Back pain is a very common problem that affects 4 out of 5 people at some point in their life. It can be extremely painful and worrying, however is rarely due to anything serious. Often there is no damage present but back still hurts. It usually settles within 2-3 months, but a longer duration is not uncommon. Many people get recurring episodes but it does not mean you will always have back pain.

Useful links:

Back advice (video 1 minute)

Video exercises for back pain

10 Facts every person should know about back pain

Types of low back pain

Non-specific back pain

Vast majority (95 out of 100 people) will develop this type of back pain. We use the term ‘non-specific’ as it is impossible to put it down to one specific 'thing' (like joint, disc or muscle). There are lots of different factors unique to you that contribute to your pain.

Sciatica

Very few (5 out of 100 people) will suffer from sciatica. It is caused by irritation of nerve roots in your lumbar spine. Common symptoms of sciatica: back pain, leg pain, pins and needles and/or numbness in your leg.   

Serious pathology

Very rarely (less than 1 out 100 people) back pain is linked with serious problem (e.g. fractur, cancer, infection). It is important patients can recognise warning signs and seek urgent medical attention when these are present.

Contributing factors

Multiple factors contribute to your level of pain, including biological, psychological and social. They can influence each other, and how you feel. Addressing these is necessary for your recovery. It is important to note that a lot of times people experience pain with no damage or injury present. 

Contributing factors of back pain

Biological	Psychological	Social
Joints, discs, muscles etc. Age, gender Weight Smoking, drinking, drugs Sleep Other health conditions	Mood, emotions Anxiety, depression Stress Past experiences of pain Fear of movement Beliefs	Interactions with others Poor social support Workplace culture Poor relationships with family /partner/friends/colleagues

Scans and X-rays

• Are needed when a serious condition is suspected (e.g. cancer, fracture, infection) these occur in only 1% of all back pain patients.
• Will almost always show something – many of these findings are common in people with no pain.
• Will NOT identify the cause of pain in vast majority of patients.
• Are not as useful as detailed questions and physical examination.

Recovery

The people who recover quickest from back pain are those who stay active and get on with life despite some pain. With the right guidance and support, most people with back pain will recover without the need for medical help. Understanding back pain and what you can do to help yourself get better is an essential part of your recovery.

Recovery Do's and Dont's

Do's	Dont's
move normally stay active exercise regularly stay at work or return to work asap modify work activities when necessary reduce load and take frequent breaks take your usual painkillers try relaxation and mindfulness address other factors which may contribute to your pain (weight, diet, smoking)	rest in bed avoid lifting/bending/twisting avoid exercises stay off work for too long rely on belts/supports/corsets take stronger painkillers unless necessary

Warning signs 

Certain symptoms require an urgent, same day opinion. Delaying a medical assessment could seriously impact your long-term health. Seek help immediately if you have back and leg pain and any of the following symptoms:

• Loss of feeling or pins and needles between your inner thighs or genitals
• Numbness in and around the back passage or buttocks
• Altered feeling when using toilet paper to wipe yourself
• Increasing difficulty when you are trying to urinate
• Increasing difficulty when you try to stop or control the flow of urine
• 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 sexual intercourse

Certain symptoms require an urgent opinion but not necessarily the same day. Seek help quickly if you have any of the following symptoms:

• Back pain that is getting worse, is severe and is different to your "normal pain"
• Pain that spreads like a band around your body, stomach area or trunk, or that spreads into your lower back, buttocks, or legs
• Odd feelings in your legs with the feeling of unsteadiness
• Altered sensation/pins and needles in both legs/feet
• Difficulty walking and heaviness in your legs
• Back pain that stops you sleeping at night or gets worse when lying down
• Fever or chills that came on around the same time as your back pain
• Night sweats
• Back pain accompanied by sudden unexplained weight loss or a general feeling of being unwell
• Structural deformity – a change in the appearance of your back/spine

To learn more about warning signs watch the video here — Warning signs video.