The 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 lower back and help perform movement.
As with all joints in the body, pain in the lower back can arise from an injury or come on suddenly when starting a new activity you are not used to and cannot control, or it can develop over time.
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.
Back pain can sometimes spread into the lower body. If any of the nerves from the back are irritated then symptoms of pain, numbness or tingling can be felt somewhere else in the leg and at times the feet. This is known as nerve related pain. Nerve related pain isn’t a condition in itself, but a symptom of another condition such as a problem with the discs or arthritis that can irritate the nerve. Medically, this can be known as radicular pain (sciatica), referred leg pain or spinal stenosis. This pain can vary from mild to severe symptoms, and will differ between people, and some may have little to no back pain at all.
Back pain that spreads to the lower limbs may be caused by other tissues in the back such as muscles and joints. This type of leg pain is called referred pain.
The symptoms of radicular or referred pain from the lower back 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, for example, you may just wake up with it.
The most common symptoms of lower back, leg and foot pain are:
- Pain in the middle or on either side of your back, but it may also extend to the buttocks, legs and even to your foot.
- Pain when resting or when moving
- 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
- Symptoms can be varied and range from dull to sharp pains, tingling and numbing sensations
- Leg and foot pain is made worse by specific activities, movements or positions that are unique to you
- Leg and foot pain is eased on specific activities, movements or positions that are unique to you
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. Bed rest is not recommended, although some people might need to rest now and again. Although short periods of rest can be helpful, it is important that we keep active.
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.
Staying active with nerve pain may seem daunting, however activity is one of the most important elements of managing back and leg pain.
There is no one treatment that works for everyone. When being active with back and leg pain you should concentrate on movements and positions that ease your symptoms, and avoid those movements or positions that increase your pain. For example, if leaning backwards increases your leg pain you should avoid it, and if bending forwards eases your leg pain you should do it more frequently. Remember, you should only go as far as is reasonably comfortable for you.
Keeping active has been shown to be the most helpful treatment for back pain with referred leg pain or sciatica. It doesn’t matter what type of activity you do, as long as you Keep Active. So choose something that you like to do it, and keep at it. Staying active can improve fitness, confidence in movement, mobility and strength. Activity can also reduce stress and tension, improve mood and quality of sleep, and help support you getting back to normal activity.
It is normal to experience some discomfort when moving, 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.
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