Back pain 

Back pain is very common and normally improves within a few weeks or months.

Pain in the lower back (lumbago) is particularly common, although it can be felt anywhere along the spine – from the neck down to the hips.

In most cases the pain isn't caused by anything serious and will usually get better over time.

There are things you can do to help relieve it. But sometimes the pain can last a long time or keep coming back.

  • How to relieve back pain

    The following tips may help reduce your backache and speed up your recovery:

    • stay as active as possible and try to continue your daily activities – this is one of the most important things you can do, as resting for long periods is likely to make the pain worse
    • try exercises and stretches for back pain; other activities such as walkingswimmingyoga and pilates may also be helpful
    • take anti-inflammatory pain killers, such as ibuprofen – remember to check the medicine is safe for you to take first and ask a pharmacist if you're not sure
    • use hot or cold compression packs for short-term relief – you can buy these from your local pharmacy, or a hot water bottle and a bag of frozen vegetables wrapped in a cloth will work just as well
    • Click here to learn about 'back pain myths'

    Although it can be difficult, it helps if you stay optimistic and recognise that your pain should get better, as people who manage to stay positive despite their pain tend to recover quicker.

    Download our patient leaflet - Back pain

  • When to get help and advice

    Back pain usually gets better on its own within a few weeks or months and you may not need to see a doctor or other healthcare professional.

    But it's a good idea to get help if:

    • the pain doesn't start to improve within a few weeks
    • the pain stops you doing your day-to-day activities
    • the pain is very severe or gets worse over time
    • you're worried about the pain or are struggling to cope

    You can see your GP, or alternatively, you may want to consider approaching one of the Camden MSK physiotherapists directly through our service - see how to see a Camden MSK specialist (link), or you could choose to pay for private treatment.

  • Treatments from a specialist

    Your GP, specialist or physiotherapist may recommend extra treatments if they don't think your pain will improve with self-help measures alone.

    These may include:

    • group exercise classes – where you're taught exercises to strengthen your muscles and improve your posture
    • psychological therapies, such as cognitive behavioural therapy (CBT) – this can be a useful part of treatment  especially if you're struggling to cope with the pain
    • occassionally (but not often) manual therapy – treatments such as manipulating the spine and massage, are offered by physiotherapists, or osteopaths but people usually need to make behavioural changes in addition to this

    Remember in Camden you can see a physiotherpist without seeing your GP first. If you would like to see a therapist for manual therapy only, you'll usually need to pay for private treatment.

    Surgery is generally only considered in the small number of cases where back pain is caused by a specific medical condition.

  • Causes of back pain

    Often it's not possible to identify the cause of back pain. Doctors call this "non-specific" back pain.

    Sometimes the pain may be a result of an injury such as a sprain or strain, but often it occurs for no apparent reason. It's very rarely caused by anything serious.

    Occasionally back pain can be due to a medical condition such as:

    • slipped (prolapsed) disc – where a disc of cartilage in the spine presses on a nearby nerve
    • sciatica – irritation of the nerve that runs from the pelvis to the feet

    These conditions tend to cause additional symptoms – such as numbness, weakness or a tingling sensation – and they're treated differently to non-specific back pain.

  • Preventing back pain

    It's difficult to prevent back pain, but the following tips may help reduce the risk of it coming back and minimising its severity:

    • do regular back exercises and stretches – your GP or a physiotherapist may be able to advise you about exercises to try
    • stay active – doing regular exercise can help keep your back strong; adults are advised to do 150 minutes of exercise a week
    • avoid sitting for too long when driving or at work
    • lose weight through a combination of a healthy diet and regular exercise if you're overweight – being overweight can increase your risk of developing back pain 
  • When to get immediate medical advice

    You should contact your GP or NHS 111 immediately if you have back pain and:

    • numbness or tingling around your genitals or buttocks
    • difficulty peeing
    • loss of bladder or bowel control
    • chest pain
    • a high temperature (fever) of 38C (100.4F) or above
    • unexplained weight loss
    • a swelling or a deformity in your back
    • it doesn't improve after resting or is worse at night
    • it started after a serious accident, such as after a car accident

    These problems could be a sign of something more serious and need to be checked urgently.

    It's not always possible to identify the cause of back pain but it’s rarely anything serious.

    Most back pain is what's known as "non-specific" (there's no obvious cause) or "mechanical" (the pain originates from the joints, bones or soft tissues in and around the spine).

    This type of back pain:

    • tends to get better or worse depending on your position – for example, it may feel better when sitting or lying down
    • typically feels worse when moving – but it's not a good idea to avoid moving your back completely, as this can make things worse
    • can develop suddenly or gradually
    • might sometimes be the result of poor posture or lifting something awkwardly, but often occurs for no apparent reason
    • may be due to a minor injury such as sprain (pulled ligament) or strain (pulled muscle)
    • can be associated with feeling stressed or run down
    • will usually start to get better within a few weeks

    Read about how to relieve back pain.

  • Medical conditions that cause back pain

    Conditions that can cause back pain include:

    • slipped (prolapsed) disc (a disc of cartilage in the spine pressing on a nerve) – this can cause back pain and numbness, tingling and weakness in other parts of the body
    • sciatica (irritation of the nerve that runs from the lower back to the feet) – this can cause pain, numbness, tingling and weakness in the lower back, buttocks, legs and feet
    • ankylosing spondylitis (swelling of the joints in the spine) – this causes pain and stiffness that's usually worse in the morning and improves with movement
    • spondylolisthesis (a bone in the spine slipping out of position) – this can cause lower back pain and stiffness, as well as numbness and a tingling sensation

    These conditions are treated differently to non-specific back pain. Click the links to find out more.

    Very rarely, back pain can be a sign of a serious problem such as:

    • a broken bone in the spine
    • an infection
    • cauda equina syndrome (where the nerves in the lower back become severely compressed)
    • cancer

    If you see your GP or Physiotherapist with back pain, they will look for signs of these.

    Back pain will usually improve within a few weeks or months. There are several things you can try to help reduce your pain in the meantime.

    There are also some specialist treatments that may be recommended if it's through simple measures aren't likely to be effective on their own.

    See your GP or a physiotherapist if your pain isn't improving despite trying simple treatments.

    The main treatments for back pain are described below. You can also read a summary of the pros and cons of back pain treatments, to compare the options.

  • Managing your back pain - things you can try

  • Stay active

    One of the most important things you can do is to keep moving and continue with your normal activities as much as possible.

    It used to be thought that bed rest would help you recover from a bad back, but it's now known that people who remain active are likely to recover more quickly.

    This may be difficult at first, but don't be discouraged – your pain will start to improve eventually. Consider taking painkillers if the pain is stopping you from carrying on as normal.

    There's no need to wait until you're completely pain-free before returning to work. Going back to work will help you return to a normal pattern of activity and may distract you from the pain.

  • Back exercises and stretches

    Simple back exercises and stretches can often help reduce back pain. These can be carried out at home as often as you need to.

    For information about the types of exercises and stretches that can help, see:

    Your GP may be able to provide information about back exercises if you're unsure what to try, or you may want to consider seeing a physiotherapist for advice. Read about how to find a physiotherapist.

    Doing regular exercise alongside these stretches can also help keep your back strong and healthy. Activities such as walkingswimmingyoga and pilates are popular choices.

    Download our patient leaflet - Exercises for acute lower back pain

  • Pain killers

    Non-steroidal anti-inflammatory drug (NSAID) tablets, such as ibuprofen, can help relieve back pain. Many types are available to buy from pharmacies or supermarkets without a prescription.

    But NSAIDs aren't suitable for everyone, so check the box or leaflet to see whether you can take the medicine first. Speak to a pharmacist if you're not sure.

    If you can't take NSAIDs, alternative medicines such as codeine may help. This is a stronger painkiller that should ideally only be used for a few days, as it can cause addiction if used for longer.

    Paracetamol on its own isn't recommended for back pain, but it may be used alongside stronger painkillers such as codeine.

    Muscle relaxants may be prescribed by your GP if you have painful muscle spasms in your back.

  • Hot and cold packs

    Some people find that heat – for example, a hot bath or a hot water bottle placed on the affected area – helps ease the pain when back pain first starts.

    Cold, such as an ice pack or a bag of frozen vegetables, placed on the painful area can also help in the short-term. However, don't put the ice directly on your skin, as it might cause a cold burn. Wrap an ice pack or bag of frozen vegetables in a cloth first.

    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 as muscle tension caused by worrying about your condition may make things worse.

    Read more about:

    Although it can be difficult, it helps if you stay optimistic and recognise that your pain should get better, as people who manage to stay positive despite their pain tend to recover quicker.

  • Specialist treatments

  • Exercise classes

    One of the team may suggest attending an NHS group exercise programme if they think it might help reduce your pain.

    These programmes involve classes led by a qualified instructor, where you're taught a mix of exercises to strengthen your muscles and improve your posture, as well as aerobic and stretching exercises.

  • Manual therapy

    Manual therapy is the name for a group of treatments where a therapist uses their hands to move, massage and apply careful force to the muscles, bones and joints in and around your spine.

    It's usually carried out by chiropractorsosteopaths or physiotherapists, although chiropractic and osteopathy aren't widely available on the NHS.

    Manual therapy can help reduce back pain, but it should only be used alongside other measures such as exercise.

    There's also some evidence that a therapy called the Alexander technique may help with long-term back pain, although the National Institute for Health and Care Excellence (NICE) doesn't currently recommend this treatment specifically.

  • Behavioural or psychological therapies

    Your GP or one of the Camden MSK team may suggest psychological therapy, in addition to other treatments such as exercise.

    Therapies such as cognitive behavioural therapy (CBT) can help you manage back pain better by shifting how you think about your condition.

    While the pain in your back is very real, how you think and feel about your condition can make it worse.

    If you've been in pain for a long time, a specialist treatment programme that involves a combination of group therapy, exercises, relaxation, and education about pain and the psychology of pain may be offered.

  • Surgery and procedures

    Surgery for back pain is usually only recommended if there's a specific medical reason for your pain, such as sciatica or a slipped (prolapsed) disc, and other treatments haven't helped.

    But a procedure called radiofrequency denervation may sometimes be used if:

    • you've had back pain for a long time
    • your pain is moderate or severe
    • your pain is thought to originate from the joints in your spine

    Your doctor will talk to you about what this procedure involves before going ahead.

  • Treatments not recommended

    A number of other treatments have sometimes been used for non-specific back pain (back pain with no identified cause), but aren't recommended by the National Institute for Health and Care Excellence (NICE) because of a lack of evidence.

    These include:

    • belts, corsets, foot orthotics and shoes with "rocker" soles
    • traction – the use of weights, ropes and pulleys to apply force to tissues around the spine
    • acupuncture – a treatment where fine needles are inserted at different points in the body
    • 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) attached to your skin
    • percutaneous electrical nerve stimulation (PENS) – electrical pulses are passed along needles inserted near the nerves in the back
    • interferential therapy (IFT) – where a device is used to pass an electrical current through your back to try to accelerate healing
    • painkilling spinal injections (although these can help if you have sciatica)
    • spinal fusion or disc replacement surgery
  • Sciatica

  • What is sciatica?

    Sciatica is the name given to any sort of pain caused by of the sciatic nerve.

    The sciatic nerve is the longest nerve in your body. It runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet.

    The pain of sciatica is usually felt in the buttocks and legs.

    Most people find it goes away naturally within a few weeks, although some cases can last for a year or more.

    When the sciatic nerve is irritated, it can cause:

    • pain
    • numbness
    • a tingling sensation that radiates from your lower back and travels down one of your legs to your foot and toes
    • weakness in the calf muscles or the muscles that move the foot and ankle

    The pain can range from being mild to very painful, and may be made worse by sneezing, coughing or sitting for a long period of time.

    While people with sciatica can also have general back pain, the pain associated with sciatica usually affects the buttocks and legs much more than the back.

  • Causes of sciatica

    In the vast majority of cases sciatica is caused by a slipped disc. A slipped disc occurs when one of the discs that sit between the bones of the spine (the vertebrae) "slips" and starts pressing on the nerves.

    It's not always clear what causes this to happen, although as you get older your discs become less flexible and more likely to be damaged. The good news is that most slipped discs resolve on their own but this can take some weeks or months.

    Less common causes include:

    • spinal stenosis – narrowing of the nerve passages in the spine
    • spondylolisthesis – when a vertebra slips out of position
    • a spinal injury or infection
    • a growth within the spine – such as a tumour
    • cauda equina syndrome – a rare but serious condition caused by compressed and damaged nerves in the spinal cord
  • Treating sciatica

    Most cases of sciatica pass in around six weeks without the need for treatment.

    A combination of things you can do at home – such as taking anti-inflammatory painkillers for any back pain, staying active and exercising, and using hot or cold packs – may help reduce the symptoms until the condition improves.

    Further treatment may be needed in some cases, such as:

    • an exercise programme under the supervision of a physiotherapist
    • injections of anti-inflammatory and painkilling medication into your spine
    • stronger painkiller tablets
    • manual therapy (treatments such as manipulating the spine and massage, usually carried out by physiotherapists, chiropractors or osteopaths)
    • psychological therapy and support

    In rare cases surgery may be needed to correct the problem in your spine.

  • Preventing sciatica

    You can minimise your risk of a further episode of sciatica by:

    • adopting a better posture and lifting techniques at work
    • stretching before and after exercise
    • exercising regularly