low back pain lead more active lives and manage their condition more effectively. Many of the people who took part in the study also found that they had the knowledge to prevent further attacks if they felt an episode of back pain coming on. You can find more information about the 12-week programme at www.yogaforbacks.co.uk.

Many community and sports centres also run yoga classes if you’re interested in trying it. Make sure you speak to the teacher before you start so they’re aware that you have back pain.

As with any physical activity it’s normal to feel some aches in your muscles, especially if you’ve just started doing more exercise, but you should stop if you get any joint pain that doesn’t go away quickly.

Often people stop exercising once their back pain has cleared up. But if you stop exercising all the improvements you’ve made will disappear within a few weeks. So, it’s important that you continue to exercise regularly and don’t stop when the pain is gone and you’re feeling better.

If you’re ever having any trouble exercising, it can be a good idea to see a GP or ask for a referral to a physiotherapist for tailored exercise advice. If you're a member of a gym, there may well be personal trainers there who can give you expert advice. Make sure you tell them about your condition.