Back Pain

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Overview

Back pain is a very common problem, which affects 4 out of 5 of us at some point – A very unpleasant but normal part of life. Fortunately, most back pain is not due to anything serious and rarely needs a scan although multiple factors can contribute to it, including physical, mental and lifestyle aspects. The people who recover quickest due to back pain are those who stay active and get on with life despite some pain.

With the right guidance and support, most people with back pain will recover without the need for medical help. Understanding back pain and what you can do to help yourself get better is an essential part of your recovery.

Watch this short video by the Chartered Society of Physiotherapy on how to manage back pain and then look at the other sections for more information.

Type of Back Pain

Acute Back Pain

Have you have been experiencing back pain for less than 6 weeks? If yes, then you are suffering with acute back pain.
This is a recent onset of pain which might be caused by a sprain or strain of the back although more commonly it starts for no obvious reason without sustaining any specific injury to your back.
The pain can come on suddenly or over a few days or weeks and can range from a mild pain or ache to quite severe pain, which can be extremely distressing and can sometimes stop you carrying out your everyday activities.
Despite having acute back pain, it is essential that you keep moving from day one, even if you might have to temporarily do a little bit less than usual initially, and then gradually build up to return to your normal activities.
For more help with improving acute back pain, please see other sections.

Persistent Back Pain

Have you been experiencing back pain for more than 3 months? If yes, then you are suffering with persistent, also known as chronic, back pain.
This type of back pain will initially start like Acute Back Pain although the pain continues even after the original cause of back pain has healed.
The pain you feel is just as real and unpleasant although it is much less to do with any ongoing tissue damage in the back, but more due to an over sensitive protective system that continues to produce pain in your back and sometimes the legs too.
This pain protective system can be influenced by multiple things including thoughts, feelings and beliefs as well as confidence to move the back again. Unfortunately, there are a lot of unhelpful and incorrect messages given about back pain which can actually make the problem worse. Click on the FAQ section to bust some myths about back pain and start trusting your back again.
Although persistent back pain can be more complex, it can still be improved through understanding pain better and changing the way to approach it.
For more help with improving Persistent Back Pain, please see other sections.

Sciatica

If you’re feeling pain in your lower back or hip that radiates to the back of your thigh and into your lower leg, you may have sciatica.
This is an umbrella term for any condition that is causing irritation of the sciatica nerve. Despite what you’re told and read, nerves are very rarely ‘trapped’. Pain will usually be worse in the leg than in the back and you may also have some tingling, pins and needles or numbness in the leg or foot.
Sciatica only happens in less than 5% of back pain cases and usually gets better within 4 to 6 weeks but can last longer. The reasons for the pain lasting longer than this could be related to your thoughts and feelings about the problem and how you are approaching it so complete the section ‘Is My Back Pain Likely To Persist?’ and visit the page on ‘Persistent Pain’ for more details if necessary.
However, there are some rare cases where it might be related to a specific structure in the back. Click on Further Support for additional information and when to see a healthcare professional. Some people with sciatica may require prescribed medication to help with nerve pain as well as carrying out back and leg exercises. See exercises in Self-Help section.

Is my back pain likely to persist?

Take our one minute test

This quick questionnaire can help you identify how likely your pain is to persist over the next 6 months and whether you may need some extra support. It has been developed by a team of experts from Keele University – Click here for more information about the tool.

The tool has been shown to be very useful for people with common Musculoskeletal pain to profile individual risk of having a poor recovery and to use as a guide in conjunction with support from a healthcare professional if necessary.

Try out the questionnaire for yourself to see how you score and to get further help and advice. It will also be useful to retake the questionnaire after you have learned more key facts about your pain, either from this website or from a healthcare professional, to re-assess in time whether your back pain problem is improving.

For question 1 – 9, think about just the last two weeks:
Pain intensity
1. On average, how intense was your pain? [where 0 is “no pain”, 10 is “pain as bad as it could be”]











Select one of the options for each question below Yes No
2. Do you often feel unsure about how to manage your pain condition?
3. Over the last 2 weeks, have you been bothered a lot by your pain?
4. Have you only been able to walk short distances because of your pain?
5. Have you had troublesome joint or muscle pain in more than one part of your body?
6. Do you think your condition will last a long time?
7. Do you have other important health problems?
8. Has a pain made you feel down or depressed in the last two weeks?
9. Do you feel it is unsafe for a person with a condition like yours to be physically active?
10. Have you had your current pain problem for 6 months or more?

High Risk

This test suggests you have some serious concerns about how well your back will recover.

This may be related to feeling low and anxious generally or by being afraid that you might have done something serious to your back.

It might help to discuss your concerns with a doctor or physiotherapist if things are still not improving over the next few weeks after following the advice and exercise in the Self Help section.

Also, visit the section on Persistent Pain for more information and support.

99 times out of 100 your back pain is not related to a serious condition. Allowing yourself to move normally, without too much worry, will help your back to return to normal. Painkillers often help you to move normally, while your back recovers.

If you are feeling low or anxious, whether this is related to your back pain or not, and you would like further help and information, visit NHS website – Health in Mind.

Medium Risk

This test suggests you may have some doubts about how well your back will recover.

This may be related to feeling low and anxious generally or by being afraid that you might have done something serious to your back.

It might help to discuss your concerns with a doctor or physiotherapist if things are still not improving over the next few weeks after following the advice and exercise in the Self Help section.

99 times out of 100 your back pain is not related to a serious condition. Allowing yourself to move normally, without too much worry, will help your back to return to normal. Painkillers can help you to move normally, while your back recovers.

You might also want to access the Essex Lifestyle Service for further support and help on making healthy lifestyle choices and live healthier lives as this could be contributing to your back pain.

Low Risk

Congratulations! You most likely have the right ideas about your back pain, and feel in control of how you manage your recovery.

We all know an episode of back pain is very annoying, and at times extremely painful. Carrying on as normal and continuing to bend and move your back allows the quickest recovery, and stops your back stiffening up.

Keep going as you are, although check out this link for more information and advice to get better even quicker.

You might also want to access the Essex Lifestyle Service for further support and help on making healthy lifestyle choices and live healthier lives as this could be contributing to your back pain.

Please select all options.

Back Pain Beliefs Calculator

You can also complete this short questionnaire created by NHS 24, which can help measure your beliefs about back pain and if these beliefs are affecting your recovery. Keep a note of your current score and try the questionnaire again after you have looked at the information on the website.
There is no treatment for back pain
☆☆☆ ☆☆
Back pain will eventually stop you from working
☆☆☆ ☆☆
Back pain means periods of pain for the rest of one’s life
☆☆☆ ☆☆
Back pain makes everything in life worse
☆☆☆ ☆☆
Back pain may mean you end up in a wheelchair
☆☆☆ ☆☆
Back pain means long periods of time off work
☆☆☆ ☆☆
Once you have had back pain there is always a weakness
☆☆☆ ☆☆
Back pain must be rested
☆☆☆ ☆☆
Later in life back pain gets progressively worse
☆☆☆ ☆☆

Please select all options.

Low Score

The lower the score then the more likely it is that your beliefs about your back pain are limiting your recovery.

Worrying that you will never return to normal will not help your recovery. It may in fact slow things down.

Most back pain does improve with time and is rarely due to any serious illness or disease.

There is plenty you can try to help yourself get back to normal.

A good place to start this recovery is by looking at the information in the Self Help and FAQs sections for back pain and Self Help and FAQs sections for persistent pain. Don’t take back pain lying down.

High Score

The higher your score then the more likely it is your positive beliefs about your back pain are helping your recovery.

This is great news! Having positive beliefs about recovery and getting back to normal helps you maximise your recovery.

Keeping active and not letting back pain take over your life does help you get back to normal quicker.

It would still be worthwhile to take some time to look at the advice on this website and see if you can help yourself even more.

High Score

Please Select Some Values

Self help

Evidence has shown that people who understand their Musculoskeletal health problem and take an active involvement to help themselves have a much better outcome. Here are some really helpful leaflets, videos, exercises and useful links to other websites that have been approved by our physiotherapists so that you can start getting better today.

Leaflets

Source: Versus Arthritis
Low Risk Back Pain
Source: Tasmanian Health Organisation South
Cauda Equina Syndrome

Videos

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Watch this useful short video for advice on how to manage back pain
Source: Chartered Society of Physiotherapy

Watch this useful short video for advice on how to manage back pain
Source: Chartered Society of Physiotherapy

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Excellent summary by Dr Mike Evans talking about the latest research on low back pain and the best ways to manage it
Source: DocMikeEvans

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Professor Peter O'Sullivan discusses some of the myths about back pain which are widely held and negatively impact on the perception and treatment of back pain including real patient experiences
Source: Pain-Ed. com

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Video on a rare but potentially serious back condition called Cauda Equina Syndrome, what are the signs and symptoms to be aware of and when to seek urgent medical attention.
Source: Nguyễn Hải Phong

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Exercises

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Video demonstrating back exercises to help keep your back comfortable and healthy
Source: NHS

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In this video a physiotherapist demonstrates gentle exercises for degenerative disc disease. The aim of these exercises is to strengthen, mobilise and stabilise the surrounding area in order to prevent any further pain.
Source: NHS

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In this video a physiotherapist demonstrates gentle exercises for disc problems causing sciatica. The aim of these exercises is to reduce the pressure on the nerve caused by the disc bulge and to reduce the inflammation around it.
Source: NHS

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In this video a physiotherapist demonstrates gentle exercises for spinal stenosis to help relieve symptoms caused by this specific back condition
Source: NHS

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In this video a physiotherapist demonstrates gentle exercises for piriformis syndrome, a form of sciatica. The aim of these exercises is to stretch and mobilise the piriformis muscle in the buttocks and therefore to reduce the symptoms of sciatica.
Source: NHS

Play

Progressive exercise for simple ways to help ease sciatica when sitting
Source: Rehab My Patient

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Progressive exercise for simple ways to help ease sciatica when sitting
Source: Rehab My Patient

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Progressive exercise for simple ways to help ease sciatica when sitting
Source: Rehab My Patient

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Useful Links

  • All you need to know about back pain, informed by physiotherapists
  • 10 things you need to know about your back to give you insights into previously held beliefs about back pain based on the current evidence. Check your own back pain beliefs using this Calculator before and after you read these back pain facts.
  • Simple back exercises and stretches you can do at home to help ease your back pain and improve your strength and flexibility.
  • Further information on back pain including causes, treatment, prevention and when to get immediate medical advice.
  • Information on sciatica including causes, treatment and when to get medical help as well as the ‘do’s and don’ts’ on how you can ease the pain from sciatica yourself and how to stop it coming back.

Further Support

If your back pain is still not improving despite following the advice and guidance provided on the website for up to 6 weeks and you score a ‘Medium’ or ‘High Risk’ when completing the ‘Is My Back Pain Likely To Persist?’, you may require further help and support from the Physiotherapy Outpatients Service. Please see your GP if you wish to be referred or discuss the management of your back problem further.

Remember that most causes of back pain are not due to anything serious, although there are rare cases where you would need to seek urgent medical help. Contact your GP or NHS 111 for immediate advice if you have any of the following symptoms that have started around the same time as your back pain:

  • Numbness or tingling around your genitals or inner thighs
  • Difficulty passing urine
  • Loss of bladder or bowel control
  • Unexplained weight loss
  • Fever or chills
  • Significant trauma e.g. car accident, fall
  • Previous history of cancer

If you have any of the first three symptoms in the list above that accompany your back pain, for more information.See cauda equina syndrome leaflet and video

FAQs

No - Scientific studies now indicate prolonged rest and avoidance of activity for people with low back pain actually leads to higher levels of pain, greater disability, poorer recovery and longer absence from work.
In the first few days of a new episode of low back pain, avoiding aggravating activities may help to relieve pain. However, staying as active as possible and returning to all usual activities gradually is actually important in aiding recovery – this includes staying in work where possible.
While it is normal to move differently and more slowly in the first few days of having back pain, this altered movement can be unhealthy if continued in the long-term.
You rarely need a scan and it can do more harm than good. This is because seeing perfectly normal changes to their spine related to age, which are not predictive of back pain, can cause people to avoid the activities they should be doing to get better, such as exercise and movement in general.
Studies have shown that a scan does not show the exact reason for back pain in 95% of cases and will not guide further management. Watch Video
However, there are extremely rare cases of back pain where immediate medical advice and need for scanning may be required. Know More
No – You should not fear bending and lifting. These movements are often portrayed as causes of back pain and while an injury can occur if something is picked up in an awkward or unaccustomed way, it’s most likely to just be a sprain or strain.
The important thing is to practice and get your body used to carrying different loads and weights in a way you find comfortable and efficient. People who completely avoid bending and lifting due to back pain are more likely to develop longer term problems with their back.
The more you gradually expose your back to these normal movements and activities that the spine is designed to carry out, the more comfortable and easier they become.
Yes, absolutely! Exercise and activity reduces and prevents back pain. Exercise is shown to be very helpful for tackling back pain and is also the most effective strategy to prevent future episodes.
Start slowly and build up both the amount and intensity of what you do and don’t worry if it’s sore to begin with – you won’t be damaging your back.
No one type of exercise is proven to be more effective than others so just pick an exercise you enjoy, that you can afford to maintain in the long-term and that fits in with your daily schedule.
Painkillers may be necessary for a short period if back pain is severe although this will not speed up your recovery.
They should only be used in conjunction with other measures, such as exercise, and even then just as a short-term option as they can bring side effects.
Exercise, which is safer and cheaper, is considered the preferred option. Movement is the best medicine for back pain!
Surgery is rarely needed.
There are some uncommon back conditions where there is pressure on the nerves that supply the legs and the patient gets leg symptoms, such as pain, pins and needles or numbness. For these conditions, surgery can help the leg symptoms but it is important to understand that it is not always required.
You also need to know that on average, the results for back surgery are no better in the medium and long term than non-surgical interventions, such as exercise.
So a non-surgical option, which includes exercise and activity, should always come first.

10 things you need to know about your back