Back pain

Key points about back pain

  • Back pain is common and usually occurs in the lower back. Most back pain is not serious and will improve over time.
  • To help you recover more quickly, keep active and continue to move your back. It is fine to have some pain while moving.
  • Keep doing your normal work or daily activities, or return to doing these as soon as you can.
  • Use heat or ice packs, pain relief medication and exercise or massage if these reduce your pain.
  • Rarely is back pain a sign of a more serious problem. But you should get it checked right away if you:
    • have any weakness in your lower legs
    • develop any bowel or bladder problems
    • have numbness over your buttocks or anal region (back passage).
Graphic view of lumbar region of man's spine

(Dr Michael Evans & Reframe Health Films Inc, 2014)

Back pain can start suddenly or it can come on slowly over a few days or weeks.

  • Most episodes are short term (acute back pain). These episodes often improve a lot over the first 2 weeks, then settle further over the following months. Do not be concerned if you continue to have low level discomfort .
  • Sometimes back pain can last longer than 3 months (persistent back pain). This does not mean that there is a serious problem. Persistent pain also tends to get better over time. Read more about chronic pain.
  • It is not uncommon to have further episodes of back pain (recurrent back pain). This does not mean that your back has not healed from the previous episode. There are things you can do to reduce the chance of recurrence.
  • If a nerve in your back becomes irritated, you may have pain that is worse in your lower leg than your back (leg-dominant or radicular pain). This often resolves with time, but it is a good idea to see your doctor to discuss whether specific medication may be helpful.
  • If a nerve in your back is compressed, you may have weakness and numbness in one of your legs. This often resolves with time, but it is a good idea to see your doctor so that they can assess your nerve function and help you to decide whether any other treatment options are needed.

Back pain refers to pain or stiffness in the back. You may have limited movement and moving your back may increase you pain. Sometimes pain may spread to your buttocks or legs. You may also feel pins and needles or numbness in one of your legs or feet.

Although rare, back pain can be a sign of a more serious condition. If you experience any of the following 'red flag' symptoms with your back pain then please see a doctor urgently.

See your GP or physiotherapist if:

  • You have back pain that is not getting better after a few weeks of trying simple exercises and following the tips for a healthy back.
  • Your pain is worse in your lower leg than your back and is not easing.
  • You have weakness and numbness in one of your legs.
  • You have a rash in the same area as your pain.

'Red flag' symptoms – see a doctor urgently if you have:

  • numbness in the groin or buttocks
  • loss of bladder or bowel control
  • redness or swelling on your back
  • difficulty walking
  • constant pain, especially at night
  • pain that is getting much worse, or spreading up your spine
  • numbness or pins and needles in both legs
  • feeling unwell with your back pain, such as a fever or significant sweating that wakes you from sleep.

Most back pain is not due to any serious injury or disease. People often have back pain for no apparent reason or after a minor or common movement. This means that there has not been any injury.

Sometimes back pain starts after you use your back differently or more than normal, like heavy lifting, this does not necessarily mean that you are injured. Back pain can also start after something traumatic like a fall or collision.

Man with sore back after lifting boxes

Image credit: Canva

Back pain is one of the most common reasons for time off work, but staying at work has been shown to improve recovery, although you may need to modify some tasks. When you have back pain, keep as active as you can. Avoid bed rest — this does not help and can make symptoms worse. Although you may feel some pain when you are active, it is safe to exercise while you have back pain.

Benefits of keeping active

Keeping active will:

  • make you feel better
  • help you to keep doing things that are important or that you enjoy
  • help you feel more positive
  • shift your focus away from your back 
  • give you an opportunity to be with others
  • improve your confidence in your back
  • help to control your pain
  • help you feel more in control
  • enable you to be able to return to work more quickly.

Fortunately, most back pain gets better relatively quickly and there are simple things that can be done to recover and reduce the chance of pain returning. It's important to keep doing your normal work or daily activities, or return to doing these as soon as you can. 

Ideas about back pain have changed a lot over recent years. It is a good idea to read more about back pain as you may be surprised to discover that some of the things you thought were bad for the back are actually not a problem (or are even good for it). Examples include:

  • sitting is not bad for the back
  • poor posture cannot injure the back
  • the back is designed to bend, twist and lift
  • moving and using the back makes it more healthy.

Read more at 10-facts-about-back-pain(external link)(external link) or 15 things you didn’t know about back pain.(external link)(external link)

 

What to do if you have back pain

Move your back

Gentle movements (starting as soon as possible) will help to reduce pain and spasm and to regain full range of motion. Movement also helps healing. Sometimes movements are initially more comfortable when you are lying down, such as lying on your back and pulling your knees to your chest (flexion) or lying on you front and pushing up with your arms to arch you back (also known as the cobra position; extension).

 

Exercise

Exercise can help to reduce the total duration of pain and prevent recurrent episodes. It can be challenging to exercise if you are in pain. If you do have pain, it is safe for you to exercise, as long as any pain or discomfort feels manageable and stable and does not get a lot worse.

  • The best types of exercises are ones that you enjoy and can do regularly.
  • At times you may have a ‘flare up’ or marked increase in pain (this can happen whether you exercise or not). If this happens, you may be happier reducing the amount you exercise for a couple of days, but try not to stop completely.
  • As the pain eases, try and build back up to the previous level as soon as you can.
  • If you get frequent episodes of low back pain, keep doing regular exercise to prevent new episodes.

 

Work

You can continue to work if you have low back pain, so long as it is possible to do your job safely. You may need to modify some tasks for a few days while your pain settles. Work helps you to focus on things that are not related to your back. Work is good for your general health too.

 

Apply gentle heat or ice

Applying gentle heat or cold can offer relief and help to ease pain during the first few weeks. Use whichever one gives you the most relief.

  • Apply ice or cold packs to the painful area for 10–15 minutes every few hours. Wrap a plastic bag of ice (or a bag of frozen vegetables) in a damp cloth or light towel. Never place ice directly on your skin.
  • Apply a moist, warm compress, or a warm wheat bag to the painful area for 20–30 minutes several times a day. Keep the compress warm for best effect.

 

Physiotherapy

One of the most common treatments for back pain is physiotherapy. Physiotherapists are able to:

  • assess your back pain and confirm that your pain is not due to anything serious
  • assess movement limitations and identify the best way to address these
  • identify things that you are doing that may be adding to your pain
  • explore ways to modify your work and other daily tasks so that you can continue to do these
  • teach you exercises that can help to reduce pain and prevent further episodes
  • work with you to develop a plan to get you back doing everything you would like to do.

 

Medications

Medications can be used to supplement other things that you are doing for back pain, but often do not provide much additional benefit. If you are using pain relief medication, it's best to take it on a regular basis for 3 to 5 days, rather than using the medication only when the pain becomes unbearable.

Medication Description
Paracetamol
  • Paracetamol has not been found to be effective for acute or chronic back pain.
Non-steroidal anti-inflammatory drugs (NSAIDs) 
  • Examples include ibuprofen, naproxen or diclofenac.
  • NSAIDs can help to ease acute back pain, but they have side effects and are not suitable for everyone. Before taking NSAIDs, check with your pharmacist or doctor if they are suitable for you.
  • NSAIDs are not suitable for chronic back pain because of the harmful effects associated with their ongoing use.
  • Read more about NSAIDs.
Opioids
  • Examples include codeine, morphine, tramadol and oxycodone.
  • Opioids are not recommended for routine use as the benefits are usually small compared to the risks.
  • Short-term use of opioids may be considered for some people with acute back pain but these are not recommended for chronic back pain because they have not been found to be more effective than other pain medications and have harmful side effects when used on an ongoing basis.
  • Read more about opioids.
Muscle relaxants
  • Examples include orphenadrine (Norflex®).
  • It may be helpful for short-term use when pain is related to muscle spasms but has harmful side effects when used on an ongoing basis.
  • Read more about orphenadrine.

Non-medicine treatments

There's a variety of other non-medicine-based treatment options to manage pain such as acupuncture, manipulation and massage. Before starting any treatment, talk to your doctor so that treatment options can be discussed and to ensure that a specific treatment option is suitable for you. Read more about non-medicine treatments for pain.

  • A few sessions of spinal manipulation may offer some relief and improved function in people with acute low back pain.
  • How we think and feel has a large impact on pain. Psychological therapies can be very helpful for helping to recover from back pain.
  • Massage or yoga was found to have greatest benefit in people with chronic back pain who expected to improve with these treatments.
  • Acupuncture is helpful for some people with back pain.

Video showing simple back exercises to help prevent aches and pains.

(Chartered Society of Physiotherapy, UK, 2017)

 

Back stretches

(NHS, UK, 2020)

 

Links to more videos for treating back pain

Back care classes(external link) NHS, UK
These set of 6 classes focus on a variety of movements to help improve strength and flexibility of muscles that support the back
Exercises for back pain(external link) Chartered society of physiotherapists, UK
Back pain pilates video workout(external link) NHS, UK
This video demonstrates pilates exercises that are suitable for those with chronic back pain.

What we do day to day is very important to help keep us healthy and prevent back pain.

  • Keep active – regular exercise improves health and reduces recurrent back pain. Try to get at least 150 minutes of moderate or intense physical activity a week.
  • Sleep well.
  • Manage your stress and anxiety levels.
  • Don’t smoke because nicotine decreases blood flow to your back. Back pain is more common and recovery is slower in smokers.
  • If you have recurring back pain, the following may help:
    • exercise regularly – people who do regular exercise have less back pain than those who are inactive
    • aim for a weight within your healthy range
    • manage stress and mood
    • ask your physiotherapist or health provider to explore with you the types of movements and activities that are best for you.

9 for spine tips:

Tip 1: get regular exercise

(North American Spine Society, US, 2014)

Tip 2: quit smoking(external link)(external link)
Tip 3: maintain a healthy body weight(external link)(external link)
Tip 4: keep your core strong(external link)(external link)
Tip 5: use proper body mechanics(external link)(external link)
Tip 6: have good posture(external link)(external link)
Tip 7: reduce stress(external link)(external link)
Tip 8: keep healthy, strong bones(external link)(external link)
Tip 9: don't be a weekend warrior
(external link)(external link)

Learn more

Low back pain(external link)(external link) Pain Health, Australia
10 things you need to know about your back(external link)(external link) CPS, UK
How physio can help back pain(external link)(external link) Physiotherapy NZ
Back pain – range of resources(external link)(external link) Medline Plus, US

 

Brochures

Back exercises(external link)(external link)(external link) NHS, UK
What is back pain?(external link)(external link)(external link) National Institute of Arthritis and Musculoskeletal and Skin Disease English(external link)(external link)(external link) Chinese(external link)(external link)(external link) Korean(external link)(external link)(external link) Vietnamese(external link)(external link)(external link)
10 facts about back pain(external link)(external link)(external link) LaFisiotherapia.net
15 things you didn't know about back pain(external link)(external link)(external link) Irish Independent, 2015
Back pain – imaging tests(external link)(external link)(external link) Choosing Wisely, NZ, 2016
Caring for your...Short term low back pain (acute)(external link) ACC NZ
Knowing about your low back pain  [PDF, 155 KB]ACC NZ
10 things you need to know about your back(external link) Chartered Society of Physiotherapy UK
Back pain – imaging tests(external link) Choosing Wisely, NZ 

 

Books

Treat your own back(external link)  by Robin McKenzie
Fix your back(external link) Dr Giresh Kanji, Pain Specialist, NZ

Apps/Tools

Back and neck exercise apps

 

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Ben Darlow, musculoskeletal physiotherapy specialist in private practice, and a senior lecturer and researcher, University of Otago, Wellington.

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