Lower back pain is one of the most common health issues affecting the population today, with approximately 23% of adults at any one time reporting lower back pain.1 For many people, lower back pain lasts a few weeks and improves on its own, although it can last longer and may require interventions to improve it. Unfortunately, people tend to have recurrent periods of lower back pain, with 50% reporting multiple episodes in one year.5,6
Chronic or persistent back pain is pain which lasts for longer than three months. There are many different causes of lower back pain. Often the cause is not obvious, however, specific causes can include back strain, a herniated disc or arthritis. Rarely, something more serious may cause lower back pain.
The lower back is a very active area. It supports the weight of the upper body, connects to the pelvis, and is crucial in many everyday activities such as bending, lifting, twisting, and even walking.
Carry on reading to learn about what causes lower back pain, how to recognise it and what you can do to manage it. Additionally, find out what important red flags to look out for which could indicate a more serious problem.
Causes of lower back pain
As mentioned before, sometimes the cause of your lower back pain may not be obvious.2 Other times, you may know what has caused it, such as a fall.
Common causes of lower back pain may include the following.
Pulled muscle or tendon (strains and sprains)
Like bones and muscles, the back is made up of tendons and ligaments. Tendons are fibrous bands of tissue that connect muscle to bones. Ligaments are fibrous bands of tissue that connect bone to bone. These can be injured as well as the muscle itself. Muscles, tendons and ligaments can be stretched or strained by lifting something too heavy, twisting or bending awkwardly, and even by sneezing or coughing. A chronic strain (long-term) may be caused by a long period of overuse or repetitive movements.
There are many different types of arthritis, but the most common form of spinal arthritis is osteoarthritis, which develops through wear and tear and is non-inflammatory. It usually affects the joints between the vertebrae. Cartilage, which is a strong and flexible material, wears down over time through mechanical damage. Additionally, osteoarthritis commonly leads to the cartilage between the joints connecting the vertebrae to break down, known as facet joint damage.
Herniated disc (sometimes known as a ‘slipped’, ruptured or bulging disc)
The lower back is made up of five bones or vertebrae, known as the lumbar spine. These bones have small discs between them, which cushion the bones and act as shock absorbers. The discs consist of a tougher outer layer and a jelly-like inner section.
Various nerves also begin in the lower back area, known as nerve roots. The outer layer of the discs can weaken and break, which allows the inner jelly to leak out. This can occur anywhere along the spine but is much more common in the lower back. This leaked jelly can press on and irritate nerves, causing pain. Several factors can contribute to a herniated disc, including ageing (over time, discs become flatter and weaker), being overweight, repetitive motions and sudden strain. In most cases, herniated discs will recover in 4-6 weeks.
There are other causes of lower back pain which are less common.
After a traumatic accident such as a car crash or a fall, bones (vertebrae) in the spine may break.
The spinal canal is a tunnel through the vertebrae that contains the spinal cord and nerves. Spinal stenosis, a condition where the spinal canal becomes too narrow, can occur due to various factors such as the formation of new bone (spurs), the thickening of ligaments, or the wearing down of discs. When the canal becomes narrow, it can pinch the nerves running through it, leading to pain.
Some women may experience back pain during pregnancy. The ligaments become softer and stretch during pregnancy as part of the body’s way of preparing for labour. However, this can affect the joints in the lower back, putting a strain on them.
The kidneys are located in the back area. Kidney issues such as kidney stones may cause back pain. However, there are usually other symptoms present.
Although rare, most tumours in the spine will have started in another part of the body and spread to the spine, such as prostate cancer.
Some inflammatory conditions can cause back pain such as ankylosing spondylitis.
Rarely, there may be an infection affecting the bones in the spine. Symptoms might include a high fever alongside back pain.
Signs and symptoms of lower back pain
Everyone’s body is unique and different. Therefore, symptoms may vary.3,4 They can be sudden and not last very long or develop more slowly and last for a long time. Symptoms can be dependent on the specific cause.9
Signs and symptoms may include the following.
- Pain may be achy or sharp and may be worse on movement. Sometimes, it is mild but can range to severe pain
- Your back may feel stiff. It may be difficult to move or straighten the back
- Your muscles may contract or go into spasm causing pain and stiffness
- If the nerve root which leads onto the sciatic nerve is irritated or compressed (by a herniated disc for example) this can cause pain to move into the buttocks and shoot down the back of the leg, which is known as sciatica
Red-flag symptoms that may indicate something more serious:
- A high temperature
- Night sweats
- Unintentional weight loss
- A lump or swelling in the back
- A history of cancer
Go to A&E or call an ambulance if you experience any of the following with your back pain:
- Numbness or tingling in both legs or around the bottom
- Difficulty controlling your bladder or bowels
- Being unable to urinate
- Pain or weakness in both legs
- Chest pain
Most cases of back pain improve by themselves, and therefore, doctors may initially not recommend any further tests or treatment to avoid doing anything unnecessary.4
In some cases, your GP may want to do tests such as imaging studies, perhaps if you recently had an injury to your back, the pain has lasted a long time, or they suspect an underlying cause.
These may include:
Management and treatment for lower back pain
Usually, lower back pain gets better on its own or with some simple measures to speed up the recovery in a few weeks.4,8
It is vital to stay as active as possible and continue with normal activities.10 This increases blood flow to the area as well as keeping muscles and joints moving. Too much rest can worsen the pain.
Low-impact exercises and stretches such as pilates or yoga can be helpful as they will strengthen and improve the flexibility of back muscles. Consider this 12-week yoga programme specifically developed to help with lower back pain. These types of exercises may not help straight away and it can take time to notice a difference. Exercising might cause a bit of soreness at first, which is natural. However, if the pain is significant, then stop doing the exercise.
Other great exercises for back pain are walking and swimming.
There are other ways to manage lower back pain.
- Anti-inflammatory medications such as ibuprofen are recommended for back pain. Some anti-inflammatory creams and gels can be applied to the area
- Using an ice pack on the area (wrapped in a tea towel) or something similar like a bag of frozen peas can help with pain and swelling, as the cold combats inflammation
- A heat pack (wrapped in a tea towel) may help stiff joints and relieve spasms. Alternatively, a warm shower or bath can have the same effect
Some people may require alternative treatment methods if the above is not sufficient.7
A physiotherapist can recommend specific treatments and exercises tailored to your type of back pain to improve strength and flexibility. This may not be suitable for everyone; therefore, speak to your GP before trying this.
It is understandable that suffering from back pain, especially if it has been going on for a long time or if it is affecting day-to-day activities, can affect one’s mood. Your GP can refer you to talking therapies or you may wish to go privately.
If over-the-counter medications aren’t working, your GP may prescribe additional pain relief or sometimes injections.
Rarely, some people may require an operation, but this depends on the underlying cause and is usually a last resort.
How common is lower back pain?
It has been reported that 84% of adults will experience lower back pain during their lifetime, and up to 50% of them will have multiple episodes.6
Who is at risk of lower back pain?
- Inactivity or poor fitness level: weak back muscles do not support the spine well. On the contrary, over-exerting yourself with excessive physical activity may cause lower back pain
- Obesity: being overweight can put additional stress on the back, which may increase the likelihood of experiencing lower back pain
- Smoking: Smoking increases inflammation in the body and makes it harder for the body to heal and recover itself
- Stress: a lack of sleep, depression or anxiety can trigger or worsen back pain. It may also change how people perceive pain
- Age: with age, bones and muscles can become weaker
- Occupational factors: jobs involving heavy lifting, twisting, pushing or pulling could cause back injury. Working at a desk may also cause back pain due to poor posture or sitting in an uncomfortable chair
- Heredity: some conditions may run in the family e.g. ankylosing spondylitis
How can I prevent lower back pain?
Prevention of lower back pain is recognised as a major challenge in high-risk populations. You can prevent lower back pain by making lifestyle changes. One of the most effective ways to prevent lower back pain is to ensure your back muscles are strong. You can do this by doing muscle strengthening and flexibility exercises. It is also important to lead a healthy lifestyle to keep your weight in an optimal range. You can do this by ensuring a balanced diet and keeping active.
What can I expect if I have lower back pain?
For most people, lower back pain improves within a few weeks. Some people who have had lower back pain before may have a recurrence of these symptoms.
When should I see a doctor?
- The back pain doesn’t improve after a few weeks
- You cannot continue with your normal activities
- You have severe pain, or the pain is worsening (severe pain is pain that makes it very hard to move)
- You’re worried or struggling to cope
- You are experiencing any red-flag symptoms
Lower back pain is a very common health problem, but most cases self-resolve within a few weeks. However, in other cases, further tests and management may be required. Recurrent episodes of pain are common. The causes of lower back pain vary, although the most common causes are back strain/sprain, herniated discs and arthritis. You can try and improve your back pain on your own by staying as active as possible, doing low-impact exercises, using heat or ice packs and using over-the-counter pain relief. If these things don’t help after a few weeks, book a GP appointment. If you have severe or red-flag symptoms, seek urgent medical attention.
- Casiano VE, Sarwan G, Dydyk AM, Varacallo M. Back pain. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Nov 22]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK538173/
- Ammer K, Ebenbichler G, Bochdansky T. Low back pain—a disease or condition of impaired functional health? Definition-inherent consequences for the comprehensive care of back pain patients. BioMed [Internet]. 2022 Jun [cited 2023 Nov 22];2(2):270–81. Available from: https://www.mdpi.com/2673-8430/2/2/22
- Krismer M, Van Tulder M. Low back pain (Non-specific). Best Practice & Research Clinical Rheumatology [Internet]. 2007 Feb [cited 2023 Nov 22];21(1):77–91. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1521694206001082
- Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ [Internet]. 2006 Jun 17 [cited 2023 Nov 22];332(7555):1430–4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1479671/
- Deyo RA, Tsui-Wu YJ. Descriptive epidemiology of low-back pain and its related medical care in the United States: Spine [Internet]. 1987 Apr [cited 2023 Nov 22];12(3):264–8. Available from: http://journals.lww.com/00007632-198704000-00013
- Cassidy JD, Carroll LJ, Côté P. The Saskatchewan health and back pain survey: the prevalence of low back pain and related disability in Saskatchewan adults. Spine [Internet]. 1998 Sep [cited 2023 Nov 22];23(17):1860–6. Available from: http://journals.lww.com/00007632-199809010-00012
- Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP. Low back pain. The Lancet [Internet]. 2021 Jul [cited 2023 Jul 14];398(10294):78–92. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673621007339
- Traeger AC, Qaseem A, McAuley JH. Low back pain. JAMA [Internet]. 2021 Jul 20 [cited 2023 Nov 22];326(3):286. Available from: https://doi.org/10.1001/jama.2020.19715
- DePalma MG. Red flags of low back pain. JAAPA [Internet]. 2020 Aug [cited 2023 Nov 22];33(8):8. Available from: https://journals.lww.com/jaapa/fulltext/2020/08000/red_flags_of_low_back_pain.1.aspx
- O’Sullivan P, Caneiro JP, O’Keeffe M, O’Sullivan K. Unraveling the complexity of low back pain. J Orthop Sports Phys Ther [Internet]. 2016 Nov [cited 2023 Nov 22];46(11):932–7. Available from: http://www.jospt.org/doi/10.2519/jospt.2016.0609