Low back pain Mamae ā-tuarā o raro
Low back pain is very common. Around 80% of people have it at least once in their life and approximately 10% of the world's population have back pain at any one time. In many cases we do not know exactly what is causing your back pain. This is called non-specific low back pain.
Understanding your back
Your spine is made up of bones called vertebrae. There are discs between the vertebrae, which act as shock absorbers and allow your spine to be flexible.
Strong bands of tissue called ligaments support your spine, and muscles make it move. Joints between the vertebrae, called facet joints, guide the way it moves.
Your spine protects your spinal cord, which contains nerves to and from your brain. Nerves from your spinal cord come out from between the vertebrae and continue to other parts of your body.
The medical name for your lower back is your lumbosacral spine.
Causes of low back pain
A disc bulges out, which can irritate or press on your spinal nerves causing pain. The pain can then travel (radiate) down your leg. This is sometimes called sciatica.
A crack or break in one of the bones in your back. This could be due to osteoporosis, a fall from a height, for example, from a ladder, or a sporting accident.
Caused by a condition such as ankylosing spondylitis.
This is a rare disorder where the nerves at the bottom of your spine are squashed (compressed). Cauda equina syndrome can cause low back pain plus problems with going to the toilet, numbness around your back passage or anus and weakness in one or both legs.
If you have or have had cancer anywhere in your body, your low back can be a site for secondary cancer. You can get an infection in your lower back if you have a poor immune system, for example, you are having chemotherapy, have HIV or AIDS, or you have had a recent open wound.
Diagnosing low back pain
Your healthcare provider will ask you questions and examine you to help diagnose the cause of your low back pain.
If you have non-specific back pain, you are unlikely to need any tests such as x-rays or scans in the first few weeks.
If your pain does not get better as expected or your healthcare provider is concerned about a specific cause of the pain, you may need x-rays or scans such as MRI. Or you might need to see a specialist.
Self care for low back pain
One of the best things you can do to help your back pain get better is to keep doing your normal activity as much as possible. Walking, cycling and swimming can help.
You may have some minor discomfort as you try to keep active but do what you can without causing any significant pain or discomfort. If you notice an increase in pain, stop doing the activity straight away.
Bend backwards rather than forwards
- Decreasing the amount of bending forward you do and instead doing backwards-bending exercises can help a lot.
- While lying on your front, do 10 back bends every one to two hours. You may be able to do this exercise while standing but ask your health professional first.
One of the main ways you can help your back pain is to change what you are doing whenever you notice the pain. Give your usual activities a try but if they bring on or worsen your pain, either work out another way of doing it that does not hurt or stop and try again later.
Watch how you are sitting
- Good sitting posture is important. Put a cushion or folded towel (or lumbar roll) in the small of your back when you are sitting.
- If you sit at work, make sure your chair is adjusted properly to support the small of your back.
- Make sure your feet are flat on the floor or a footstool and your chair points straight at your desk or screen.
- Avoid sitting for long periods. Stand up every 30 minutes and walk around for a few minutes.
Be careful lifting
- Try to avoid any bending or lifting until your episode of back pain is over.
- If you do have to lift something, point your feet towards the thing you are lifting, bend at your knees and hips. Keep items close to you while you are lifting and carrying.
As well as exercise and watching your posture, you may want some pain relief. If so, take it regularly, as that is more likely to ease the pain enough to let you exercise and stay active. Pain relief will not completely take the pain away, but it may take the edge off it.
Anti inflammatory pain medicines such as ibuprofen, diclofenac and naproxen may be helpful. However they may not be suitable if you have other health issues such as asthma, stomach problems, high blood pressure, kidney or heart failure. Check with your healthcare provider or pharmacist if it safe for you to take them.
Sleep in any way that is comfortable on the most comfortable surface, as long as it is flat and not sagging. We used to advise people to sleep on a firm mattress but there is no evidence that this is better than any other type of mattress.
Some people find that a small, firm pillow between their knees, or a folded towel under the small of their back makes them more comfortable when sleeping.
Get back to work as soon as possible — you do not need to wait for the pain to go away. Returning to work (or staying at work if you can) generally helps to reduce your pain by keeping you active.
If you are worried about your work, talk to your employer and treatment provider about what you can and cannot do. Some people need to gradually ease back into their usual work tasks, perhaps doing fewer hours and not doing physical tasks like heavy lifting or twisting.
ACC can also help you get back to work if you are having problems returning to your normal duties.
Recovery at work — ACC (external link)
Treating low back pain
Most low back pain gets better with self care but sometimes you will need help from a health professional.
You may want help from a chiropractor, osteopath, or physiotherapist to help you recover from your back pain. All give similar treatment and can be effective — choose the one that best suits you.
You can expect whichever health professional you choose to thoroughly assess you, advise you on how you can help yourself, and give you an individual treatment plan. This plan will include exercises and manual therapy.
Structured exercise programme
Your exercise programme might include:
- flexion (bending forward) and extension (bending backward)
- strengthening
- aerobic exercise (like walking, swimming or cycling)
- general fitness
- a combination of these.
It might include supervised exercise sessions or exercises you can do at home.
Manual therapy
Manual therapy includes spinal mobilisation and spinal manipulation.
Manipulation involves moving a joint in your spine more than it would normally move. Mobilisation involves moving a joint in your spine within the range it would normally move. Once they have examined you and talked about the options, the therapist may use one or both techniques.
Manual therapy may also include massage, techniques to reduce tension and checking how well the joints in your spine are working.
If treatment is not working
If you do not get significantly better after 5 to 6 treatments, talk to your therapist or healthcare provider about what other options you have.
If your pain lasts for more than 3 months, the HealthInfo website has information on chronic (persistent) pain.
Preventing low back pain
Low back pain is very common and if you have had it once, it may happen again. Unfortunately, there is no magic bullet to totally prevent it. But there are 2 simple measures that can help to reduce the rate and impact of any future back pain.
Keep active
It does not matter what exercise you do. Just do something you enjoy. Research shows that doing strengthening exercises specifically for your spine and abdomen does not prevent back pain, but regular general exercise and activity can.
Do 10 modified push ups once or twice a day
- Lie face-down on the floor with your arms bent and your hands under your shoulders.
- Push up with your arms and arch your back, leaving your hips on the floor.
- Relax your stomach muscles and let your back sag for a second.
- Slowly return to the floor.
Repeat this exercise 10 times. Do it every day.
Other measures to prevent back pain
- Sleep well.
- Manage your stress and anxiety levels.
- Do not smoke because nicotine decreases blood flow to your back. Back pain is more common, and recovery is slower in smokers.
- Aim to achieve and maintain a healthy weight.
- Avoid slouching when sitting for long periods of time. If sitting with a correct posture helped to get rid of your back pain last time, it makes sense to make sitting correctly a lifetime habit.
- If your previous low back pain was caused by bending forward, make sure you arch backwards every now and then whenever you are in a situation where you're bending a lot, for example, gardening.
- Use correct lifting techniques.