Lower back pain is extremely common. Most adults will have at least one significant episode, and it’s the most common reason people come to see me. The reassuring part is that most back pain gets better, and there’s a lot you can do to help it along.
What causes it?
Most lower back pain is called non-specific or mechanical: it’s coming from the joints, muscles, ligaments and discs of the lower back, and it isn’t a sign of serious damage. Common triggers include:
- Lifting, bending or twisting awkwardly
- A sudden increase in activity, like a weekend of gardening
- Long periods of sitting, driving or standing
- Poor sleep, stress and low activity, all of which make pain more likely and slower to settle
Less commonly, a disc can irritate a nerve and cause sciatica: pain, tingling or numbness travelling down the leg.
A small number of cases have a serious cause. Read when back pain needs a doctor urgently for the warning signs.
What helps
The evidence is fairly consistent:
- Stay active. Keep doing as much of your normal routine as you can, modified to what pain allows. Walking is excellent.
- Exercise. Over the longer term, regular exercise of almost any kind reduces pain and recurrences. The best exercise is the one you’ll keep doing.
- Hands-on treatment. Clinical guidelines for low back pain include spinal manipulation, mobilisation and massage as options, usually alongside exercise and staying active.
- Heat for comfort.
- Reassurance. Understanding that your back is strong and that hurt doesn’t always mean harm genuinely helps recovery.
- Pain medication, if you need it, as advised by your doctor or pharmacist.
What doesn’t help much
- Bed rest
- Routine scans without warning signs
- Long courses of passive treatment with no exercise or plan to get you independent
How I treat back pain
At the first visit I’ll take a full history, examine you, and check for warning signs. Then I’ll explain what I think is going on, in plain language.
Treatment usually combines:
- Soft tissue work to ease muscle spasm
- Spinal manipulation or mobilisation for stiff joints, if appropriate and if you’re comfortable with it
- Dry needling for tight, tender muscles, if it’s suitable
- Exercises to do at home, and practical advice on sitting, lifting, sleep and getting back to activity
Most people with a recent episode notice an improvement within a few visits. If you’re not improving as expected, I’ll change the plan or refer you.
Stopping it coming back
- Keep active and keep strong, especially through the hips and trunk
- Break up long periods of sitting
- Build up new activities gradually
- Sleep well and manage stress, which really does affect pain
Read next: should I see a chiropractor? or what to expect at your first visit.
Questions parents and patients ask
Should I rest or keep moving with back pain?
Keep moving, as much as pain allows. Bed rest tends to slow recovery. Gentle walking and normal daily activity, modified where needed, is one of the best things you can do.
Do I need an X-ray or MRI for back pain?
Usually not. Most back pain doesn't need imaging, and scans often show changes that are normal for your age and not the cause of your pain. Imaging is useful when there are warning signs, when a serious cause is suspected, or when it would change the treatment plan.
Heat or ice for back pain?
For most back pain, heat (a hot water bottle or warm shower) feels better and helps tight muscles relax. Ice can help in the first day or two after a strain if it feels better to you. Use whichever eases your pain more.
This guide is general information, not a diagnosis. If you're worried about yourself or your child, get checked by a health professional. In an emergency, call 10177 or 112 from a cellphone.