Lumbago (low back pain)
Back pain is a common problem that affects most people at some point in their life.
It may be triggered by bad posture while sitting or standing, bending awkwardly, or lifting incorrectly. It’s not generally caused by a serious condition.
In most cases, back pain will improve in a few weeks or months, although some people experience long-term pain or pain that keeps coming back.
Types of back pain
Backache is most common in the lower back ('lumbago'), although it can be felt anywhere along your spine, from your neck down to your hips.
Sometimes, back pain can be caused by an injury or disease, such as:
a slipped disc – when one of the discs in the spine is damaged and presses on the nerves
sciatica – irritation or compression of the sciatic nerve, which causes pain, numbness and tingling that travels down one leg
whiplash – neck injury caused by a sudden impact
frozen shoulder – inflammation around the shoulder that causes pain and stiffness
ankylosing spondylitis – a long-term condition that causes pain and stiffness where the spine meets the pelvis
The rest of this information will focus on back pain that doesn’t have an obvious cause. Doctors call this “non-specific back pain”.
What to do
Most cases of back pain get better on their own and you may not need to see a doctor.
If you’ve only had back pain for a few days or weeks, the following advice may help relieve your symptoms and speed up your recovery:
remain as active as possible and try to continue with your daily activities
take over-the-counter painkillers, such as paracetamol or ibuprofenif you feel you need to
use hot or cold compression packs – you can buy these from your local pharmacy, or a bag of frozen vegetables and a hot water bottle will work just as well
Although it can be difficult to be cheerful or optimistic if you are in pain, it’s important to stay positive because this can help you recover faster.
Treatments for long-term back pain
If you’re worried about your back or your pain hasn’t improved by around six weeks, it’s a good idea to visit your GP, who can advise you about the treatments available.
exercise classes – where you are taught specific exercises to strengthen your muscles and improve your posture
manual therapy, such as physiotherapy, chiropractic or osteopathy
counselling, such as cognitive behavioural therapy (CBT)
support and advice at a specialist pain clinic
Some people choose to see a therapist for manual therapy or acupuncture without seeing their GP first. If you want to do this you will usually need to pay for private treatment, which is likely to cost around £30-50 for each appointment.
Spinal surgery is usually only recommended when all else has failed.
Preventing back pain
How you sit, stand, lie and lift can all affect the health of your back.
Try to avoid placing too much pressure on your back and ensure it's strong and supple. Regular exercise, such as walking and swimming, is an excellent way of preventing back pain.
Activities such as yoga or pilates can improve your flexibility and strengthen your back muscles.
Signs of a serious problem
You should seek urgent medical help if you have back pain and:
a high temperature (fever)
unexplained weight loss
a swelling or a deformity in your back
it’s constant and doesn't ease after lying down
pain in your chest
a loss of bladder or bowel control
an inability to pass urine
numbness around your genitals, buttocks or back passage
it's worse at night
it started after an accident, such as after a car accident
These problems could be a sign of something more serious and need to be assessed as soon as possible.
Causes of back pain
Your back is a complex structure made up of bones, muscles, nerves and joints. This can often make it difficult to pinpoint the exact cause of the pain.
Most cases of back pain aren't caused by serious damage or disease but by minor sprains, strains or injuries, or a pinched or irritated nerve.
These types of back pain can be triggered by everyday activities at home or at work, or they can develop gradually, over time. Possible causes of back pain include:
bending awkwardly or for long periods
lifting, carrying, pushing or pulling heavy objects
slouching in chairs
driving or sitting in a hunched position or for long periods without taking a break
overusing the muscles – for example, during sport or repetitive movements (repetitive strain injury)
Back pain sometimes develops suddenly for no apparent reason. For example, you may wake up one morning with back pain and have no idea what's caused it.
Who's most at risk?
Certain things can increase your chances of developing back pain. These include:
being overweight – the extra weight puts pressure on the spine; you can use the BMI healthy weight calculator to find out if you need to lose weight
smoking – this may be due to tissue damage in the back caused by smoking or the fact that people who smoke tend to have unhealthier lifestyles than people who don't smoke
being pregnant – the extra weight of carrying a baby can place additional strain on the back
long-term use of medication known to weaken bones – such ascorticosteroids
being stressed or depressed
In a few cases, your symptoms may suggest a specific medical condition is causing your back pain. For example:
pain in your lower back associated with pain, numbness and a tingling sensation that travels down one leg may be a symptom ofsciatica or a slipped or prolapsed disc
joint pain (including in the back) when walking and stiffness first thing in the morning are symptoms of arthritis – if the pain and stiffness take more than 30 minutes to resolve on waking up, or seem to start when you stop to rest after exercise, make sure you mention this to your GP
shoulder pain and stiffness, which makes it difficult to dress, drive or sleep, may be a sign of frozen shoulder
neck pain and stiffness, headaches and back pain following an accident can be symptoms of whiplash
Rarely, back pain can be a sign of a serious condition such as a spinal fracture, an infection of the spine, or cancer.
If you see your GP with back pain, they will look for signs of these conditions.
Diagnosing back pain
Most cases of back pain do not require medical attention and can be treated with over-the-counter painkillers and self-care.
However, you should visit your GP if you are worried about your condition or struggling to cope with the pain.
Seeing your GP
Your GP will ask you about your symptoms and examine your back.
The examination will usually assess your ability to sit, stand, walk and lift your legs, as well as testing the range of movement in your back.
Your GP may also ask you about any illnesses or injuries you may have had, as well as the type of work you do and your lifestyle. Below are some of the questions your GP may ask. It might help to think about these before your appointment..
When did your back pain start?
Where are you feeling pain?
Have you had back problems in the past?
Can you describe the pain?
What makes the pain better or worse?
What happens next
If your GP thinks there may be a more serious cause, they will refer you for further tests, such as an X-ray or magnetic resonance imaging (MRI) scan.
Otherwise, your GP can advise you about things you can do and treatments that may help reduce your pain and speed up your recovery.
Treating back pain
Treatments for back pain vary depending on how long you have had the pain, how severe it is, and your individual needs and preferences.
Short-term back pain
Initially, back pain is usually treated with over-the-counter painkillers and home treatments. Most people will experience a significant improvement in their symptoms within six weeks.
It used to be thought that bed rest would help you recover from a bad back, but it's now recognised that people who remain active are likely to recover more quickly.
This may be difficult at first if the pain is severe, but try to move around as soon as you can and aim to do a little more each day.
Activity can range from walking around the house to walking to the shops. You will have to accept some discomfort but avoid anything that causes a lot of pain.
There is no need to wait until you are completely pain-free before returning to work. Going back to work will help you return to a normal pattern of activity, and it can distract you from the pain.
Paracetamol is often one of the first medications recommended for back pain, although some people find non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, more effective. A stronger painkiller, such as codeine, is also an option and is sometimes taken in addition to paracetamol.
Painkillers can have side effects, some can be addictive and others may not be suitable, depending on your health and medical history. For example, the long-term use of NSAIDs can affect how well your kidneys work.
Your pharmacist or GP will be able to give you advice about the most appropriate type of medication for you.
If over-the-counter medications are not controlling your pain, your GP may be able to prescribe something stronger. They may also recommend a short course of a muscle relaxant, such as diazepam, if you experience muscle spasms in your back.
Hot and cold treatments
Some people find that heat – for example, a hot bath or a hot water bottle placed on the affected area helps ease the pain.
Cold, such as an ice pack or a bag of frozen vegetables, placed on the painful area can also be effective. Don't put the ice directly on to your skin though, as it might cause a cold burn. Wrap an ice pack or bag of frozen vegetables in a cloth before putting it on your skin.
Another option is to alternate between hot and cold using ice packs and a hot water bottle. Hot and cold compression packs can be bought at most pharmacies.
Relax and stay positive
Trying to relax is a crucial part of easing the pain because muscle tension caused by worrying about your condition may make things worse.
Although it can be difficult, it's also important to stay optimistic and recognise that your pain should get better because people who manage to stay positive despite their pain tend to recover quicker.
Change your sleeping position
Changing your sleeping position can take some of the strain off your back and ease the pain.
If you sleep on your side, draw your legs up slightly towards your chest and put a pillow between your legs. If you sleep on your back, placing pillows under your knees will help maintain the normal curve of your lower back.
Exercise and lifestyle
Try to address the causes of your back pain to prevent further episodes. Common causes include being overweight, poor posture and stress.
Regular exercise and being active on a daily basis will help keep your back strong and healthy. Activities such as walking, swimming andyoga are popular choices. The important thing is to choose an enjoyable activity that you can benefit from without feeling pain.
Long-term back pain
If you have had back pain for more than six weeks (known as chronic back pain), your GP will advise you about which painkillers to take and may recommend:
Exercise classes – group classes supervised by a qualified instructor, where you are taught exercises to strengthen your muscles and improve your posture, as well as aerobic and stretching exercises.
Manual therapy – therapies including manipulation, mobilisation and massage, usually carried out by chiropractors, osteopaths orphysiotherapists (although chiropractic and osteopathy aren't widely available on the .
Acupuncture – a treatment where fine needles are inserted at different points in the body.
These treatments are often effective for people whose back pain is seriously affecting their ability to carry out daily activities and who feel distressed and need help coping.
There is also some evidence that a therapy called the Alexander technique may help people with long-term back pain, although the National Institute for Health and Care Excellence (NICE) does not currently recommend this treatment.
If painkillers do not help, you may be prescribed tricyclic antidepressants (TCAs), such as amitriptyline. TCAs were originally intended to treat depression, but they are also effective at treating some cases of persistent pain.
If you are prescribed a TCA to treat persistent back pain, the dose is likely to be very small.
If the treatments described above are not effective, you may be offered psychological therapy to help you deal with your condition.
While the pain in your back is very real, how you think and feel about your condition can make it worse. Therapies such as cognitive behavioural therapy (CBT) can help you manage your back pain better by changing how you think about your condition.
If you have long-term pain, you may be able to attend a specialist pain clinic.
Pain clinics help people manage their pain and provide advice about things such as increasing your activity level and how to have a better quality of life despite being in pain.
Your programme may involve using a combination of group therapy, exercises, relaxation and education about pain and the psychology of pain.
Surgery for back pain is usually only recommended when all other treatment options have failed or if your back pain is so severe you are unable to sleep or carry out your daily activities.
The type of surgery suitable for you will depend on the type of back pain you have and its cause.
Two procedures sometimes carried out include:
a discectomy – where part of one of the discs between the bones of the spine (the vertebrae) is removed to stop it pressing on nearby nerves (known as a slipped or prolapsed disc)
spinal fusion – where two or more vertebrae are joined together with a section of bone to stabilise the spine and reduce pain
These procedures can help reduce pain caused by compressed nerves in your spine, but they are not always successful and you may still have some back pain afterwards.
As with all types of surgical procedures, these operations also carry a risk of potentially serious complications. In some cases, nerves near the spine can be damaged, resulting in problems such as numbness or weakness in a part of one or both legs or, in rare cases, some degree of paralysis.
Before you agree to have surgery, you should fully discuss the risks and benefits with your surgeon.
Treatments not recommended
A number of other treatments have sometimes been used to treat long-term back pain, but are not recommended by The National Institute for Health and Care Excellence (NICE) because of a lack of evidence about their effectiveness in treating non-specific back pain (back pain with no identified cause).
low level laser therapy – where low energy lasers are focused on your back to try to reduce inflammation and encourage tissue repair
interferential therapy (IFT) – where a device is used to pass an electrical current through your back to try to accelerate healing while stimulating the production of endorphins (the body’s natural painkillers)
therapeutic ultrasound – where sound waves are directed at your back to accelerate healing and encourage tissue repair
transcutaneous electrical nerve stimulation (TENS) – where a machine is used to deliver small electrical pulses to your back through electrodes (small sticky patches) that are attached to your skin; the pulses stimulate endorphin production and prevent pain signals travelling from your spine to your brain
lumbar supports – cushions, pillows and braces used to support your spine
traction – where a pulling force is applied to your spine
injections – where painkilling medication is injected directly into your back
Preventing back pain
Keeping your back strong and supple is the best way to avoid getting back pain. Regular exercise, maintaining good posture and lifting correctly will all help.
If you have recurring back pain, the following advice may be useful:
lose weight – too much upper body weight can strain the lower back; you can use the healthy weight calculator to find out whether you need to lose weight
wear flat shoes with cushioned soles as they can help reduce the pressure on your back
avoid sudden movements which can cause muscle strain
try to reduce any stress, anxiety and tension, which can all cause or worsen back pain –
stay active – regular exercise, such as walking and swimming, is an excellent way of preventing back pain (see below)
Exercise is both an excellent way of preventing back pain and of reducing it, but should seek medical advice before starting an exercise programme if you've had back pain for six weeks or more.
Exercises such as walking or swimming strengthen the muscles that support your back without putting any strain on it or subjecting it to a sudden jolt.
Activities such as yoga or pilates can improve the flexibility and the strength of your back muscles. It's important that you carry out these activities under the guidance of a properly qualified instructor.
Below are some simple exercises you can do several times a day at home to help prevent or relieve back pain.
Bottom to heels stretch – kneel on all fours, with your knees under hips and hands under shoulders. Slowly take your bottom backwards, maintaining the natural curve in the spine. Hold the stretch for one deep breath and return to the starting position. Repeat eight to 10 times.
Knee rolls – Lie on your back and place a small flat cushion or book under your head. Keep your knees bent and together, then roll them to one side while keeping both shoulders on the floor. Hold the stretch for one deep breath and return to the starting position. Repeat eight to 10 times, alternating sides.
Back extensions – Lie on your stomach, and prop yourself on your elbows. Arch your back up by pushing down on your hands. Breathe and hold for five to 10 seconds. Return to the starting position. Repeat eight to 10 times.
Stop these exercises immediately if they make your pain worse.
How you sit, stand and lie down can have an important effect on your back. The following tips should help you maintain a good posture.
Stand upright, with your head facing forward and your back straight. Balance your weight evenly on both feet and keep your legs straight.
Make sure you sit upright with support in the small of your back. Your knees and hips should be level and your feet should be flat on the floor (use a footstool if necessary). Some people find it useful to use a small cushion or rolled-up towel to support the small of the back.
If you use a keyboard, make sure that your forearms are horizontal and your elbows are at right angles.
Make sure that your lower back is properly supported. Correctly positioning your wing mirrors will prevent you from having to twist around. Your foot controls should be squarely in front of your feet.
If you are driving long distances, take regular breaks so you can stretch your legs.
Your mattress should be firm enough to support your body while supporting the weight of your shoulders and buttocks, keeping your spine straight.
If your mattress is too soft, place a firm board (ideally 2cm thick) on top of the base of your bed and under the mattress. Your head should be supported with a pillow, but make sure your neck is not forced up at a steep angle.
Lifting and carrying
One of the biggest causes of back injury, particularly at work, is lifting or handling objects incorrectly. Learning and following the correct method for lifting and handling objects can help prevent back pain. You should:
Think before you lift – can you manage the lift? Are there any handling aids you can use? Where is the load going?
Start in a good position – your feet should be apart, with one leg slightly forward to maintain balance; when lifting, let your legs take the strain – bend your back, knees and hips slightly, but do not stoop or squat; tighten your stomach muscles to pull your pelvis in; do not straighten your legs before lifting as you may strain your back on the way up.
Keep the load close to your waist – keep the load close to your body for as long as possible with the heaviest end nearest to you.
Avoid twisting your back or leaning sideways, particularly when your back is bent – your shoulders should be level and facing in the same direction as your hips; turning by moving your feet is better than lifting and twisting at the same time.
Keep your head up –once you have the load secure, look ahead, not down at the load.
Know your limits – there is a big difference between what you can lift and what you can safely lift; if in doubt, get help.
Push rather than pull – if you have to move a heavy object across the floor, it is better to push it rather than pull it.
Distribute the weight evenly – if you are carrying shopping bags or luggage, try to distribute the weight evenly on both sides of your body.
If your child needs to carry a bag to school, they should use a well-designed backpack that is worn over both shoulders. Avoid putting anything unnecessary in their bag to keep the weight to a minimum.