Lower back pain
Lower back pain is very common. Almost two out of three of us have pain in the lower back at some time in our lives. The cause isn’t normally serious and most of the time the pain improves within four to six weeks. But for some people, it can continue for months or even years.
You can often manage lower back pain yourself. But with some symptoms, you may need to see a physiotherapist
About your back
Your back has many connected parts, including bones, joints, muscles, ligaments, nerves and tendons. Your spine supports your back. It’s made up of 24 separate bones called vertebrae stacked on top of one another. Below the vertebrae, at the bottom of your spine, are the bones in your sacrum and coccyx. Between the vertebrae, discs act as shock absorbers and allow your spine to bend. Your spinal cord threads through the vertebrae, carrying nerve signals between your brain and the rest of your body. The spinal cord runs as far as your lower back, then continues as a bunch of nerves. This is called the ‘cauda equina’, Latin for ‘horse’s tail’, which it’s thought to resemble. It’s usually difficult for doctors to say exactly what’s causing back pain. This is because there are so many different parts to your back and tissues that surround it..
Symptoms of lower back pain
The symptoms of lower back pain can vary from person to person. It may come on suddenly, perhaps after you’ve lifted something heavy or moved in a way that’s hurt your back. Or it may come on gradually over time or for no apparent reason. The pain can be mild or severe. Some people also have pain in the buttock or down one leg, sometimes as far as the calf or the toes. This is called sciatica.
Most people with back pain symptoms have what’s called non-specific back pain. This means there’s no clear or specific cause (such as an underlying medical condition). It means that often tests can’t really help because no specific damage to the spine or muscles around it would show up on them. This might sound unsettling, but it means that there’s no serious cause for the pain.
When to get medical help and advice
Nine out of 10 people find their lower back pain improves within four to six weeks. You may find that you feel better sooner than this, in a few weeks. But contact your GP if the pain is severe, getting worse over time or isn’t improving after four to six weeks. Also, contact your GP urgently if you feel unwell or have a high temperature. And if you have had cancer or osteoporosis, your GP may want to check that there isn’t a more serious cause.
Seek medical attention right away if you:
- have numbness or tingling around your bottom or genitals
- can’t control when you pee or can’t go at all
- lose control of your bowels
- are unsteady when you walk, your legs feel weak or your foot is dropping or dragging
These may be signs that the nerves at the bottom of your spine are being squashed. This is called cauda equina syndrome and needs urgent treatment.
Causes of lower back pain
Non-specific back pain
This is by far the most common type of back pain. Your doctor is unlikely to be able to tell you exactly what’s causing the pain, but it’s not usually due to a serious problem. It’s mostly caused by a simple strain of the muscles, tendons or ligaments around your back, but no one knows for sure.
A specific event or movement may have started your back pain. Perhaps you were straining, twisting or lifting something heavy. Or it may have come on gradually. In some people it’s linked to repetitive tasks at work or sitting in one position for a long time. You are also more likely to have lower back pain if you are overweight. Back pain may happen as a result of the normal ‘wear and tear’ on the bones of your spine as you get older. Poor posture can put stress on the muscles around your spine. Back pain may be caused by a combination of several factors, including emotional ones.
Specific back pain
Sometimes, back pain is caused by damage to parts of your spine, including:
- a slipped (herniated) disc – a disc bulges and presses on your spinal nerves
- a fracture – a crack or break in one of the bones in your back, perhaps due to osteoporosis
- inflammatory lower back pain, caused by a condition such as ankylosing spondylitis, when your immune system causes inflammation in the spinal joints and ligaments
Back pain can also be caused by a serious condition such as an infection or cancer, but this is very uncommon.
Diagnosis of lower back pain
Your physiotherapist or GP will usually be able to diagnose lower back pain from your symptoms and by examining you. A physiotherapist is a healthcare professional who specialises in maintaining and improving movement and mobility. You may want to go straight to see a physiotherapist.
Prevention of lower back pain
If you know how to look after your back, you can greatly reduce your risk of getting back pain. It can help to do the following.
- Exercise regularly – walking, swimming or using an exercise bike are all things you can do even if your back feels a bit sore. Take time to build up your fitness if you’re trying new activities.
- Use your legs to lift objects by bending your knees and hips, not your back.
- Keep a good posture – if you work at a desk, make sure your chair, desk and computer screen are set up correctly. It will help if your employer assesses your work station.
- Move regularly – don’t sit in the same position for long periods of time.
Treatment options for lower back pain
Your physiotherapist will probably encourage you to try self-help measures. They can also advise you on what exercises you can do to help your back.
Your GP may recommend physiotherapy for lower back pain. This might include:
- exercises involving physical activity, movement, muscle strengthening, controlling posture and stretching
- Manual physiotherapy, such as massage or spine manipulation