Your back and how to look after it

Back pain is a very common condition, affecting four out of five people at some time in their lives.

It is often very difficult to say exactly what is causing the symptoms, which can make back pain sufferers frustrated and anxious.

It is rarely due to any serious injury or disease, but commonly due to strain of a muscle, tendon or ligament.

Occasionally, symptoms can be felt travelling into the buttock or further down into the leg. This is commonly referred to as ‘sciatica’ and is sometimes caused by irritation of the nerve travelling into the leg.

Common factors contributing to lower back pain include:

  • weak muscles
  • lack of mobility leading to stiffness
  • muscle strain/ligament sprain.
  • psychological factors such as worries and mood
  • lifestyle factors such as sleep and general fitness

Do I need to see a healthcare professional?

As back pain is usually caused by a non-serious problem, it is not normally necessary to see a healthcare professional.

If the correct advice is followed, the symptoms should ease within six to eight weeks.

Contact your healthcare professional if you:

  • have unexpectedly lost weight recently
  • have constant night pain
  • are feeling generally unwell
  • have a new onset of severe back pain while ill with other problems such as cancer or rheumatoid arthritis
  • have severe pain that is getting worse or has not improved within six to eight weeks.

When to seek help urgently

Cauda equina syndrome

Many patients have a combination of back pain, leg pain, leg numbness and weakness.

These symptoms can be distressing for you but don’t necessarily require emergency medical attention.

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.

Warning signs for Cauda Equina Syndrome include:

  • new pain or symptoms going down both legs
  • numbness in or around your anus or buttocks
  • altered feeling when using toilet paper to wipe yourself
  • increasing difficulty when you try to pee
  • increasing difficulty when you try to stop or control your flow of pee
  • loss of sensation when you pee
  • leaking pee or recent need to use pads
  • not knowing when your bladder is either full or empty
  • inability to hold on when you need to poo or leaking
  • loss of sensation when you poo
  • loss of sensation in genitals during sexual intercourse

If you experience any of these symptoms suddenly, please go to your nearest emergency department (A&E) immediately.

Watch this video for more information about when you should seek urgent help for your backpain

This information can be found in different languages at this website https://www.macpweb.org/Cauda-Equina-Information-cards

How can I reduce the pain myself?

Pain relief

Simple off-the-shelf anti-inflammatories (such as ibuprofen) can be used to control your pain.

If you have concerns about taking them, check with the pharmacist prior to taking them and always follow the recommended dose on the packet.

Try to take them before the pain gets too bad, but try to use the lowest effective dose for the shortest amount of time possible and discontinue if they do not help relieve your symptoms.

If you are unable to take simple anti-inflammatories or if you have stomach problems or any other issues while taking over-the-counter pain medication, stop taking them and consult your pharmacist or GP.

If these medications do not help, your GP may be able to prescribe alternative medications.

Stay active and exercise

Physical activity is beneficial for everybody, and this is still the case when you have back pain.

It is important that you remain active. Research has shown that bed rest does not help back pain and can make it worse.

Inactivity can lead to joint stiffness and muscle weakness, which can contribute to ongoing pain.

Although exercise can make your back feel a bit sore at first, starting slowly and gradually building up exercise levels can make the back stronger and more flexible, and hopefully help to reduce your pain.

Using pain relief can help you control your pain, allowing you to do more in terms of exercise. Exercise can also release endorphins, which are hormones that can act as your body’s natural pain relief.

Examples of good forms of exercise to start with include:

  • walking
  • swimming
  • cycling
  • low impact gym work
  • pilates and yoga

Ice or heat

If your back pain started recently, or is a flare-up of a long standing problem, using ice may help reduce pain and inflammation.

Wrap some ice in a damp tea towel and apply to the area for 10 to 20 minutes. You can repeat this every two to three hours.

After a few days, you may then find it more beneficial to use gentle heat in the form of a hot water bottle or wheat pack in order to help relax the muscles of the back.

To help protect your skin when applying heat, wrap your hot water bottle in a towel or similar.

Apply for 10 to 15 minutes three to four times a day.

Do not apply ice or heat directly to the skin.

Do not use ice or heat if there is reduced sensation in the area you are applying it to.

Posture

Staying still or maintaining the same position for a long period can make your back pain worse.

Movement is important to prevent static muscle loading, joint stiffness and muscular fatigue.

Recent research has shown that there is not necessarily one ideal posture to help prevent or relieve back pain, as we all come in different shapes and sizes and are affected by back pain in different ways.

It may be more helpful to consider comfort and function:

  • am I comfortable?
  • if not what could I do to make myself more comfortable?
  • am I able to do what I need to do?

At work

When you are working, look at your workstation to make sure it is suitable for you.

This may be even more relevant since the Covid-19 pandemic with more people working flexibly from home or remotely.

  • is your computer monitor at eye level?
  • is your keyboard or laptop close to you?
  • is your chair at an appropriate height?
  • are you able to adjust your working position, for example standing?

If your employer offers workplace assessments, this may be beneficial as they may be able to provide equipment such as a standing desk or adjustable chairs.

Make sure you get up and move regularly.

  • if you work in a job that involves a lot of standing, are you able to sit occasionally to change position?

Bending and lifting

It is a commonly held belief that bending can cause or increase back pain but this is not necessarily correct.

The spine and surrounding soft tissues are strong structures that are ‘designed’ to bend and straighten.

However, repetitive heavy or awkward lifting can contribute to back pain.

During an episode of back pain, you may want to avoid heavy lifting for a short period until your pain improves.

As your pain improves it is important to return to lifting gradually if possible. Planning the task and pacing yourself by taking regular breaks may also help.

Commonly people are taught to lift while avoiding bending the back to reduce the risk of back pain, but evidence supporting this is limited. In fact there is some evidence showing that increased lumbar flexion (bending) is not associated with lower back pain in manual workers.

When lifting, you may want to consider:

  • the task- what does it involve and how will I carry it out
  • the load- is it too heavy or big to lift on your own?
  • the environment- do you need to step or lean over anything to lift- if so can you change this to make it easier
  • can you use equipment to help you lift?
  • when lifting multiple loads (for example shopping bags), try to split the loads evenly each side.

Pacing activities

Try breaking up activities and take short rest breaks during a task or activity rather than pushing through the pain to get things done.

Driving

If you are driving, plan your journey. If it is a long drive, allow time for regular breaks to get out of the car and walk a little to change position.

Try adjusting your car seat, steering column and mirrors so you feel as comfortable as possible.

Treatment

By following the advice given on this page, the majority of people should be able to effectively manage back pain resulting in a significant reduction of symptoms within six to eight weeks.

However, if symptoms do not improve, you may require further medical treatment.

GetUBetter app

If you have a smart phone or computer, you can use the getUBetter app to help you self-manage your back pain. The app includes videos of exercises that you can follow to help with new or recurrent problems.

Information about the getUBetter app

Physiotherapy

If your back pain is not resolving with self-management, you may be referred to your local physiotherapy service by your healthcare practitioner.

The physiotherapist will ask about your symptoms and assess your back, and if appropriate, treat it with the best techniques that they feel can help.

This may involve exercises and manual therapy, also known as ‘hands-on’ treatment, and advice on how to best manage your pain.

Complementary medicine

Although not supported by the latest research, complementary medicine such as acupuncture, massage therapies and homeopathy can also be used to reduce back pain.

Some physiotherapists are trained in acupuncture and may use it as part of their evidence-based treatment if it is deemed appropriate.

Treatment from a chiropractor or osteopath

Treatments from a chiropractor or osteopath are not usually provided by the NHS. However, some people find them helpful and pay for treatment privately.

A chiropractor or osteopath can also provide hands-on treatment in the form of spinal manipulations and soft tissue techniques.

Evidence suggests that hands-on treatment may be helpful for temporary symptom relief but this is usually more effective when combined with exercise.

Steroid injections

Steroid injections may be used to treat leg pain (sciatica) if symptoms are severe and persist despite the use of other treatments.

Steroid injections usually consist of a combination of anaesthetic and steroids which can be injected near a nerve root that may be the source of symptoms.

Surgery

In very rare cases (1 to 2 per cent in the UK) people with specific spinal conditions may require surgery for their symptoms.

This may include planned surgery such as for spinal stenosis or nerve root irritation, or emergency surgery if bladder, bowel or leg control is lost.

Can I continue working? When can I return to work?

Whether you can continue working or return to work can depend on the severity of your symptoms, the type of job you do and the tasks that are involved.

Try to stay at work if you can manage your pain and function effectively – this can help you recover faster.

If you do need time off, aim to return to work as soon as you can.

The pain does not have to be completely resolved before returning to work. A sore back may limit you with some tasks, but you are likely to be able to manage other tasks without aggravating your pain.

You may need to discuss with your employer the option of lighter duties or a phased return to your normal workload for a short period.

If there is an occupational health service that you can access through your employer, they will be able to help you with your return to work and any adaptations that could be made to help your return.

Do I need to have a scan or X-ray?

Current national guidelines encourage healthcare practitioners to use a ‘wait and see’ approach when diagnosing back pain and deciding whether any further investigations are needed. Most cases of back pain resolve on their own or by following the advice given on this page.

If symptoms are ongoing, an assessment by a GP or physiotherapist may be required.

Back pain can be managed well without the need for a scan or X-ray.

If your healthcare practitioner feels that there is an underlying ‘cause’ to your back pain or the symptoms have been ongoing for a long time without improving, you may be referred for a scan such as a Magnetic Resonance Imaging (MRI) scan.

Spinal MRI patient advice leaflet from BestMSK Health Collaborative

There are limitations to scans and X-rays for back pain:

  • scans don’t show pain – they only show structures such as soft tissue, joints, bones and organs
  • scans are rarely needed for people with back and neck pain
  • scans are more useful for investigating the potential causes of spinal-related leg pain, such as sciatica
  • X-rays are rarely used to investigate back pain as they only show the bones and would expose you to unnecessary radiation
  • our spines naturally age as we do, so many changes on scans such as ‘bulging discs’ are normal and may not be related to your symptoms

When might a scan be useful?

  • to see if it is suitable for you to have specific treatment, such as a nerve root block when you have been diagnosed with sciatica or nerve root pain

Image of a patient advice leaflet called BestMSK Spinal MRI

Why does back pain become persistent or chronic?

Persistent or ‘chronic’ pain is a term that is often used by medical professionals to describe pain that persists for several months or even years.

It is often not clear why back pain becomes a persistent problem.

Even if a structural cause can be found, such as disc or facet joint degeneration, or muscle or ligament strain, pain may continue after the original problem has settled.

When you are experiencing pain, your natural reaction may be to avoid normal movements and activities.

However, this can lead to muscles becoming weaker and joints becoming stiffer, which can make you more susceptible to further problems. This is commonly known as deconditioning.

The neural pathways and pain receptors within the brain can also become used to experiencing pain, which can lead them to be more sensitive to stimulation that otherwise would not cause pain.

A person’s mood and emotional wellbeing can also impact upon the severity and duration of pain. For example, your pain may be more severe during or following a particularly stressful time.

Living with chronic pain can affect many aspects of your life, such as work, social activities and relationships. It can have an effect on how you live your life, as you may start avoiding doing the things that you enjoy doing.

However, this can lead to further deconditioning, making the chronic pain cycle worse.

It is important to try and stay as active as you can when the pain first begins. This will avoid deconditioning and pain becoming persistent.

Recovery – the good news!

For the majority of people, the chance of recovery from back pain is good, with 75 to 90 per cent recovering within weeks.

Back pain can return, especially as we get older, but this can be managed each time effectively by following the advice given on this page.

Back exercises

The following exercises are examples of simple exercises that can help stretch and strengthen your back, improve confidence, keep you moving and hopefully help reduce your pain.

The repetitions are given as a guideline only – do more or less as you feel your symptoms can tolerate.

1. Lumbar rotation

Lie on the floor or a firm bed on your back.

Gently rotate your bent knees from side to side, holding the stretch for 10 seconds before rotating to the other side. Repeat five to 10 times on each side.

Bring the top knee higher and add pressure towards the floor with your hand to increase the stretch.

2. Knee hugs

Lie on the floor or a firm bed on your back.

Hug one knee in towards your chest and hold for 10 seconds, then repeat with the other leg. Repeat five to 10 times on each side.

Progress by hugging both knees at the same time. If you have knee problems, you can hold the thighs behind the knees.

3. Bridging

Lie on the floor or a firm bed on your back with your knees bent.

Squeeze your buttocks gently and lift the pelvis and lower back.

Hold in this position for 5 seconds and then gently lower.

You can use your arms on either side of you to add support or have them on your pelvis to progress.

4. Cat stretch

Kneel with your hands positioned under your shoulders and your back straight.

Arch your back towards the ceiling and hold for five to 10 seconds, then lift your head and arch your back down towards the floor and hold for five to 10 seconds.

5. Child’s pose

While kneeling, sit your bottom back towards your ankle as far as possible.

Stretch your arms out in front of you as far as comfort allows. Hold for 10 to 20 seconds.

Progress by stretching more to one side and then the other. Repeat 5 to 10 times.

6. Standing exercises

Rotate your upper body round to one side. Hold for 5 seconds and repeat to the other side.

Slide one hand down the outside of the thigh as far as possible, hold for 5 seconds and then repeat on the other side.

Place your hands on the top of your buttocks. Gently arch your back as far as comfort allows. Hold for 5 seconds then return to the starting position. Repeat 5 to 10 times

Specific Back Conditions

For further information about specific conditions affecting your spine, please see the links below: