Lower back pain: causes, treatment, how long it lasts and when to get help

The NHS says back pain can have many causes, it is not always obvious what causes it, and it often gets better on its own. A common cause is an injury such as a pulled muscle (strain).

Arthritis UK says back pain often does not have one specific cause but may be due to one or more of the following: lack of exercise resulting in stiffening of the spine and weak muscles, muscle strains or ligament sprains, poor posture, and inadequate work or home working set-up.

NICE CKS describes most cases as non-specific low back pain, meaning pain not attributable to an underlying cause. It is also called mechanical, musculoskeletal or simple low back pain. It lists risk factors including obesity, physical inactivity, heavy lifting, and stress or depression.

Sometimes a specific medical condition is responsible. The table sets out those described by the NHS and Arthritis UK, with how they typically differ.

The NHS says back pain often improves within a few weeks and there are things you can do to speed recovery. If it is severe or not getting better you may be prescribed painkillers, and other treatments may be recommended if it does not improve after a few weeks.

• Stay active and carry on with your daily activities as far as you can.

• Take an anti-inflammatory such as ibuprofen if suitable, and ask a pharmacist or GP if unsure. The NHS says paracetamol on its own is not recommended for back pain but may be used with another painkiller.

• Use an ice pack (or bag of frozen peas) wrapped in a tea towel to reduce pain and swelling, or a heat pack or hot water bottle wrapped in a tea towel for stiffness or muscle spasms.

• Try exercises and stretches, and stop if the pain gets worse. Walking, swimming, yoga and pilates may also help, according to the NHS.

• Do not stay in bed for long periods.

• If pain persists: group exercise sessions and physiotherapy, manual therapy, and cognitive behavioural therapy (CBT) to help you cope with pain.

• For long-term lower back pain only: a procedure to seal off some of the nerves so they stop sending pain signals.

• If a medical condition such as a slipped disc is the cause and other treatments have not helped, surgery may be an option.

NICE CKS names nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line medicines and short-term codeine, with or without paracetamol, as second-line. The NHS notes anti-inflammatories may not be suitable for everyone, which is why checking with a pharmacist or GP matters.

Arthritis UK suggests using painkillers when needed and ideally before the pain becomes very bad, as a short course of about a week to 10 days, and checking with a pharmacist or doctor before using more than one NSAID.

NICE CKS describes low back pain as pain in the lumbosacral area, from the 12th ribs to the iliac crest and sometimes the buttocks and gluteal folds. It can affect daily activities including work, study, leisure and sleep.

Pain that spreads down the leg may suggest a nerve is involved, as in sciatica. See the red-flag section below for symptoms that need urgent help.

The NHS says back pain usually improves within a few weeks, though it can last longer or keep coming back. NICE CKS says acute low back pain typically lasts less than 3 months, chronic low back pain typically lasts 3 months or more, and for most people it is self-limiting and resolves within a few weeks.

NICE CKS suggests review if symptoms persist or worsen after 3 to 4 weeks, with reassessment for an underlying cause. The NHS says to see a GP if the pain does not improve after treating it at home for a few weeks.

The NHS says it is very common to get backache or back pain in pregnancy, especially in the early stages. Ligaments naturally become softer and stretch to prepare for labour, which can put a strain on the joints of the lower back and pelvis.

The NHS suggests bending your knees when lifting, avoiding heavy objects, wearing flat shoes, balancing the weight between two bags, supporting your back when sitting, getting enough rest and using a supportive mattress. It says you can take paracetamol in pregnancy unless your GP or midwife says not to, and that an obstetric physiotherapist may be able to help.

Contact your GP or midwife urgently if you have back pain in your second or third trimester (this could be a sign of early labour), or have fever, vaginal bleeding or pain when you pee, or pain in one or more sides under your ribs. Call 999 or go to A&E if you lose feeling in one or both legs, your bottom or your genitals.

Very rarely, back pain is a sign of a serious problem. The NHS says to call 999 or go to A&E if you have back pain and any of the following, and not to drive yourself there.

• Pain, tingling, weakness or numbness in both legs.

• Loss of feeling around the genitals or anus.

• Changes in bladder or bowels, such as difficulty peeing, or peeing or pooing yourself.

• Changes in how the penis or vagina feels during sex, or being unable to get or keep an erection or to orgasm.

• Chest pain.

• Pain that started after a serious accident, such as a car accident.

• The NHS says to ask for an urgent GP appointment or call NHS 111 if you also feel hot, cold, shivery or unwell, or have severe pain that starts suddenly or is getting worse quickly.

The NHS says to see a GP if your back pain does not improve after treating it at home for a few weeks, is stopping you doing day-to-day activities, or you are worried or struggling to cope. It also lists:

• unexplained weight loss

• a lump or swelling in your back, or a change in the shape of your back

• pain that does not improve after resting or is worse at night

• pain that is worse when sneezing, coughing or pooing

• pain coming from the top of your back, between the shoulders, rather than the lower back

• In many areas you can refer yourself to NHS community musculoskeletal (MSK) services for help such as physiotherapy without a GP referral.

Arthritis UK says doctors often start with a watch-and-wait approach, because most back pain improves on its own within a few weeks. Most problems can be diagnosed by talking about symptoms and examining your back, and you usually will not need tests.

A scan may be considered if you have had an injury such as a bad fall, your doctor suspects an underlying cause, or the pain has lasted unusually long. It says X-rays are rarely used because many causes involve soft tissues that do not show up.

NICE CKS describes using a risk stratification tool to identify people at risk of a prolonged or complex recovery, and considering referral to a specialist back pain service for chronic pain when non-invasive treatments are not working.

Most people start with self-care, a pharmacist or a GP, and the NHS says in many areas you can self-refer to community MSK services for physiotherapy. Persistent pain may lead to physiotherapy, group exercise, psychological support or a specialist back pain service.

Some people choose to see a private physiotherapist, osteopath or pain specialist to be seen sooner. Red-flag symptoms always need urgent NHS assessment, and imaging is usually only useful where it will change the treatment plan. Ask what a test is likely to add before paying for it.