Back pain is very common affecting 4 out of 5 people at some stage of their life. The most common causes are sprains, muscle strains, minor injuries or a pinched or irritated nerve and will get better over 4-12 weeks. Key points to be aware of include:
- When you have back pain, AVOID bed rest. This does not help and can make you worse.
- Keep as active as you can, avoid heavy lifting or twisting movements
- See a doctor straight away if you have any weakness in your lower legs, develop any bowel or bladder problems (such as incontinence) or numbness over your buttocks and anal region.
- If you have chronic back pain (pain lasting 12 weeks or more) see your doctor or a physiotherapistl for a proper assessment.
- To prevent back pain - keeping active and good posture are two key activities you can do that help.
Lower back pain (of the lumbosacral spine) is the second most common cause of missed work. (The most common cause is the common cold!) It costs the country hundreds of millions of dollars a year through ACC payments, sick leave costs to businesses and the personal cost to individuals and families of lost income, pain and suffering!
Back pain can come on slowly over a few days or weeks or it can start suddenly from reaching or twisting. Simple muscle strains or spasms are usually the reason and tend to come right in a few weeks. This is known as acute or short term back pain and usually lasts less than three months, after which normal function returns.
Chronic (long term) back pain tends to develop over time, lasts more than three months and can cause ongoing physical, mental and social disabilities.
When to see a health professional
Although rare, back pain can be a sign of a more serious condition. If you experience any of the following symptoms with your back pain then please see a doctor urgently.
- You have tried simple measures like in the Back Pain video above for a few weeks and your pain is not getting better
- If you have any RED flags such as:
- Numbness in the groin
- 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.
Most back problems are not due to any serious injury or disease. Rather they are due to poor posture, lack of physical activity or incorrect lifting. If your back pain is not settling, some of the causes include:
- Poor posture - how we sit and how active we are has a big impact on our backs
- Back injuries - most often from lifting, sports, or accidents at work or home
- Herniated Disc - this can present with sciatica pain radiating down your buttock and thigh
- Ankylosing Spondylitis - this is a type of arthritis that causes back pain
- Osteoarthritis - this is the most common type of arthritis
- Spondylolisthesis - this is a slipping of one vertebra on the other, often at the base of the spine
- Spinal curvature disorders - some people develop lordosis, kyphosis or scoliosis due to misaligned curvature of the spine
- Spinal stenosis - rarely, the spinal canal narrows resulting in back pain
- Keep active - regular exercise such as walking, swimming, and dancing are excellent
- Good posture - sit up straight and review how you sit or relax.
- Take extra care with lifting - bend your knees, keep your head up, back straight and be sensible about what you lift given your age, size and general health.
If you have recurring back pain, here are some tips that can help:
- Keep active - people who do regular exercise have less back pain than those who are inactive
- Lose weight – the more overweight someone is, the more strain this put on all your joints, muscles and back.
- Avoid activities that cause sudden movements and muscle strain - squash and physical contact sports are less ideal as we get older
- Review your footwear - flat shoes with good arch support and cushioning can help.
- Manage stress, mood and anxiety - Low mood, anxiety and stress can all increase muscle tension and back pain. Find ways to manage these or talk with your doctor/nurse.
- Check with your physiotherapist or health provider what preventive exercises and stretches are best for you.
- Review the resources, videos and books on this page.
Recommended books and resources include:
- VIDEO - Healthy back at work - NHS Choices
- How to sit correctly - NHS Choices
- BOOK - Treat Your Own Back - Robin McKenzie
- The Pain Toolkit and website
- Factsheet - caring for acute back pain - ACC ( 2 pages)
Remember, if you have any of the Red Flag symptoms above, see a doctor straight away.
One of the most common treatments for back pain are exercises to improve posture, lifting, and other day to day activities. Physiotherapists specialize in function and movement and are able to assess your back, identify actions or habits that may be adding to your pain and provide you with exercises and advice to reduce pain and prevent further episodes.
- Pain Relief - regular pain relief such as paracetamol can help
- Self-help measures as above - Back pain is one of the most common reasons for time off work, but research shows that staying at work improves recovery... (you may need to modify some tasks).
- If you have severe pain or any of the red flags, see your doctor straight away
Resources you may find useful:
- Booklet - Taking care of your back - Physiotherapy NZ
- Treat Your Own Back - McKenzie Institute NZ
- Back Pain - Treatments - Best Health UK
- View Paul's story of how physiotherapy has helped reduce his pain
Red Flags 1:
- Unrelenting pain, or pain worse at night (supine)
- Age <20 years, or new back pain age >50 years
- History of cancer
- Systemic symptoms
- IV drug use
- Immunosuppression or steroids
- Widespread or progressive neurological deficit
Serious causes of acute low back pain are rare and include:
- Osteoporotic or trauma related vertebral fracture (4%)
- Cancer involving the lumbar spine (0.66%)
- Inflammatory disease such as ankylosing spondylitis (0.3%)
- Spinal osteomyelitis associated with IV drug use, urinary tract infection or skin infection (0.01%)
- Acute low back pain - Best Practice Journal - June 2009
- Back Pain - Range of Resources - Medline Plus
- Back Pain - the essentials - Best Health, UK