Back pain is a very common problem and will affect most of us at some point during our lives. In most cases, it is not possible to identify the exact cause of back pain. The lower back is made of bones (vertebrae) separated by softer cartilage known as spinal discs. The back, like all other joints, has ligaments, muscles and tendons that work together to support the back and help perform movement.
As with all joints in the body, pain in the back can arise from an injury or come on suddenly when starting a new activity you are not used to and cannot control or can develop over time for no obvious reason.
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
The spine has two main functions; one is to perform and allow movement while the second is to cover and protect the spinal cord and nerves that serve the rest of the body. The many vertebrae and discs allow movement in all directions while still protecting the spinal cord.
The symptoms of lower back pain vary from person to person. For some people it may come on suddenly, perhaps after lifting something heavy or moving in a certain way. For others, it may come on gradually over time and for no obvious reason.
The most common symptoms of back pain are:
- Pain in the middle or on either side of your back, but it may also extend to the buttocks
- The pain can vary between a dull or sharp pain, and sometimes both
- Have pain when resting or when moving
- Have tightness in the muscles of your back and hips, especially if you’ve been still such as sitting or sleeping in one position for a long time
- Your lower back won’t move as far as it normally does, for example when you try to bend over and put on your socks
- Gentle activity may help relieve pain and increase your flexibility
Diagnosis is usually made from a consultation with your Health Care Professional, involving a detailed history of the onset of symptoms, current pattern of symptoms and your current functional ability.
An image or investigation is generally not needed to confirm pain. If the Health Care Professional needs further information to finalise the diagnosis, they will organise further tests or they will refer you to a specialist.
The primary aim of treatment is to help manage your pain. This allows you to move more and help you return to normal activities sooner. Initial treatment therefore is aimed at pain control. This might involve pain medication, or the use of heat or cold treatments.
Once your pain is under control, working on the movement and strength of your lower back is what will help long term.
If your sleep is affected, changing the number of pillows may be helpful. Versus Arthritis suggest your head and neck should be supported so your head is level with your body in a neutral position. The pillow should fill in the natural hollow between the neck and shoulders – a soft or moulded pillow may be useful, or a supportive roll inside your pillowcase can support the hollow of your neck. You could also try a pillow between your knees to help support your lower back.
If your work requires you to maintain a static position for long periods (sitting at a desk, driving a HGV, standing at a checkout), it is important to change positions as often as possible and realistic. This can include standing up from your chair and working at a higher surface, going for a walk, doing some stretches, or simply moving the area of the body that feels stiff and sore. The only wrong position is the one that you stay in all day.
You can help to reduce pain, ease stiffness, strengthen your muscles and improve overall general fitness by Keeping active. Below are some basic exercises specific to your lower back to get you started.
Exercise has been shown to be the most helpful treatment for on-going back pain. Back stretches and good posture tend to be useful and improve back pain. Choose something that you like to do it and keep at it.
It is normal to experience some discomfort when doing exercises, and individuals may start at different points. Pain should not increase excessively during or immediately after the activity. Discomfort should return to pre-activity levels 24-48 hours after the activity has finished.
The number (reps) and frequency (sets) of exercises suggested here are a guide, and should be performed to your personal tolerable pain levels. This means repetitions will vary between individuals and you should only go as far as is reasonably comfortable for you.
Single leg knee hug
Lie on your back with both legs straight. Bring one knee in towards your chest, using your arms on your shin to help with the movement. At the point where you feel a stretch, hold this position.
Knee Rolls
Lie on your back with your knees bent and your feet flat on the floor. Keeping your shoulders flat on the bed, roll both knees out to one side. Hold this position. You may feel the stretch in your hips, as well as your lower back. Bring your knees back to the middle before repeating the same movement on the other side.
Bridge
Lie on your back with your knees bent and your feet flat on the floor. Tighten your buttock muscles and lift your hips up into the bridge position. Make sure you keep your hips up and level throughout the movement.
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