Lower Back

Back pain is very common and most of us will have it at some point in our lives. In most cases, it is not possible to identify the exact cause of back pain. 

Pain in the back can arise after an injury (e.g a fall), or develop with no new injury (e.g a flare of arthritis). 

It can affect muscles, tendons, ligaments, bones, discs which may or may not irritate nerves or other tissues in the spine.

Pain originating in the spine can be felt in other areas of the body that the nerve supplies. This is commonly known as referred pain.

Back pain may be caused by a number of factors, including: 

• Poor posture 
• Lack of activity resulting in reduced ability to cope with daily tasks
• Muscle strains / sprains 
• Degeneration / arthritis 
• Disc bulges 

It is important to know that pain does not necessarily mean there is a serious problem. 

While it can be painful and upsetting, this type of back pain usually gets better quickly without the need to see a doctor. Most of the time it can be managed through advice and remaining active. 

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. However, if you are experiencing one or more of the symptoms below you will need to be seen in A&E urgently and report the symptoms you are experiencing:

• Loss of feeling/pins and needles between your inner thighs or genitals
• Numbness in or around your back passage or buttocks
• Altered feeling when using toilet paper to wipe yourself
• Increasing difficulty when you try to urinate
• Increasing difficulty when you try to stop or control your 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 bowel motion
• Change in ability to achieve an erection or ejaculate
• Loss of sensation in genitals during sexual intercourse

This information is also available as a card created by the Musculoskeletal Association of Chartered Physiotherapists (MACP). These cards are available in many different languages from the MACP website.

You should see your doctor about your back pain if you: 

• Have pain that doesn’t show any signs of improvement, within a couple of weeks of self help
• Have pain that has rapidly deteriorated or suddenly worsened despite self help
• Have a history of inflammatory arthritis, immuno-suppression, cancer, Tuberculosis (TB), drug abuse, AIDS or other infection
• Feel unwell, have a fever, or unexplained weight loss
• Are experiencing significant and regular changes to your usual sleeping pattern
• Have severe pain after trauma, such as a road traffic collision or fall 
• Have symptoms such as pins and needles, weakness, or numbness in your legs 
• Have noticed changes to walking pattern (ie. clumsiness or falls) 

If you do not have any of the above, you may be able to effectively self manage your condition

There are several ways you can help yourself including: 

• Taking pain medication
• Keep active and avoid static postures/positions
• Trying core stability exercises / pilates / yoga 
• Learning how to relax (particularly your shoulder and neck muscles) 
• Find a balance between rest and some activity, try not to overdo things (alter activities that make it worse so they are less painful) 
• Using cold treatment, eg. ice packs, or heat treatment, eg. heat packs
• Find a sleeping position that is most comfortable for you, using pillows for support
• Maintain a healthy Body Mass Index (BMI). Being overweight can increase your risk of developing back pain.

Regular exercise has been shown to be the most helpful treatment for back pain. It doesn’t matter what type of exercise you do, as long as you keep active. Choose something that you like to do and keep at it. 

If you have back pain that doesn’t show any signs of improvement, or worsens, within a couple of weeks, consider seeking further advice from your GP / Healthcare Professional.