Lower Back Pain: Causes, Self-Care and When to See a Doctor

Back pain is one of the most common reasons people seek medical advice, and the lower back is where it shows up most often. The good news is that most back pain improves on its own. This article explains the usual causes, what you can do at home, what doctors may offer, and the signs that need urgent care.

How common is back pain?

According to MedlinePlus from the US National Library of Medicine, about 8 out of 10 people have back pain at some point in life. It can feel like a constant dull ache or a sudden sharp pain.

Doctors often describe it in two ways:

• Acute back pain starts suddenly and usually lasts from a few days to a few weeks.
• Chronic back pain has lasted for more than three months.

The NHS notes that most episodes get better within a few weeks, although some people have pain that lingers or keeps coming back.

What causes lower back pain?

It is often hard to pinpoint exactly why the back hurts. The NHS describes these as the main causes:

• A strain, such as a pulled muscle. This is the most common reason.
• Medical conditions including a slipped disc, sciatica (an irritated or trapped nerve) and ankylosing spondylitis, a condition that causes inflammation in the joints of the spine.
• Serious problems, which are rare, such as a broken bone, an infection or cancer.

Self-care that can help

The NHS advises that staying active is one of the most useful things you can do. Lying in bed for long stretches tends to make things worse, and MedlinePlus also warns that more than a day or two of bed rest can slow recovery.

Things that may help:

• Keep going with your usual daily activities as much as you can.
• Try gentle back exercises and stretches, and stop and get advice if the pain gets worse.
• Walking, swimming, yoga and pilates may ease back pain.
• A cold pack wrapped in a cloth can calm pain and swelling.
• A heat pack or hot water bottle wrapped in a cloth can loosen stiffness and muscle spasm.
• Ask a pharmacist or doctor which pain relief, if any, is suitable for you. The NHS points out that some anti-inflammatory painkillers are not suitable for everyone, and that paracetamol on its own is not recommended for back pain.

Treatment options a doctor may discuss

If self-care is not enough, the NHS and MedlinePlus describe a range of options. Your doctor decides what fits your situation:

• Prescribed pain relief when pain is severe or not improving.
• Physiotherapy or group exercise classes if pain carries on beyond a few weeks.
• Manual therapy, where a trained therapist massages and moves the muscles, joints and bones of the back.
• Cognitive behavioural therapy (CBT), a talking therapy that helps you manage how pain affects your life.
• Injections, mentioned by MedlinePlus among possible treatments.
• A nerve procedure that stops some nerves sending pain signals, used only for long-term lower back pain.
• Surgery, considered for problems such as a slipped disc when other treatments have not helped.

When to see a doctor

MedlinePlus suggests contacting a health care provider if back pain is severe, has not improved after three days, or started after an injury. The NHS also advises seeing a doctor if your back pain:

• Has not improved after a few weeks of home care.
• Stops you doing your normal daily activities.
• Is very worrying or hard to cope with.
• Comes with weight loss you cannot explain.
• Comes with a lump, swelling or change in the shape of your back.
• Does not ease with rest or is worse at night.
• Gets worse when you cough, sneeze or open your bowels.
• Is in the upper back between the shoulder blades.

Get urgent advice the same day if back pain comes with feeling hot, shivery or generally unwell, or if severe pain starts suddenly or worsens quickly.

Emergency warning signs

Seek emergency care straight away, according to the NHS, if back pain comes with:

• Pain, tingling, numbness or weakness in both legs.
• Numbness around the genitals or back passage.
• New problems controlling your bladder or bowels, such as being unable to pass urine or leaking urine or stool.
• New changes in genital sensation or sexual function.
• Chest pain.
• Pain that started after a serious accident, such as a car crash.

Do not drive yourself to hospital; ask someone to take you or call an ambulance.

In an emergency, call your local emergency number (112 in India, 911 in the United States).