Overview-Back pain
Back pain is very common and usually improves within a few weeks or months.
Pain in the lower back (lumbago) is particularly common, although it can be felt anywhere along the spine, from the neck down to the hips.
In most cases the pain is not caused by anything serious and will usually get better over time.
There are things you can do to help relieve it. But sometimes the pain can last a long time or keep coming back.
How to relieve back pain
The following tips may help reduce your back pain and speed up your recovery:
- stay as active as possible and try to continue your daily activities – this is 1 of the most important things you can do, as resting for long periods is likely to make the pain worse
- try exercises and stretches for back pain; other activities such as walking, swimming, yoga and pilates may also be helpful
- take anti-inflammatory painkillers, such as ibuprofen – remember to check the medicine is safe for you to take and ask a pharmacist if you're not sure
- use hot or cold compression packs for short-term relief – you can buy these from a pharmacy, or a hot water bottle or a bag of frozen vegetables wrapped in a cloth or towel will work just as well
Although it can be difficult, it helps if you stay optimistic and recognise that your pain should get better. People who manage to stay positive despite their pain tend to recover quicker.
Getting help and advice
Back pain usually gets better on its own within a few weeks or months and you may not need to see a doctor or other healthcare professional.
But it's a good idea to get help if:
- the pain does not start to improve within a few weeks
- the pain stops you doing your day-to-day activities
- the pain is very severe or gets worse over time
- you're worried about the pain or struggling to cope
If you see a GP they will ask about your symptoms, examine your back and discuss possible treatments.
They may refer you to a specialist doctor or a physiotherapist for further help.
Alternatively, you may want to consider contacting a physiotherapist directly. Some NHS physiotherapists accept appointments without a doctor's referral, or you could choose to pay for private treatment.
Treatments for back pain from a specialist
A GP, specialist or physiotherapist may recommend extra treatments if they do not think your pain will improve with self-help measures alone.
These may include:
- group exercise classes where you're taught exercises to strengthen your muscles and improve your posture
- manual therapy treatments, such as manipulating the spine and massage, which are usually done by a physiotherapist, chiropractor or osteopath
- psychological support, such as cognitive behavioural therapy (CBT), which can be a useful part of treatment if you're struggling to cope with pain
Some people choose to see a therapist for manual therapy without seeing a GP first. If you want to do this, you'll usually need to pay for private treatment.
Surgery is generally only considered in the small number of cases where back pain is caused by a specific medical condition.
Causes of back pain
It's often not possible to identify the cause of back pain. Doctors call this non-specific back pain.
Sometimes the pain may be from an injury such as a sprain or strain, but often it happens for no apparent reason. It's very rarely caused by anything serious.
Occasionally back pain can be caused by a medical condition such as:
- a slipped (prolapsed) disc – where a disc of cartilage in the spine presses on a nearby nerve
- sciatica – irritation of the nerve that runs from the pelvis to the feet
These conditions tend to cause additional symptoms, such as numbness, weakness or a tingling sensation, and they're treated differently from non-specific back pain.
Preventing back pain
It's difficult to prevent back pain, but the following tips may help reduce your risk:
- do regular back exercises and stretches – a GP or physiotherapist may be able to advise you about exercises to try
- stay active – doing regular exercise can help keep your back strong; adults are advised to do at least 150 minutes of exercise a week
- avoid sitting for long periods
- take care when lifting – read some safe lifting tips
- check your posture when sitting, using computers or tablets and watching television – find out how to sit correctly and get tips for laptop users
- ensure the mattress on your bed supports you properly
- lose weight through a combination of a healthy diet and regular exercise if you're overweight – being overweight can increase your risk of developing back pain
When to get immediate medical advice
You should contact a GP or NHS 111 immediately if you have back pain and:
- numbness or tingling around your genitals or buttocks
- difficulty peeing
- loss of bladder or bowel control – peeing or pooing yourself
- chest pain
- a high temperature
- unintentional weight loss
- a swelling or a deformity in your back
- it does not improve after resting or is worse at night
- it started after a serious accident, such as after a car accident
- the pain is so bad you're having problems sleeping
- pain is made worse when sneezing, coughing or pooing
- the pain is coming from the top of your back, between your shoulders, rather than your lower back
These problems could be a sign of something more serious and need to be checked urgently.
Causes-Back pain
It's not always possible to identify the cause of back pain but it's rarely anything serious.
Most back pain is what's known as "non-specific" (there's no obvious cause) or "mechanical" (the pain originates from the joints, bones or soft tissues in and around the spine).
This type of back pain:
- tends to get better or worse depending on your position – for example, it may feel better when sitting or lying down
- often feels worse when moving – but it's not a good idea to avoid moving your back completely, as this can make things worse
- can develop suddenly or gradually
- is sometimes the result of poor posture or lifting something awkwardly, but often happens for no apparent reason
- may be caused by a minor injury such as sprain (pulled ligament) or strain (pulled muscle)
- can be associated with feeling stressed or run down
- will usually start to get better within a few weeks
Medical conditions that cause back pain
Conditions that can cause back pain include:
- a slipped (prolapsed) disc (a disc of cartilage in the spine pressing on a nerve) – this can cause back pain and numbness, tingling and weakness in other parts of the body
- sciatica (irritation of the nerve that runs from the lower back to the feet) – this can cause pain, numbness, tingling and weakness in the lower back, buttocks, legs and feet
- ankylosing spondylitis (swelling of the joints in the spine) – this causes pain and stiffness that's usually worse in the morning and improves with movement
- spondylolisthesis (a bone in the spine slipping out of position) – this can cause lower back pain and stiffness, as well as numbness and a tingling sensation
These conditions are treated differently to non-specific back pain.
Very rarely, back pain can be a sign of a serious problem such as:
- a broken bone in the spine
- an infection
- cauda equina syndrome (where the nerves in the lower back become severely compressed)
- some types of cancer, such as multiple myeloma (a type of bone marrow cancer)
If you see a GP with back pain, they'll look for signs of these.
Treatment-Back pain
Back pain will usually improve within a few weeks or months. There are several things you can try to help reduce your pain in the meantime.
There are also some specialist treatments that may be recommended if it's thought simple measures are not likely to be effective on their own.
See a GP or a physiotherapist if your pain is not improving despite trying simple treatments.
Treatments you can try yourself
Stay active
One of the most important things you can do is to keep moving and continue with your normal activities as much as possible.
It used to be thought that bed rest would help you recover from a bad back, but it's now known that people who remain active are likely to recover quicker.
This may be difficult at first, but do not be discouraged – your pain should start to improve eventually. Consider taking painkillers if the pain is stopping you from carrying on as normal.
There's no need to wait until you're completely pain-free before returning to work. Going back to work will help you return to a normal pattern of activity and may distract you from the pain.
Back exercises and stretches
Simple back exercises and stretches can often help reduce back pain. These can be done at home as often as you need to.
For information about exercises and stretches that can help, see:
- back pain pilates workout video
- Versus Arthritis: exercises to manage back pain
A GP may be able to provide information about back exercises if you're unsure what to try, or you may want to consider seeing a physiotherapist for advice. Read about how to get access to physiotherapy.
Doing regular exercise alongside these stretches can also help keep your back strong and healthy. Activities such as walking, swimming, yoga and pilates are popular choices.
Painkillers
Non-steroidal anti-inflammatory drug (NSAID) tablets, such as ibuprofen, can help relieve back pain. Many types are available to buy from pharmacies or supermarkets without a prescription.
But NSAIDs are not suitable for everyone, so check the box or leaflet to see whether you can take the medicine first. Speak to a pharmacist if you're not sure.
If you cannot take NSAIDs, alternative medicines such as codeine may help. This is a stronger painkiller that should ideally only be used for a few days, as it can cause addiction if used for longer.
Paracetamol on its own is not recommended for back pain, but it may be used alongside stronger painkillers such as codeine.
Muscle relaxants may be prescribed by a GP if you have painful muscle spasms in your back.
Some muscle relaxants such as diazepam can make you feel drowsy, dizzy or caused blurred vision. Do not drive, cycle or operate machinery if you have these types of side effects.
Hot and cold packs
Some people find that heat (such as a hot bath or a hot water bottle placed on the affected area) helps to ease the pain when back pain first starts.
Cold (such as an ice pack or a bag of frozen vegetables) on the painful area can also help in the short erm. However, do not put ice directly on your skin, as it might cause a cold burn. Wrap an ice pack or bag of frozen vegetables in a cloth or towel first.
Another option is to alternate between hot and cold using ice packs and a hot water bottle. Hot and cold compression packs can be bought at most pharmacies.
Relax and stay positive
Trying to relax is a crucial part of easing the pain as muscle tension caused by worrying about your condition may make things worse.
Although it can be difficult, it helps to stay positive and recognise that your pain should get better. People who manage to stay positive despite their pain tend to recover quicker.
Specialist treatments
Exercise classes
A GP may suggest attending an NHS group exercise programme if they think it might help to reduce your pain.
These programmes involve classes, led by a qualified instructor, where you're taught a mix of exercises to strengthen your muscles and improve your posture, plus aerobic and stretching exercises.
Manual therapy
Manual therapy is the name for a group of treatments where a therapist uses their hands to move, massage and apply careful force to the muscles, bones and joints in and around your spine.
It's usually done by chiropractors, osteopaths or physiotherapists, although chiropractic and osteopathy are not widely available on the NHS.
Manual therapy can help reduce back pain, but it should only be used alongside other measures such as exercise.
There's also some evidence that a therapy called the Alexander technique may help with long-term back pain. However, the National Institute for Health and Care Excellence (NICE) does not currently recommend this treatment.
Psychological support
A GP may suggest psychological therapy, in addition to other treatments such as exercise and manual therapy.
Psychological therapies such as cognitive behavioural therapy (CBT) can help you manage your back pain better by changing how you think about your condition.
While the pain in your back is very real, how you think and feel about your condition can make it worse.
If you've been in pain for a long time, a specialist treatment programme that involves a combination of group therapy, exercises, relaxation, and education about pain and the psychology of pain may be offered.
Surgery and procedures
Surgery for back pain is usually only recommended if there's a specific medical reason for your pain, such as sciatica or a slipped (prolapsed) disc, and other treatments have not helped.
Nerve treatment
A procedure called radiofrequency denervation may sometimes be used if:
- you've had back pain for a long time
- your pain is moderate or severe
- your pain is thought to originate from the joints in your spine
The procedure involves inserting needles into the nerves that supply the affected joints. Radio waves are sent through the needles to heat the nerves, which stops them sending pain signals.
You're awake while the treatment is being done and local anaesthetic is used to numb your back. You will not need to stay in hospital overnight.
As with all procedures, radiofrequency denervation carries a risk of complications, including bleeding, bruising, infection and accidental nerve damage. Discuss the risks with your surgeon before agreeing to treatment.
Spinal fusion surgery
Spinal fusion surgery is another type of surgery for back pain. It may be recommended if there's significant damage to the bones in your back (vertebrae).
Spinal fusion surgery can be used to fuse 2 vertebrae together to strengthen them. This can also help to reduce any related nerve pain as it stops the damaged vertebrae squeezing the nerves that pass through the spine.
It's possible that this type of surgery could cause permanent damage to some of the nerves in your back. This may lead to some partial paralysis in your legs and bowel or urinary incontinence. This complication is estimated to happen in around 1 in every 200 procedures.
Treatments not recommended
A number of other treatments have sometimes been used for non-specific back pain (back pain with no identified cause) but are not recommended by the National Institute for Health and Care Excellence (NICE) because of a lack of evidence.
These include:
- belts, corsets, foot orthotics and shoes with "rocker" soles
- traction – the use of weights, ropes and pulleys to apply force to tissues around the spine
- acupuncture – a treatment where fine needles are inserted at different points in the body
- therapeutic ultrasound – where sound waves are directed at your back to accelerate healing and encourage tissue repair
- transcutaneous electrical nerve stimulation (TENS) – where a machine is used to deliver small electrical pulses to your back through electrodes (small sticky patches) attached to your skin
- percutaneous electrical nerve stimulation (PENS) – where electrical pulses are passed along needles inserted near the nerves in the back
- interferential therapy (IFT) – where a device is used to pass an electrical current through your back to try to accelerate healing
- painkilling spinal injections (although these can help if you have sciatica)