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. Read more about chronic pain.

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, keep as active as you can whilst avoiding any heavy lifting or twisting movements. Avoid bed rest — this does not help and can make symptoms worse. 
Keeping active will:

  • 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.

Treatment options for back pain

Apply gentle heat

For back pain due to simple muscle strain or spasm, applying gentle heat (microwave heat bag, or a warm water bottle) can offer relief and help to ease pain during the first few weeks. 

Medications

Using a non-steroidal anti-inflammatory (NSAID) such as ibuprofen, naproxen or diclofenac can help to ease acute back pain, but they may not be suitable for everyone. Before taking NSAIDs, check with your pharmacist or doctor if they are suitable for you. It is best to take pain relief medication on a regular basis for 3 to 5 days, rather than using the medication only when the pain becomes unbearable.   

  • NSAIDs are not suitable for chronic back pain because of the harmful effects associated with their ongoing use.
  • Paracetamol has not been found to be effective for acute or chronic back pain. 
  • Opioids such as codeine, morphine, tramadol and oxycodone  are not recommended for chronic back pain because they have not been found to be more effective than other pain medications and have harmful side effects when used on an ongoing basis.

Exercise

Exercises can help to increase back flexibility, strengthen the muscles that support the back and may reduce the total duration of pain and prevent recurrent episodes. It can be challenging to exercise if you are in pain. If you do have pain, it is safe for you to exercise, as long as any pain or discomfort feels manageable and stable and does not get significantly worse. Recommended activities include those that involve strengthening and stretching, such as walking, swimming, use of a stationary bicycle, and low-impact aerobics. Avoid activities that involve twisting, bending, are high-impact, or make the back hurt more. If you get frequent episodes of low back pain, keep doing regular exercise to prevent new episodes.

Work

You can continue to work if you have low back pain, so long as it is possible to avoid prolonged standing or sitting, heavy lifting, and twisting, but you may need to stay home from work if your job does not allow you to sit or stand comfortably. While standing at work, stepping on a block of wood with one foot (and periodically alternating the foot on the block) may be helpful.

Physiotherapy

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.

Other treatments

There are a variety of other non-medicine-based treatment options to manage pain such as acupuncture, manipulation and massage. Before starting any treatment, talk to your doctor so that treatment options can be discussed and to ensure that a specific treatment option is suitable for you. Read more about non-medicine treatments for pain.

  • Acupuncture may be helpful for chronic back pain but it is not clear if acupuncture is helpful for people with recent-onset (acute) low back pain.
  • Massage or yoga was found to have greatest benefit in people with chronic back pain who expected to improve with these treatments.
  • Spinal manipulation may offer some relief and improved function in people with acute or chronic low back pain. 

Preventing back pain — tips for a healthy back

What we do day to day is very important to help keep our backs strong and supple. Here are a few things you can do to keep a healthy back and prevent back pain:

  • Keep active – regular exercise improves muscle strength and reduces pain and stiffness.
  • Maintain good posture – sit up straight and review how you sit or relax.
  • If you sit for long periods, raise your hips slightly higher than your knees by placing a slender pillow under your hips, and support the lower curve of your back with another pillow.
  • If you stand for long periods, place one foot on a stool. Change your position during the day by having both standing and sitting tasks, and take frequent breaks.
  • 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.
  • Don’t smoke, because nicotine decreases blood flow to your back. Injuries occur more often and healing takes longer 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 – 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.

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.

Learn more

Back pain Ministry of Health (NZ)
Back pain - disc problems Better Health Channel
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
Credits: Health Navigator Editorial Team. Reviewed By: Rebecca Grainger, Hutt Valley DHB (24 February 2017) Last reviewed: 19 Jun 2018