Lower Back Pain: Causes, Self-Care and When to Worry
Lower back pain is among the most common reasons people visit a doctor or miss work. At some point, around eight in ten adults will experience it. The reassuring news is that most episodes are not caused by serious disease and improve within a few weeks. The less reassuring news is that recurrences are common, so understanding what helps matters.
What causes it
In the large majority of cases, no single damaged structure can be pinpointed, and the problem is called non-specific low back pain. It usually involves strained muscles and ligaments, stiff or irritated joints and discs, often triggered by lifting, twisting, prolonged sitting or an unfamiliar activity. Contributing factors include poor fitness, weak core muscles, excess weight, smoking, stress, poor sleep and low mood.
More specific causes include:
- Disc problems. A bulging disc can press on a nerve root, causing sciatica: pain, tingling or numbness shooting down the leg, usually below the knee.
- Spinal stenosis. Narrowing of the spinal canal in older adults causes leg pain or heaviness on walking that eases with sitting or leaning forward.
- Osteoarthritis of the facet joints.
- Osteoporotic fractures.
- Inflammatory conditions, such as axial spondyloarthritis, in younger people.
- Rarely, infection, tumour or other disease.
Red flags that need urgent assessment
Seek immediate medical help if back pain is accompanied by:
- Numbness around the genitals or buttocks (saddle numbness)
- New difficulty passing urine or controlling the bladder or bowel
- Progressive weakness in one or both legs
- Fever, unexplained weight loss or a history of cancer
- Severe pain after a significant injury or fall, or in people with osteoporosis
- Intense night pain that is not eased by lying down
These can signal cauda equina syndrome, fracture, infection or malignancy, which need prompt treatment.
What helps in the first weeks
Stay active. Bed rest slows recovery. Gentle walking and returning to normal activities as soon as you can are the best early treatments.
Keep reading
The rest of this guide is free. Watch a short ad to unlock it and support independent health writing.
Preparing your ad…
Heat. A heat pack or warm shower eases muscle spasm and provides short-term relief.
Medicines. Simple analgesics help. Paracetamol has limited benefit for back pain, while anti-inflammatory drugs such as ibuprofen are more effective for many people, taken at the lowest dose for the shortest time and with food, if suitable for you. Strong opioids are not recommended for routine back pain. Always check with a doctor or pharmacist about what is safe for you, especially if you have kidney disease, stomach ulcers or asthma.
Keep moving gently. Changing position regularly, walking and light stretching all help. Sitting for long periods tends to worsen symptoms, so stand and move every 30 minutes.
Sleep position. Lying on your side with a pillow between the knees, or on your back with a pillow under the knees, can be more comfortable.
Physiotherapy and exercise
If pain lasts beyond a few weeks, supervised exercise is among the best-supported treatments. Programmes that combine strengthening of the abdominal and back muscles, flexibility and gradual aerobic activity reduce pain and prevent recurrence. Approaches such as yoga, tai chi and Pilates have good evidence for chronic back pain. Manual therapy, such as spinal manipulation or massage, may provide short-term relief as part of a wider plan.
Psychological factors
Fear of movement, stress and low mood can amplify and prolong pain. Cognitive behavioural approaches and pain education help people regain confidence, move more and cope better. Good sleep and managing worry matter as much as strengthening exercises.
Scans and procedures
Most people with back pain do not need an X-ray or MRI. Imaging often shows age-related changes that are also found in people without pain, and can lead to unnecessary worry or treatment. Scans are recommended when there are red flags or when symptoms persist and surgery or injection is being considered. Injections or surgery may help specific conditions, such as severe sciatica that has not improved after six to twelve weeks or spinal stenosis with disabling symptoms.
Prevention
- Stay physically active, and build walking, swimming or cycling into your week
- Strengthen your core and legs
- Lift by bending the knees and keeping the load close
- Maintain a healthy weight
- Set up your workstation so that your feet are flat and screen is at eye level
- Stop smoking, which impairs disc health
- Take breaks from prolonged sitting
The outlook
Most people recover substantially within six weeks, and the best predictor of a good outcome is staying active and positive. Persistent pain is common enough to need a longer-term plan, but it rarely means serious damage.
This article is for general information and is not a substitute for professional medical advice. If you are worried about your health or have symptoms, speak to a doctor or other qualified health professional.