Back pain

Back pain, usually in the lower back, is a common problem. Fortunately, there are many things that can be done to recover and reduce the chance of pain returning, including keeping active and maintaining good posture.

See your doctor immediately if you:
  • You have any weakness in your lower legs
  • Develop any bowel or bladder problems (such as incontinence, when you pee or poo unexpectedly)
  • Have numbness over your buttocks or anal region (back passage)

What causes back pain?

Most back pain is not due to any serious injury or disease. Rather they are the result of bending, twisting, lifting and other mechanical actions we put our backs through on a daily basis. Poor posture, lack of physical activity or incorrect lifting can make you prone to back problems.

If your back pain is not improving, other possible causes include:

  • Back injuries – usually from lifting, sports or accidents at work or home.
  • Slipped or ruptured disc – a problem with one of the rubbery cushions or discs between the individual bones in your spine.
  • Osteoarthritis – this is the most common type of arthritis that occurs when the when the protective cartilage on the ends of your bones wears down over time.
  • Spondylolisthesis – this is a slipping of one vertebra on the other, often at the base of the spine.
  • Spinal curvature disorders – such as lordosis, kyphosis or scoliosis which are abnormal curvatures of the spine.
  • Spinal stenosis – rarely, the spinal canal (the space around spinal cord) narrows, resulting in back pain.
  • Ankylosing spondylitis – this is a type of arthritis of the spine.

Is your back pain acute or chronic?

Back pain can start suddenly after a specific activity or movement, or it can come on slowly over a few days or weeks.

  • Short term (acute) back pain is often caused by simple muscle strains or spasms. It usually lasts less than 3 months, after which normal function returns. Usually about 8 in every 10 first-time low back pain episodes get better within 6 weeks.
  • Long term (chronic) back pain develops over time and lasts more than 3 months. This is less likely to be linked to tissue damage or injury. It may be due to a long-term condition of the spine or to inappropriate activation of pain sensing areas in the brain.

Should I avoid activity if I have back pain?

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, avoid bed rest. This does not help and can make symptoms worse. Keep as active as you can whilst avoiding any heavy lifting or twisting movements because keeping active will:(2)

  • prevent the joints in your spine from getting stiff. Stiff joints can become more painful
  • keep your muscles strong
  • reduce the severity of your pain
  • help you feel more positive
  • enable you to be able to return to work more quickly.

When to see your doctor about back pain

You should see your doctor or physiotherapist if you have back pain which is not getting better after a few weeks of trying simple exercises and following the tips for a healthy back below.

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:

  • 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.

Treatment options for back pain

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

  • assess your back and pinpoint where any problem areas may be
  • identify actions or habits that may be adding to your pain
  • provide you with exercises and advice to reduce pain and prevent further episodes.

If your back is uncomfortable, regular pain relief such as paracetamol can help. However, if you have severe pain or any of the red flags listed above, see your doctor straight away.

Tips for a healthy back

What we do day to day is very important to help keep our backs strong and supple. Three tips for healthy backs:

  1. Keep active – regular exercise such as walking, swimming and dancing are excellent.
  2. Maintain good posture – sit up straight and review how you sit or relax.
  3. 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, 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 – the more overweight someone is, the more strain this put on all their joints, muscles and back.
  • Avoid activities that cause sudden movements.
  • Review your footwear – flat shoes with good arch support and cushioning can help.
  • Manage stress, mood and anxiety – these can increase muscle tension and back pain. 

Ask your physiotherapist or health provider what preventive exercises and stretches are best for you.

Learn more

Back pain Ministry of Health (NZ)
How physio can help back pain Physiotherapy New Zealand
Back pain – range of resources Medline Plus (US)

References

Know your back North American Spine Society
Low back pain Oxford University Hospitals Trust, NHS, UK

Credits: Health Navigator Editorial Team. Reviewed By: Rebecca Grainger, Hutt Valley DHB (24 February 2017)