Back pain

Back pain, usually in the lower back, is a common problem. 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. These include keeping positive and active.

Key points

  1. Most back pain is not serious and will improve over time.
  2. To help you recover more quickly, keep active and continue to move your back. It is fine to have some pain while moving.
  3. Keep doing your normal work or daily activities, or return to doing these as soon as you can.
  4. Use heat or ice packs, pain relief medication and exercise or massage if these reduce your pain.
  5. 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 (such as not being able to pee even though your bladder feels full, or you have incontinence when you pee or poo unexpectedly)
  • have numbness over your buttocks or anal region (back passage).

What are the symptoms of back pain?

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.

What causes back pain?

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.

Types of back pain

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.

Activity and 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, 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.

Things you should know

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 or 15 things you didn’t know about back pain.

What to do if you have back pain

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. You can use heat or ice packs, pain relief medication and exercise or massage if these reduce your pain. Read more about treatment options for back pain. 

Preventing back pain — tips for a healthy back

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.

When to see your doctor about back pain?

You should see your doctor 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.

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.

'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.

You should also see your doctor or physiotherapist if:

  • 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.

Learn more

Low back pain Pain Health, WA
10 things you need to know about your back CPS, UK
How physio can help back pain Physiotherapy New Zealand
Back pain – range of resources Medline Plus, US

References

  1. The principles of managing acute pain in primary care BPAC 2018
  2. Paracetamol is ineffective for acute and chronic low-back pain Goodfellow Gems
  3. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet 2018

Reviewed by

Dr Ben Darlow is a musculoskeletal physiotherapy specialist in private practice in Wellington and a senior lecturer and researcher in the Department of Primary Health Care and General Practice at the University of Otago, Wellington. 
Credits: Editorial team. Reviewed By: Dr Ben Darlow, musculoskeletal physiotherapy specialist in private practice, and a senior lecturer and researcher, University of Otago, Wellington. Last reviewed: 24 Sep 2018