How to manage back pain 

Back pain is a common complaint with a variety of causes. It usually improves on its own.

What exactly is low back pain? {#introduction}

When to get immediate medical advice

Causes of back pain {#causes}

Medical conditions that cause back pain

How to relieve back pain {#treatment}

Getting help and advice

Treatments from a specialist

Treatments not recommended for back pain

How to prevent back pain

Key points

## What exactly is low back pain? {#introduction}

Back pain is particularly common and it can be felt anywhere along the spine – from the neck down to the hips. However, it most commonly affects the lower back.

In many cases the pain is not 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.

## When to get immediate medical advice

You should contact your doctor 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](/health-library/symptoms/chest-pain)
- a high temperature (fever)
- unexplained weight loss
- a swelling or a deformity in your back
- it does not improve after resting, is worse at night or does not improve within 3 to 4 weeks or gets worse over time
- it started after a serious accident, such as after a car accident
- the pain is so bad, you are having problems sleeping and/or doing your daily activities
- it is made worse when sneezing, coughing or pooing
- it is coming from the top of your back, between your shoulders, rather than your lower back
- you are worried about the pain or struggling to cope

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


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## Causes of back pain {#causes}

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)](/health-library/conditions/sprains)
- 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](/health-library/symptoms/back-pain/#treatment).


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## Medical conditions that cause back pain

Conditions that can cause back pain include:

- a [slipped (prolapsed) disc](/health-library/conditions/slipped-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](/health-library/conditions/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](/health-library/conditions/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](/health-library/conditions/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](/health-library/conditions/cauda-equina-syndrome) (where the nerves in the lower back become severely compressed)
- [cancer](/self-care/cancer)

If you see a doctor with back pain, they will look for signs of these.


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## How to relieve back pain {#treatment}

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

However the following tips may help reduce your backache and speed up your recovery.

### Stay active

Stay as active as possible and try to continue your daily activities. It used to be thought that bed rest would help you recover from a bad back, but it is now known that people who remain active are likely to recover more quickly.

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

There is no need to wait until you are 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. If you need adjustments to your work environment to make it easier to work with back pain, contact your occupational health or human resources department.

### Try 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.

Your doctor will be able to provide information about back exercises if you are unsure what to try, or you may want to consider seeing a physiotherapist for advice.

Take care to avoid doing things that make your back worse, such as heavy lifting, sitting for long periods of time, or bending or twisting your back until the pain gets better.

### Take painkillers as needed

Non-prescription painkillers, such as paracetamol or [non-steroidal anti-inflammatory drugs (NSAIDS](/health-library/drugs/anti-inflammatories-non-steroidal)[)](/health-library/drugs/anti-inflammatories-non-steroidal), can help to relieve back pain. You can buy these from a pharmacy, supermarket or high-street chemist without a prescription. However, paracetamol and NSAIDS are not suitable for everyone, so check the box or leaflet to see whether you can take the medicine first. Speak to a pharmacist if you are not sure.

Applying a warm compress to your back can also provide short-term relief from pain. You can buy warm heat patches from your local pharmacy, but  a hot water bottle will work just as well.

If your pain does not improve with non-prescription painkillers and heat, your doctor may also prescribe a muscle relaxant or a stronger type of painkiller. If your doctor prescribes a strong painkiller or muscle relaxant, they will usually only give you a short course as you can become dependent on these medicines if you take them for a long period of time.

### Relax and stay positive

Trying to relax is a crucial part of easing the pain because muscle tension caused by worrying about your condition may make things worse.

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


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## Getting 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 does not 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 doctor, who will ask about your symptoms, examine your back, and discuss possible treatments. They may refer you to a specialist doctor or a [physiotherapist](/health-library/treatments/physiotherapy) for further help.

Alternatively, you may want to consider approaching a physiotherapist directly. Read more about [how to find a physiotherapist](/health-library/treatments/physiotherapy/#accessing-physiotherapy).

## Treatments from a specialist

Your doctor, specialist or physiotherapist may recommend extra treatments if they do not think your pain will improve with self-care measures alone.

### Exercise classes

Exercise 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.

### Touch therapy

Touch 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 [chiropractors](/self-care/chiropractic), osteopaths or [physiotherapists](/health-library/treatments/physiotherapy).

Touch therapy can help reduce back pain, but it should only be used alongside other measures such as exercise and with medical advice.

Some people choose to see a therapist for touch therapy without seeing their doctor first. If you want to do this, you'll usually need to pay for private treatment.

### Psychological support

Therapies such as [cognitive behavioural therapy (CBT)](/health-library/treatments/cognitive-behavioural-therapy) can help you manage your back pain better by changing 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, which involves inserting needles into the nerves that supply your back, may sometimes be used if:

- you have 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

## Treatments not recommended for back pain

A number of other treatments have sometimes been used for non-specific back pain (back pain with no identified cause), but there is no clear evidence to suggest they work, and as such, doctors do not recommend them.

These include:

- back supports or braces
- acupuncture – a treatment where fine needles are inserted at different points in the body
- [traction ](/health-library/treatments/traction)– the use of weights, ropes and pulleys to apply force to tissues around the spine
- 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

## How to prevent back pain

It's difficult to prevent back pain, but the following tips may help reduce your risk:

- do regular back exercises and stretches – remember to speak to a doctor or physiotherapist for specific advice about the best exercises for you
- 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
- take care when lifting – read some [safe lifting tips](/self-care/safe-lifting-tips)
- check your posture when sitting, using computers and watching television
- ensure the mattress on your bed supports you properly
- 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.

## Key points

- back pain is common and usually not caused by anything serious
- you can often relieve back pain by doing exercises and stretches — and taking painkillers if needed
- some medical conditions can cause back pain, including a slipped (prolapsed) disc and sciatica. It may also be caused by problems like a broken bone in the spine or an infection
- if you have back pain, touch therapy, exercise, cognitive behavioural therapy (CBT) and even surgery may be used to treat it
- you can help prevent back pain by improving your posture, not sitting for too long in the same position and staying active

_Date of last review:_  _24 June 2020_

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