Back pain is very common, affecting up to 8 out of 10 adults in the UK.
It can often be extremely painful and limits day-to-day life. It may cause hot, burning, shooting or stabbing pains in your back and legs. You may also get pins and needles.
Most episodes of back pain improve within 6 to 8 weeks. It can be as little as just a few days. In some people, symptoms go away and in others they can rumble on.
Managing your symptoms and returning to all normal activities is the key to a good recovery
- Lower back pain is rarely linked to serious disease or tissue damage.
- Clicking and creaking of the back is common and is rarely a sign of harm or damage.
- Backs do not ‘go out of place’ and discs do not ‘slip out’, your back is very strong and resilient!
- There is no one ideal posture, changing posture regularly will help symptoms.
- Your back can become healthier and stronger with regular movement and exercise.
- Treatments such as surgery, injections or strong pain medications and not very effective for most non-specific low back pain in the long term. They can also often have negative side effects.
- Even if you have had back pain for a long time, it can often improve with the right management – consistency is key!
- X-ray and scans are not usually needed to diagnose low back pain.
- X-ray and scans are not able to tell us how much pain you are experiencing.
- X-rays and scans often will identify normal age-related changes which are common finding, even in those that do not have low back pain and this will often not change the management of the condition.
- X-rays and scans are best used when there is suspicion of serious injury ie broken bone, or conditions such as cancer or infections.
Golden rules
(North of England Regional Back Pain Pathway 2018)
- Keep moving even if slowly at first
- Keep living and working normally
- Avoid bed rest during the day
- Exercise
- Don’t sit down for too long
- Stay active and remember to re-introduce activities like heavy lifting gradually
- Don’t be afraid to take simple painkillers
- Keeping your pain well controlled is an important part of managing your recovery.
- Taking regular medication does not mask pain, it helps you to stay active and will speed your recovery.
- If you are struggling with pain then you should contact a pharmacist or GP, they will be able to give you advice about which medication to use.
- Stay active
- When your back is sore, it is common to worry about making it worse. Remember your back may be sensitive, but it remains very strong. It is important to understand that pain does not equal harm and that doing more activity will help your recovery.
- Staying at work - Staying at work has been proven to help back pain and supports quicker recovery rates. In some cases, this is not possible, and you may require short-term adjustments of your work duties. If this is the case, please contact your employer to find out what options are available to you. If you are absent from work, it is important to have an achievable, timely return to work plan. Early return to work assists your recovery and reduces the chances of developing ongoing symptoms.
Doing things that you value the most helps you recover quicker from your flare-up. For example, walking the kids to school, going to work and enjoying hobbies.
- Exercise is very good for your back. All forms of light exercise (including walking, cycling, and swimming) are strongly linked with healthy backs. If you normally exercise regularly, try to build things back up. If you aren’t currently very active, choose something you think you would enjoy. Aim to continue exercising in the long term after your current back pain episode has eased.
- Improving your sleep and general health is also important for lower back pain.
If you see a health professional, they will examine you and ask you some important questions. Once confident there is no serious problem, they will often diagnose you with ‘non-specific’ lower back pain. ‘Non-specific’ means that there is not one structure or cause to your symptoms. In this case, you may not require an x-ray or scan.
More than 99% of lower back pain has no serious cause
Up to 40% of people with lower back pain also have related leg pain - sciatica. Leg pain tends to be the most troublesome symptom and there may be no back pain at all. For some people, sciatica improves in 6 to 12 weeks. 50% of people with acute sciatica report some improvement within 10 days. 75% report improvement within 4 weeks. Sciatica is caused by an irritation of a sciatic nerve. This runs from the lower part of the spine, down the back of the leg, to the foot. Although the nerve is sensitised, typically there’s nothing wrong with the nerve itself. The symptoms are temporary and mainly due to local inflammation.
- Seek advice if there has been significant trauma (fall from height) or a direct injury to the spine
- If you have severe pain and are unable to move your back at all due to pain
- Feel feverish or unwell with the onset of your back pain
- A rare but serious back condition, cauda equina syndrome, can lead to permanent damage or disability and will need to be seen by an emergency specialist spinal team. Please see below the warning signs for cauda equina syndrome and things to look out for. Should you have any combination of these symptoms seek help immediately:
- Loss of feeling/pins and needles between your inner thighs or genitals
- Numbness in or around your back passage or buttocks
- Altered feeling when using toilet paper to wipe yourself
- Increasing difficulty when you try to urinate or loss of sensation when you pass urine
- Leaking urine or recent need to use pads
- Not knowing when your bladder is either full or empty
- Inability to stop a bowel movement or leaking
- Loss of sensation when you pass a bowel motion
- Change in ability to achieve an erection or ejaculate
- Loss of sensation in genitals during intercourse
All you ever wanted to know about back pain (University of Limerick)
Simple, evidence-based advice on what to do, and what not to do to help deal with low back pain - https://www.rte.ie/brainstorm/2018/0203/937071-all-you-ever-wanted-to-know-about-back-pain/
Northumbria Healthcare's patient information leaflet on back pain
https://www.northumbria.nhs.uk/application/files
Northumbria Healthcare's video on back pain
https://www.youtube.com/watch?v=5gFFboq5VnM
Resources on back pain (NHS South Tees)
This really helpful catalogue of resources and wider reading can assist you in managing your low back pain effectively - https://www.southtees.nhs.uk/services/back-pain/back-pain-triage-and-treat/patient-information-educational-resources/
Simple exercises for back pain (Versus Arthritis)
A clear sheet with some exercises that you can try at home to help with the movement of your spine that some people find helpful for back pain - https://www.versusarthritis.org/media/21786/backpain-exercise-sheet.pdf
Information and advice on sciatica (NHS South Tees)
A simple explanation on what sciatica is and how it can be managed - https://www.southtees.nhs.uk/resources/10-sciatica-facts/
When to seek urgent help for your back pain
Information video from the Musculoskeletal Association of Chartered Physiotherapists - https://
Cauda equina syndrome
Written information cards (available in more than 40 languages) - www.
Help and support
- If after six weeks you have tried the advice and exercise suggested and your symptoms haven’t improved, a self-referral to NTIMS may be beneficial.
- Click here for self-referral