Back pain usually occurs in the lower back, the lumbar spine. Each bone in the spine (vertebra) is connected to the one above and below by small joints, strong ligaments and spinal muscles, and by the intervertebral disc. Each disc is made of tough gristle-like tissue containing a soft centre which acts as a shock absorber. The bones in the lower spine create a flexible bony tunnel through which the spinal nerves run from the spinal cord to the legs. If these spinal nerves are squashed or irritated, shooting pains are produced, spreading through the buttocks and into the back of the leg and maybe to the toes. This is called sciatica.

Mechanical back pain

Back pain is common. The vast majority of cases are due to a simple strain or mechanical back pain. Mechanical back pain is usually worse with movement, is not there permanently and does not persist throughout the night.

Rare conditions

There are several conditions which are known to make it more likely to develop back pain. For example, patients with a certain gene in their chromosomes (HLA-B27) are more likely to develop a condition called ankylosing spondylitis which produces chronic back pain because the ligaments harden. Some athletic adolescents have a weakness in the structure of the lumbar spine which appears on x-ray as a small gap in the bone. This is called spondylolysis. In a more severe form, occasionally affecting adolescent girls, one of the lower vertebrae can slide forwards on the one below (spondylolisthesis) causing sudden back pain and difficulty in walking. However, all these are relatively rare compared to simple mechanical back pain.

Osteoporosis

After the menopause, many women develop osteoporosis where the amount of bone decreases. This can lead to crush fractures of the lumbar vertebrae and back pain. Osteoporosis can also be caused by certain drugs, notably anti-inflammatory steroids, especially if taken for a long time. Preventing osteoporosis is one reason to maintain a high level of exercise because exercise increases your bone density. Your bone mass increases until your mid 30's after which it slowly declines. Smoking also contributes to osteoporosis and is another reason why it is sensible not to smoke. Being overweight places an added strain on the spine and undoubtedly makes any back pain more likely to occur, or persist. For more information about osteoporosis click here.

Back pain usually settles

Most attacks of acute back pain get better within 2 to 6 weeks. It is unnecessary to perform any investigations for most lower back pain. X-rays are not usually helpful and expose you to harmful radiation. If your back pain has persisted for longer than 6 weeks or is continuous and keeps you awake at night it is sensible to have this checked by your doctor. Pain occurring in the back in the chest should also be assessed by a doctor as it is less likely to be mechanical in origin.

Painkilling drugs may be used and these be either simple analgesics like paracetamol or paracetamol/codeine tablets or anti-inflammatory drugs like ibuprofen. These are both available over the counter from the chemist. Ibuprofen should not be used if you suffer from asthma, stomach ulcers or kidney problems.

Physiotherapy and osteopathy

There is no evidence to suggest that final recovery from mechanical back pain is influenced by whether or not the patient has physiotherapy or osteopathy. In addition there is no evidence to suggest that it is useful to start physiotherapy or osteopathy within 2 weeks of the onset of back pain and we know that 90% of people will have recovered by this time without treatment anyway. Physiotherapy and osteopathy may help to shorten the length of the attack with patients recovering, on average only 1 or 2 weeks earlier. Therefore, if pain is not settling after 2 weeks and you need to get back to work as soon as possible then this becomes a sensible option. In other circumstances, expect your back pain to have settled by 6 weeks. The amount of time taken off work depends more on your sex (men take more time off on average) and whether you like your job or not, than on other factors.

The physiotherapist can also give advice about sensible exercises that can be done to try and stop further attacks, what movements to avoid in future, and how to improve posture. Much back trouble results from work which involves a lot of sitting. You may need advice on such matters as the height and shape of your office chair, and the positioning of any equipment that you operate, such as VDUs.

Osteopaths can be helpful in the treatment of simple back pain by manipulation. Check first with your doctor that there is no actual bone disorder present (such as osteoporosis) that would make manipulation dangerous. We do not provide osteopathy as an NHS service but if you need a private referral please discuss this with us.

When to see the doctor

90% of attacks of acute back pain are better within 2 weeks and 98% have settled by 6 weeks. If severe pain develops, which goes right down the leg into the foot, then this is usually due pressure on a nerve in the back. The doctor needs to be contacted. You should also contact the doctor if pain gets significantly worse, if you develop severe pain in the leg, if you have difficulty in passing water, or if there is any loss of feeling in the legs or buttocks. These symptoms suggest compression of nerves which may require further treatment.

Only 2% of patients have back pain persisting for more than 6 weeks and these need to be assessed. Pain killers may reduce discomfort whilst you are recovering.

One of the side-effects of painkilling drugs is constipation: drink plenty of fluids and eat plenty of cereals and fresh fruit. Indigestion may develop from anti-inflammatory drugs like ibuprofen and should prompt you to stop taking them.

Back pain often recurs

60% of sufferers of mechanical back pain have a further attack within the next year. If the back pain is simple lower back discomfort then it should respond to the same measures. It is not unusual for patients to suffer recurrent back problems for a number of years before things settle down.

Most back pain that is mechanical in nature will settle without treatment. For most people no special investigations or therapy are required other than some simple pain relief in the first couple of weeks. If you are losing time from work then physiotherapy or osteopathy after the initial two weeks may help you get back to work a week or two earlier, but most people recover within 6 weeks.