What is low back pain?

Back pain is a very common problem, with 1 in 6 Australians reporting having back problems. About 4 out of 5 people have low back pain at some time in their lives.

People experience low back pain in different ways — most feel pain, stiffness and soreness.

• Some people say it feels like a sharp pain; other people report dull aches or spasms.
• You may feel stiff or find it hard to turn or bend in certain directions.
• If you have sciatica, the pain can travel down one or both of your legs.

Back pain can impact you physically and mentally. Some people with low back pain may feel irritable or short-tempered. You may worry about whether the pain will control your life and you may experience feelings of helplessness.

What causes low back pain?

Your spine or backbone is a complex structure. It is made up of 24 small bones called vertebrae that are stacked on top of each other. Discs sit between each vertebra to act as cushions or shock absorbers and give your spine flexibility.

The vertebrae are joined together by small joints called ‘facet’ joints. These joints allow you to move and bend your back. A mesh of ligaments and muscles hold the spine together and provides structural support, which allows you to move.

Back pain can come from any of these structures, but in most cases, back pain doesn’t result from any significant damage to your spine. Back pain usually stems from the surrounding muscles, ligaments or joints and occasionally spinal disc problems.

Back pain that is related to a serious medical problem (such as cancer, infection, a spinal fracture or conditions such as ankylosing spondylitis) is uncommon.

Non-specific low back pain

About 8 in 10 people have back pain that is not caused by any particular condition — this is called ‘non-specific low back pain’.

Non-specific low back pain is most common in people aged 35 to 55 years, but it can affect people of all ages.

Risk factors for non-specific low back pain include:

• heavy physical work
• frequent twisting, bending or lifting
• poor posture
• weakness in back and abdominal muscles
• sitting too long — for example, sitting in an office environment
• too little physical activity
• being overweight

When should I see my doctor?

You should see your doctor or other health care professional for further advice if:

• your pain bothers you
• your back pain doesn’t improve after a few weeks or gets worse
• you have symptoms such as weight loss, tingling or numbness in the legs, or problems with bladder and/or bowel control
• you have osteoporosis

You should see your doctor as soon as possible if you:

• have a history of cancer
• are prone to infection
• use intravenous drugs

How is low back pain diagnosed?

Your health professional will first assess your back pain. They may ask questions including:

• When did your back pain begin?
• Where is the pain?
• What activities were you doing differently before your back pain started?
• How would you describe the pain?
• Is there tingling or numbness?
• What makes the pain better or worse?
• Do you have pain elsewhere, such as in your legs?

They will also ask how the pain makes you feel and if it is affecting your daily activities.

Your doctor will also ask about your other health conditions and do a physical examination. They may refer you for tests. Tests can include blood tests or imaging tests.

In most situations, imaging such as x-ray, CT scans or MRI scans are not helpful, unless there is an obvious injury or strain. Unnecessary imaging tests can be expensive. Many investigations will show changes in your spine that reflect the normal passage of time, rather than damage to your spine.

How is low back pain treated?

You can do several things to manage back pain. A conversation with your doctor or physiotherapist can help address any concerns you may have and help you to better understand your treatment.

Remember that not all information is trustworthy, so let your healthcare team know about any treatments you are considering before you begin them.

Most people with non-specific low back pain get better quickly. Ways to manage non-specific low back pain include the following.

Keeping active

Try to return to some physical activity or regular work as soon as you can. Your back is designed to move, so don’t rest your back for more than a day or 2.

Physiotherapy

A qualified physiotherapist can assess your pain. They can provide massage and suggest exercises to keep your back moving.

They may also suggest heat or cold packs to relieve back pain.

Exercise

Exercise can help manage back pain. Walking, water-based walking (in a pool), swimming and floor stretches are good choices to start with.

The frequency and intensity of exercises can be increased over time. You may start squats or lunges, or programs such as:

• yoga
• Pilates
• cycling

Check with your doctor or physiotherapist if you are not sure about which exercises are best.

Losing weight

If you are overweight, losing weight can help relieve low back pain.

Pain relief medicines

The goal of taking medicines for back pain should be to help you stay active. Use pain-relief medicines to keep moving, not to stop the pain altogether.

Non-steroidal anti-inflammatory drugs (NSAIDs) can provide short-term relief of non-specific low back pain, but side effects may be a concern. If NSAIDs (such as ibuprofen) are not suitable, you can try paracetamol.

If you take pain-relief medicines to manage back pain, use the lowest effective dose for the shortest time possible. For some people, topical NSAIDs (such as a gel formulation) may be a safer option than NSAIDs in tablets.

Strong pain medicines are not recommended for back pain. Research shows strong pain medication provides little benefit and can cause side effects such as drowsiness, sedation and/or dependence.

If you have severe back pain and your current medicine is not adequately managing it, talk to your doctor about a suitable treatment plan.

Psychological treatments

Your doctor may also recommend psychological treatment if they think it will help with your recovery. This may be cognitive behavioural therapy to help you develop coping strategies to manage pain.

How can back pain be prevented?

Healthy lifestyle choices can help prevent some types of back pain.

Exercise can help prevent non-specific low back pain. Keeping a healthy weight is also important.

Doing exercise helps to keep your back flexible and strong. Exercise improves your posture and helps your muscles to support your spine. Try:

• low-impact aerobic exercise, such as walking, tai chi or swimming
• strengthening exercises, such as lifting weights
• stretching exercises, such as Pilates and yoga

Maintaining a good posture is important when you sit at home, in your workplace, or in your car.

• Try not to slouch.
• Use equipment that supports your back, such as a lumbar support or footstool if you need.

Practise safe lifting in your home or workplace. Whenever you pick up a heavy load, squat down, hold the object close to your body, and lift with your legs.

It may also help to make healthy lifestyle choices.

• Quit smoking, as smoking is associated with low back pain.
• Learn relaxation techniques and mindfulness, which can help to reduce stress and muscle tension in your back.

Complications of back pain

The good news is that most people recover from non-specific low back pain within a few weeks. See your doctor if you experience additional symptoms, such as:

• loss of bowel and/or bladder control
• severe pain that gets worse instead of better over time
• problems with passing urine or bowel movements
• numbness or a ’pins-and-needles’ sensation in your legs, back or elsewhere
• unexplained weight loss

For some people, back pain becomes an ongoing problem. Possible complications associated with persistent, long-term back pain include:

• depression
• dependence on strong pain medicines, such as opioids
• reduced quality of life
• difficulty working and keeping active

See your healthcare professional if your back pain is unresolved and limits your movement and activities. A health care professional can help you find ways to manage your pain and regain a better quality of life.