Back pain

Key points about back pain

  • Back pain can be scary, disabling and distressing.
  • It's common and usually occurs in the lower part of the back.
  • Most back pain isn't serious and will improve over time – each person's journey is different.
  • Most people will do well with self-care strategies, some will benefit from seeking help from a healthcare provider.
  • Rarely, back pain is a sign of a more serious problem. There are key signs to check for (see below). 
Man clutches sore back in pain while packing boxes
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Video : Physiotherapy advice on managing back pain

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(Chartered Society of Physiotherapy, UK, 2017)

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. Don't be concerned if you continue to have low level discomfort.
  • Sometimes back pain can last longer than 3 months (persistent back pain). This doesn't mean that there's a serious problem. Persistent pain also tends to get better over time. Read more about chronic pain.
  • It's not uncommon to have further episodes of back pain (recurrent back pain). This doesn't mean that your back hasn't 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's worse in your lower leg than your back (leg-dominant or radicular pain). This often resolves with time, but it's a good idea to see your healthcare provider to discuss whether specific medicines may be helpful.
  • If there's pressure on a nerve in your back, you may have weakness and numbness in one of your legs. This often resolves with time, but it's is a good idea to see your healthcare provider so they can assess your nerve function and help you decide whether any other treatment options are needed.

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.

Although rare, back pain can be a sign of a more serious condition 

You should go the the emergency department (ED) about your back pain if:

  • You had a trauma (eg, falling from a ladder or a car accident) that caused immediate pain.
  • You feel unwell with your back pain, eg with a fever or significant sweating that wakes you from sleep.
  • You're finding it difficult to pee (urinate) or control your bowel.
  • You have numbness (can't feel a pin prick) around your bottom or genitals.
  • You have numbness (can't feel a pin prick) or weakness in both legs.
  • You have sudden onset severe, steady, and worsening mid abdominal or upper back pain.

Video: When to seek urgent help for your back pain

This video may take a few moments to load.

(FisioCamera, UK, 2020)

Some types of back pain require specific care

You should go to your medical centre or GP clinic if:

 

  • You have redness or swelling on your back.
  • You have weakness or numbness (can't feel a pin prick) in your leg.
  • You have shooting pain in your calf that's worse than the pain in your back.
  • You have difficulty walking.
  • You have constant pain – especially at night.
  • Your pain is getting much worse, or spreading up your spine.
  • You have a rash in the same area as your pain.

Sometimes you need more support to manage your back pain 

See your healthcare provider or physiotherapist if:

 

  • Your back pain is severe, disabling or distressing
  • You're unable to work because of your pain.
  • You are worrying a lot about your back pain.
  • You have back pain that's not getting better after a few weeks of trying self-care. Read more about self-care for back pain.

Most back pain isn't 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 hasn't been any injury.

Sometimes back pain starts after you use your back differently or more than normal (eg, heavy lifting), this doesn't necessarily mean that you're injured. Back pain can also start after something traumatic like a fall or collision.

Ideas about back pain have changed a lot over recent years. It's 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 your back are actually not a problem – or are even good for it.

Examples include:

Infographic showing what won't injure your back

Image credit: Healthify He Puna Waiora

Read more by clicking on the links below:

Most people do well with self-care strategies. Here are some things you can do:

  • Build a positive mindset.
  • Regain confidence to move.
  • Stay active
  • Set goals.
  • Be kind to yourself.
  • Stay involved.
  • Apply heat.
  • Use medicines carefully.
  • Seek care if needed.

You should seek health care if:

  • your symptoms haven't started getting better within a few weeks
  • you develop symptoms of serious or specific types of back pain (do self check again – see above)
  • you're concerned about your back and worrying about it a lot
  • you can't control your pain enough to get on with life.

Read more about all of these self-care strategies on the back pain self-care page. 

If self-care approaches are not working, you may need to approach your healthcare provider or physiotherapist for assessment and advice. 

Assessment will include:

  • asking questions about what has happened for you
  • a physical examination to assess your movement and function
  • rarely, imaging tests (eg, X-ray, MRI or CT) may be done to help identify the cause of your pain
  • discussions about your options. 

Treatment for back pain can include:

  • activity and self-care for physical and mental health
  • physiotherapy
  • medicines for pain
  • non-medicine treatments, eg, acupuncture, manipulation and massage.

More information about all of these can be found on the back pain treatment page. 

Video showing simple back exercises to help prevent aches and pains.

(Chartered Society of Physiotherapy, UK, 2017)

Video: Back stretches

(NHS, UK, 2020)

Links to more videos for treating back pain

Back care classes(external link) NHS, UK
These set of 6 classes focus on a variety of movements to help improve strength and flexibility of muscles that support the back
Exercises for back pain(external link) Chartered society of physiotherapists, UK
Back pain pilates video workout(external link) NHS, UK
This video demonstrates pilates exercises that are suitable for those with chronic back pain.

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 healthcare provider to explore with you the types of movements and activities that are best for you.

Low back pain(external link) Pain Health, Australia
Low back pain clinical care guidelines for consumers(external link) Australian Commission on Quality and Safety in Health Care, Australia
10 things you need to know about your back(external link) CPS, UK
How physio can help back pain(external link) Physiotherapy NZ
Back pain – range of resources(external link) Medline Plus, US

Brochures

Common questions about back pain(external link) Australian Commission on Safety and Quality in Health Care, Australia
Back exercises(external link) NHS, UK
What is back pain?(external link) National Institute of Arthritis and Musculoskeletal and Skin Disease English(external link), Chinese(external link), Korean(external link), Vietnamese(external link)
10 facts about back pain(external link) LaFisiotherapia.net
15 things you didn't know about back pain(external link) Irish Independent, 2015
Back pain – imaging tests(external link) Choosing Wisely, NZ, 2016
Caring for your...Short term low back pain (acute)(external link) ACC NZ
Knowing about your low back pain  [PDF, 155 KB]ACC NZ
10 things you need to know about your back(external link) Chartered Society of Physiotherapy UK
Back pain – imaging tests(external link) Choosing Wisely, NZ 

Books

Back Up(external link) by Liam MAnnix 

Apps/tools

Back and neck exercise apps

References

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

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Ben Darlow, musculoskeletal physiotherapy specialist in private practice; Associate Professor and researcher, University of Otago, Wellington.

Last reviewed: