Overview

Low back pain

Low back pain is very common. More than 80 out of 100 people have this condition at some point in their life. It can be a cause of worry, disability and time off work.

Even though it can be distressing, low back pain is rarely linked with serious conditions. Most of the time, symptoms settle quickly. However, it's common to get pain that keeps returning. In some people, pain can last longer than a few weeks.

It's important to keep active. You might want to have physiotherapy and use exercises to help manage your pain.

Relaxation can also help to manage the pain and any associated stress or anxiety.

Types of low back pain

There are 3 types of low back pain.

Non-specific low back pain

This is the most common type of back pain. It is not possible to diagnose the exact cause of this back pain in most people. This is why the word 'non-specific' is used.

Sciatica (nerve root pain)

A small number of people (1 in 20 people with low back pain) get sciatica.

Sciatica is caused by physical or chemical irritation of one of the nerve roots in the lower back. It can cause leg pain. You might also have numbness or pins and needles in the leg.

Please speak to your physiotherapist for more information on sciatica.

Serious spinal pathology (red flags)

Less than 1 in 100 people with low back pain have symptoms that need urgent medical attention. These are known as red flag symptoms.

If you have any of these signs or symptoms, it is important that you tell your GP or another medical professional straight away.

  • You cannot have a pee (pass urine).
  • You have numbness around your genitals or bottom.
  • You have lost feeling in both of your legs, or you have pins and needles or numbness in both legs.
  • You have a history of cancer.
  • You have lost a lot of weight, with no explanation.
  • You have a high temperature (fever) or feel unwell.
  • You have had a trauma, or injury, in the past.

Your physiotherapist asks you questions and examines you to see if there is a more serious cause of your pain.

Causes of low back pain

There is no one cause of low back pain, but various things can contribute. These are called contributory factors. The factors are unique to you and your situation. 

Each of the factors is biological, psychological or social, or sometimes a mixture. They can all affect your pain.

Poor fitness and low levels of physical activity are associated with low back pain. Regular physical activity and better cardiovascular fitness are important for your general health. They help you to do daily tasks and leisure activities.

This is a biological factor.

Having less muscle strength can make daily tasks harder and contribute to low back pain. It is important to improve your muscle strength in your whole body. There is no one type of exercise that is better than another. The strength that you need depends on what you want to do.

This is a biological factor.

Everyone is built differently and there is no ideal amount of flexibility. It is important to build up enough mobility (movement) and flexibility to manage your daily routine.

This is a biological factor.

Sleep is an important part of feeling well and happy. Not having good sleep, or having disturbed sleep, can mean you do not get the rest you need. This can make it more difficult to manage your pain.

This is a biological, psychological and social factor.

There is a relationship between health conditions (such as diabetes, high blood pressure, respiratory and heart disease) and low back pain. Improving your overall health and how you manage other health conditions can have a positive impact on your back pain.

This is a biological, psychological and social factor.

When living with pain, it is normal to notice changes in your mood. Research has shown that pain and your emotional wellbeing are closely linked.

Your pain is a physical experience that can also be affected by anxiety and stress. For example, being worried, anxious or stressed can cause physical changes to your body (like your heart beating faster or sweaty hands). It can also increase your pain.

This is a psychological factor.

There is a link between being overweight and having low back pain.

This is a biological and social factor.

Smoking increases the risk of getting more than 50 serious health conditions, such as cancer, heart disease and a stroke. It is also linked to low back pain.

This is a biological and social factor.

There is no perfect posture. Having a particular posture does not cause low back pain. However, being in the same position for a long time can cause back pain.

This is a biological and social factor.

Your past experiences can affect how your body interprets pain and how you respond to it. Understanding this can help you make positive steps in your recovery.

This is a social factor.


Using X-ray or MRI scans for low back pain

X-rays are not needed to look into low back pain. They are only used if your medical team think that you might have a bone fracture.

MRI scans give a detailed picture of the spine. They might be used to look into low back pain. However, for most people with low back pain, MRI scans cannot find the cause of pain. They also do not reflect the amount of pain that people have. 

It's common to see age-related changes (to discs and joints) in people with and without back pain. This means that in most cases, MRI scans are not helpful. They rarely lead to a change in how low back pain is managed or improved outcomes.

It's more important that we ask detailed questions and do a physical examination.

Managing low back pain

Most people recover from an episode of low back pain in 6 to 8 weeks. However, it can be common for people to have pain that returns. 1 in 3 people have another episode of low back pain within 12 months.

For some people, low back pain can be a long-lasting condition. Having some of the contributory factors might put you at more risk of persistent pain.

Keeping as active as possible can help you to recover and do the things that are important to you. Resting and avoiding any painful activities for more than a day or 2 might actually make your pain last longer.

An important message is ‘hurt does not equal harm’. Painkillers and anti-inflammatory medicines (such as ibuprofen or naproxen) can help you to continue your usual activities.

Physiotherapy

If your low back pain continues after 6 to 8 weeks, you might have physiotherapy to help you manage.

Physiotherapy helps to find the main cause of your pain and plan your rehabilitation.

See more about exercises and physiotherapy for low back pain.

Relaxation

You may feel stressed, anxious or low when you have low back pain. These moods can make your pain feel worse.

Many people find that simple relaxation techniques help them to manage low back pain and stress that is linked to the pain.

Relaxation works better the more you do it. Try to make some time each day to practise relaxation if you find it helpful.

Other things might work better for you, such as reading, singing or lying in a hot bath.

If you find that your back pain affects your mental health as well as your physical health, talk to your physiotherapist or GP about what support you can get.

You can refer yourself for free, confidential talking therapies and specialist support to help you feel better in Croydon, Lambeth, Lewisham and Southwark.

Work

Staying at work, or returning to work quickly, has been shown to help people's recovery.

If your work involves activities that make your pain worse, it is important that you tell your work manager (or your occupational health department, if you have one). You can explain that you might need some help to continue with your work duties.

It might be possible to change your work activities in the short term to help you return to work sooner.

Keeping active for free (or reduced cost) locally

There are schemes in your local area to help you get active.

Useful sources of information

Versus Arthritis has information on back pain.

Chartered Society of Physiotherapy (CSP) has information on back pain and physiotherapy.

National Institute for Health and Care Excellence (NICE) has guidelines on diagnosing and managing low back pain and sciatica

Resource number: 4876
Last reviewed: December 2019
Next review: December 2022

Contact us

If you have any questions or concerns, please contact the physiotherapy department.

Phone: 020 7188 5094 Monday to Friday, 8.30am to 5pm.

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