Backpain

Warning
Warning:

This site gives you information NOT medical advice. You should consult your medical practitioner if you have any unexplained symptoms of illness or concerns about treatment. Do not stop a prescribed conventional treatment without consulting a doctor. Tell all the practitioners you're working with, conventional or complementary, about any medicines, remedies, herbs or supplements you are taking or considering using.

What do we mean by acute low back pain?

The low back is the part between the bottom of your ribs and the crease of your buttocks. Every year in the UK, one adult in three will get back pain and about 20% of them will see their GP about it. This makes low back pain the second most common reason for seeing a GP; the commonest being digestive problems.

What causes the pain?

Most back pain is due to tension, soreness and stiffness in muscles that have been overused or overstretched. Nineteen times out of twenty, no particular cause (such as a fracture, or arthritis or a disc problem) can be found. This is why it's often called 'non-specific low back pain'. Typically, it feels worse if you use your back, and eases off when you are lying down flat. Generally, if you haven't moved for a while, and the muscles tense up, it will feel worse as you start to move again, or perhaps when you roll over in bed. Non-specific low back pain is sometimes called 'simple mechanical back pain' because the pain is linked to movement and tension, and because it comes from the back muscles and stiff joints.

Usually, even very painful, acute ('acute' means it began recently) low back pain eases off after a few days. Even though the pain may be bad at first, 90% of people improve a lot or recover completely within six weeks, and often much sooner. But some people find that the pain keeps coming back. In fact, once you have had low back pain, you are more likely to get it again. But if this happens to you, you can do a lot to speed up your recovery and prevent it coming back at some point. In a few cases, it can become a persistent, ongoing problem.

Research has shown that keeping active, and regular walking, running or swimming, will help prevent this. It obviously helps to be 'back aware': for instance, not to twist or bend sideways when you're trying to lift things; and to remember to use the power of your knees rather than your back when you are picking up something heavy.

What other information might be helpful?

When to see a doctor

Immediately:

As soon as you can:

simplechangesMake Some Simple Changes


pencil Eating a healthy diet

OverviewIt is always important to have a healthy diet. This means a diet that includes enough vitamins and minerals, and plenty of fruit, vegetables and whole grains. The Food Standards Agency has eight tips for eating well:

1. Base your meals on starchy foods.
2. Eat lots of fruit and vegetables.
3. Eat more fish.
4. Cut down on saturated fat and sugar.
5. Try to eat less salt - no more than 6 g a day.
6. Get active and try to keep to a healthy weight.
7. Drink plenty of water.
8. Don't skip breakfast. It sets you up for the day and it helps get your body and mind going first thing.

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simplechanges Exercise

OverviewStiff muscles hurt but moving won't harm them. If you have acute back pain, you might feel like resting and staying still as much as you can. But in fact people with back pain who rest in bed take longer to get better. This is probably because their muscles get stiff and tight when they aren't moving and stretching enough. Therefore, once the worst of the pain has eased off, try to carry on with your normal activities, even if you have to use a mild painkiller (such as paracetamol, co-codamol, aspirin or ibuprofen) to take the edge off the pain. Most people find that this works. Prolonged time off work also seems to slow recovery down. So, if you are not back at work after a fortnight, you should definitely go back and get more medical advice. And rather than staying off work for a longer period, ask your employer to you find you lighter work for a time. Generally speaking, staying fit and active will speed up your recovery and help prevent further problems.
EvidenceThere is good evidence that staying active and taking regular exercise is helpful for people who are prone to getting lower back pain. Choose the sort of exercise you enjoy. There is no particular 'back strengthening' exercise that is better than another for preventing back pain. Just half an hours brisk walk every day can improve your long-term fitness and mood.
SafetyBuild up gradually. Don't exercise immediately before bedtime because it might keep you awake. See Attending classes for other types of exercise. If you have a heart or breathing problem, and you're not sure about getting more active, check with your doctor.
CostYou can exercise at home for nothing - walking and gardening is all exercise. There will probably be a small cost (usually £5-£8 a class), if you join an organised programme.
Find out moreNatural England is one of several organisations that organise walking schemes designed to help people improve their health. The Walking for Health Programme has about 600 local groups, and around 40,000 people take part in short local walks every week. Find out about Green Gyms where volunteers take on voluntary projects outdoors. Many local councils organise Health Walks for people who want to get active in company.

Check your local leisure centre for exercise classes.
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simplechanges Hot and cold packs and heat treatments

OverviewIf you have acute low back pain, you may find that putting a hot or cold pack on the painful area will help your back muscles relax. You'll need to try both hot and cold to find out which works better for you as an individual. You can use a bag of frozen peas, or a warm hot-water bottle. Always wrap the hot or cold pack in a thin towel or cloth so it doesn't burn or freeze you. Usually, applying heat or cold for about 20 minutes will help your muscles relax so that you are less stiff. Then you may feel loose enough to try some slow stretches and get the blood flowing back into cramped muscles. You may find it helpful to alternate between hot and cold packs every five minutes.
EvidenceResearch has shown that heat can reduce pain and stiffness in back pain that has lasted less than three months, though the effect is small and short-lived. Stretching exercises, combined with heat, seem to be more helpful. It is not clear whether heat works for pain lasting longer than three months.
SafetyThere are no safety problems with hot or cold packs, as long as you remember to wrap the pack in a thin towel or cloth to protect your skin.
CostYou can buy special heat packs or use something you already have, like a hot water bottle. Other possible heat sources include: soft heated packs filled with grain, poultices, hot towels, hot baths, saunas, steam, heat wraps, heat pads, electric heat pads and infra-red heat lamps.
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simplechanges Meditation, music and audio aids

OverviewMeditation is a state of mind, not a religion, though it features in most major religions, especially Eastern ones. Meditation seems to harmonise the activity between the two sides of the frontal brain, and encourages a 'relaxation response'. The 'relaxation response' happens when the body and mind do the opposite of what they do when you feel stressed. In meditation the body is relaxed while the mind is alert. You don't need an experienced teacher or a spiritual faith in order to take up meditation. You can learn the basics from a book or a podcast. Meditation is easily accessible, and it is remarkably effective, both for rapid stress reduction and as a way of promoting long-term health.

Most research suggests that soft, slow melodies, usually classical music, can help you relax. Audio aids, which may take the form of relaxing music or natural sounds like waves or gentle wind or even quiet heartbeat rhythms, can also be useful.
EvidenceIt isn't clear from research whether meditation, relaxing with music or listening to audio aids can help long-term back pain directly. But if they help you relax, they should ease muscle tension, and help break the pain stress cycle.
SafetyThere are no safety problems with meditation, music or audio aids.
CostYou can buy special relaxation music, but it's really a matter of finding out what works for you. Meditation involves certain (simple) techniques that can be easily practised at home. There are many books and audio aids available and some people find it useful to join a class initially.
Find out moreVisit The British Holistic Medical Association for podcasts and leaflets.

See also Yoga in the Classes section. Meditation classes are often advertised in your local library or adult education college.
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simplechanges Progressive muscular relaxation (PMR)

OverviewProgressive muscular relaxation is a technique designed to deeply relax your muscles. PMR teaches you to notice muscular tension and learn to relax your muscles to release the tension. It works by having you tense then relax various parts of your body, starting with the muscles of your feet and working your way up. At each level, you aim to notice how it feels when your muscles are tense, and how it feels when you let them go and relax. Gradually you get used to the feeling of relaxation and learn how to make it happen at will. As with most relaxation methods, you need to start by finding a quiet, relaxing place to practise. Put yourself into a comfortable position, whether sitting or lying, and start by allowing your out-breathing to get softer, longer and deeper.
EvidenceThree small studies suggest that progressive relaxation helps for a short time with back pain.
SafetyProgressive relaxation is generally safe but should be used cautiously in people with musculoskeletal injury or a long-standing or severe mental health problem.
CostOnce you have learned the relaxation techniques, there are no costs. There are many books and audio aids available and some people find it useful to join a class initially.
Find out moreVisit The British Holistic Medical Association for podcasts and leaflets. See also our leaflet on Stress and Anxiety.
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buysomethingBuy Something


pencil Before You Buy

OverviewFor safe use of over-the-counter medicines, herbal remedies and supplements:

Consult a qualified person (such as a pharmacist) before buying or taking any medicine, remedy or supplement:
- if you have a serious medical condition
- if you are breast-feeding, pregnant or planning to become pregnant
- if you are already taking other medicines, herbal remedies or supplements
- if you suffer from allergies

Always read the package insert before taking any product.
Avoid taking the product if you think you may be allergic to any of the ingredients.
Do not combine any over-the-counter medicines, remedies or supplements with other medicines, remedies or supplements unless you have first checked with a qualified person (such as the pharmacist in your local chemist).

Seek advice from your doctor or pharmacist:
- If your symptoms do not get better
- if your symptoms get worse
- if you get new symptoms or have a side effect

The information here, including dosages, only applies to adults (over 16 years). Keep all medicines out of the reach of children.

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buysomething Cayenne (capsicum)

OverviewCayenne (or hot chilli) peppers were brought to Europe after Christopher Columbus discovered America. In modern times a chemical called capsaicin, made from cayenne, has been researched. It has pain-relieving properties when it is applied over a sore area.
EvidenceThere is a very long tradition across the world of applying heat-generating remedies like cayenne and mustard to painful joints. It is likely that these remedies increase blood flow to the joint for longer than applying heat directly (see Using hot and cold packs).
SafetyApplying capsicum products to the skin is usually safe but sometimes it can get sore and itchy. If you have this reaction, stop using the capsicum immediately. The burning sensation you get with these remedies is caused by nerve stimulation, rather than actual heat. Never apply these products over broken skin or open wounds.

Capsaicin is an irritant, and some people find its irritating effect worse than the pain it is meant to offset. About one-third of patients get local adverse effects from capsaicin. Always read the package instructions before use, and avoid using capsaicin if you think you may be allergic to it.
Keep it away from your eyes and wash your hands immediately after applying it. Keep it away from children. Wash it off any skin areas that do not need treating, using warm cooking oil, rather than soap or detergent.
CostPlasters containing capsaicin may be available by prescription.
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buysomething Devil's Claw (Harpagophytum procumbens)

OverviewThis unusual plant from the desert regions of southern Africa has a thorny root, which the local people used as a remedy for arthritic problems. It is becoming rare nowadays in its natural state so it is important to buy only from reliable manufacturers who supply pure, sustainably farmed devil's claw.
EvidenceSome good research has found that taking devil's claw can reduce low-back pain.
SafetyDevil's claw is generally safe in recommended dosages. A few people get an upset stomach when they take it. There are no reasons to suspect that it causes problems but it is advisable to get advice from a healthcare professional around pregnancy or breast-feeding. Most of the side-effects seem to be mild and uncommon: mainly headaches, ringing in the ears, loss of appetite and loss of taste. Minor side-effects also include skin rashes, stomach upsets and diarrhoea. Devil's claw increases stomach acidity, and therefore shouldn't be combined with blood-thinning medication (e.g. aspirin), painkillers (e.g. ibuprofen), heart drugs (e.g. digoxin) or stomach acid drugs (e.g. famotidine). Serious side-effects of devil's claw (abnormal heart rhythm and bleeding) are uncommon.
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buysomething Painkillers

OverviewSimple analgesics (painkillers) can be helpful in managing persistent muscle pain.
EvidenceParacetamol works as well as ibuprofen in acute back pain and is less likely to give you side-effects. If it doesn't work, then you could try ibuprofen, or codeine with paracetamol (co-codamol). Do take the recommended dose at the recommended intervals. Half doses of pain relievers taken now and then won't work! They help most if you take the full dose four times a day. Drugs such as ibuprofen may not be so helpful if you have sciatica.
SafetyIf used in the correct dose, painkillers are generally safe, but taking painkillers (whether prescription or over-the-counter) every day can cause side effects.

Side effects can include headaches, indigestion and even stomach ulcers or bleeding. Stop taking them if you start getting indigestion or stomach pain, and tell your GP or pharmacist. Always follow the stated dose.
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buysomething Transcutaneous electrical nerve stimulation (TENS)

OverviewTENS is a way of delivering a small, pulsating current to your muscles and nerve endings. It is relatively easy and safe to use. Small electrical currents are sent through pads on the skin near the site of the pain. Several small studies have suggested that using TENS machines helps some people with long-term pain in general.
EvidenceSeveral small studies suggest that using TENS machines helps some people with long-term back pain.
SafetySee the information sheet on TENS machines from Arthritis Care for information on how to use TENS machines safely.
CostTENS machines are available from many pharmacies and some Internet retailers. They usually cost between £20 and £40 but this is a one-off cost.
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buysomething White willow bark (Salix alba)

OverviewWillow is the original source of aspirin and has long been used as a remedy for joint pain. It can be used as a pain reliever in much the same way. Aspirin or paracetamol are, of course, a lot less expensive.
EvidenceThere is quite good research showing that white willow bark extract can be helpful in low back pain.
SafetySome of the same safety issues that apply to aspirin are relevant to willow bark products. Don't use them if you are allergic to aspirin or products like ibuprofen or if you suffer from stomach problems. It is better to avoid this remedy if you are taking blood-thinning agents like warfarin. Do not take it if you are breast-feeding, as the aspirin element may make your baby sensitive to aspirin. Willow is probably safe in pregnancy but you should get advice from a healthcare professional before considering it. Let your doctor know if you are taking this remedy.
CostWillow bark products are more expensive than aspirin and unlikely to be more effective.
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attendvisitAttend Classes / Visit Practitioner


pencil Developing a self-care programme

OverviewThe National Institute of Clinical Excellence (NICE) offers back pain guidelines for the NHS. These guidelines list the following three approaches, for which there is some evidence from research trials:

1 Structured exercise programmes are generally in a group supervised by a physiotherapist or qualified exercise instructor. Exercises include aerobic movement, strengthening, posture and stretching. A series means eight or so sessions over 8-12 weeks, with homework between sessions.
2 Manual therapy - this can involve sessions of deep massage, with or without spinal mobilisation (e.g. osteopathy or chiropractic).
3 Acupuncture - it is not clear how this works, but there is good evidence that it can help improve long-term low back pain.

Supervised exercise programmes are safe for most people. But at first you might feel more tired. If you're not used to doing much exercise, you should gradually increase your activity until you can manage a moderate level. If you feel worse, cut back and build up more slowly. If you think it isn't helping or that you're getting worse in any way, check with your doctor. Anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should avoid strenuous exercise.

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attendvisit Acupuncture

OverviewAcupuncture is a traditional form of treatment that began in China thousands of years ago. Thin needles are inserted into the skin at special points on the body which practitioners believe help restore health. It can also use heat, pressure, electrical currents or soft-laser light. In the UK acupuncture is most commonly used for pain relief.
EvidenceResearch shows that acupuncture improves chronic low back pain. However it does not seem to be more effective than some other treatments such as manipulation and massage.
SafetyAcupuncture is generally safe if practiced by a trained acupuncturist. The most common side effects are slight discomfort (common) and bruising (occasionally).
CostA session may cost £35-£50. Frequency of treatment will depend on you and your practitioner.
Find out moreThe following professional organisations can help you find a qualified practitioner:
Acupuncture Association of Chartered Physiotherapists
British Academy of Western Medical Acupuncture
British Acupuncture Council
British Medical Acupuncture Society
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attendvisit Alexander Technique

OverviewMany of us store a lot of tension in our back. Alexander Technique teaches you to notice how you move and breathe and how your body reacts in stressful situations. Alexander Technique helps you spot longstanding habits of movement, and change them, so it calls for very active participation and concentrated effort.
EvidenceA recent study showed that one-to-one lessons in Alexander Technique from a registered teacher can help with back pain long-term.
SafetyThere are no safety issues with if you have a qualified teacher
Cost
Find out moreIt is important to find a qualified teacher such as someone registered with
The Society of Teachers of the Alexander Technique
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attendvisit Chiropractic and osteopathy

OverviewOsteopathy is an established hands-on diagnosis and treatment method, whose main emphasis is on the way muscles and joints work. It assumes that pain and disability often stems from physical strains and tensions in the body, rather than from damage caused by disease or injury. Chiropractic is an approach to treatment based on the idea that illness stems from misalignment of the spinal column. Osteopaths and chiropractors use their hands to relax the body and stretch the joints of your spine. This can help improve mobility and relieve low back pain.
EvidenceSpinal manipulation from a chiropractor or osteopath seems to help with symptoms and stiffness. It is less helpful for people who have a definite disc problem, so seek advice if you have much pain or tingling down the leg.
SafetySide effects are rare and mainly linked to manipulation of the neck. Some mild after-effects from treatment can happen (aches) but they usually last less than 48 hours.
Cost
Find out moreAll qualified osteopaths are registered with The General Osteopathic Council
All qualified chiropractors are registered with The General Chiropractic Council
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attendvisit Exercise programmes

OverviewIf you haven't been active for some time, you should start slowly and build up when putting together a regular exercise programme.
EvidenceProgrammes that include stretching or strengthening, designed to ease pain and improve movement, help reduce and prevent back pain.
SafetySupervised exercise programmes are safe for almost everyone. Don't exercise strenuously if you have severe osteoporosis or inflamed joints, acute back pain, sprains or fractures. If you have heart or chest problems, get medical advice first.
CostThere will probably be a small cost, £5- £8 a class, if you join an organised programme. Your GP can also refer you to the local physiotherapy department.
Find out moreClasses and exercise programmes are run in most areas by both local authority leisure services and private gyms.
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attendvisit Exercising in water

OverviewIn an ordinary aerobics class, your feet are pounding away on hard floors. Doing the same sort of exercise in water has several advantages: it's far easier on the joints; your muscles have to work harder to move your body through the water; and the buoyancy takes the weight off your back while you stretch and mobilise.

Most classes exercise in the shallow part of the pool, or use buoyant jackets, so you don't need to know how to swim to do water aerobics.
EvidenceResearch suggests that exercising in water is helpful for people with low back pain, though the effects are small and only last for a short time.
SafetySupervised exercise programs are generally safe for most people. Choose a class at the beginner's level and check whether the class requires you to swim.
Cost
Find out moreClasses are run in most areas by both local authority leisure services and private gyms.
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attendvisit Massage

OverviewThere are many different types of massage, some more vigorous and going deeper into the muscles than others. Massage has traditionally been used for relaxation. It may be just on one part of the body for example, the back and shoulders, or be done on the whole body. Aromatherapy massage uses pleasant-smelling essential oils.
EvidenceResearch shows that massage can help ease low back pain. It seems to be particularly helpful in people who also take some sort of exercise.
SafetyMassage is safe if carried out by a qualified massage therapist and rarely causes problems. Vigorous massage should be avoided if you have blood disorders, some forms of cancer, skin problems or are on blood-thinning medications (such as warfarin). Allergies or skin irritation can occur with some essential oils used in massage.
CostMonthly cost will depend on how regularly you receive treatments.
Find out moreIt is important to find a qualified practitioner such as one registered with
The General Council for Massage Therapies
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attendvisit Pilates

OverviewThis physical fitness system was developed in the early twentieth century by Joseph Pilates. Core strength is the key idea in Pilates exercise. The core muscles are the deep, inner muscles in your abdomen and back. When they are strong enough, they do a lot to support your spine. If your core isn't strong enough, your back will easily get tired and sore. But when your core muscles work well together they take the strain off your spine so it can move freely and efficiently.
EvidencePilates exercises are popular and seem to help with long-term low back pain, but there is not yet much research in this area.
SafetyStart slowly in a beginners level class and get advice if you aren't improving.
Cost
Find out moreClasses are run in most areas by both local authority leisure services and private gyms. Some practitioners also offer one-to-one sessions.
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attendvisit Psychological therapies

OverviewWhen people think of 'talking therapies' they usually mean either counselling or psychotherapy. Counselling and psychotherapy aim to help people change thoughts, feelings and attitudes. Counsellors help you talk about difficult feelings and understand conflict. It can be helpful just to have time alone with a counsellor to talk in confidence about how you feel. Spending time reflecting on problems often brings insight and puts things into perspective. Psychotherapy helps people learn better ways of thinking or behaving that can reduce their symptoms, disability and distress. Some psychotherapists are trained to help you explore possible causes of distress or symptoms in your past. Cognitive behavioural therapy (CBT) is the type of psychotherapy that is currently most widely available in the NHS.

Instead of exploring causes of distress or symptoms in the past (like many other types of therapy), CBT looks for ways to improve your state of mind right now. The therapist does this by helping you spot unhelpful thought processes and change them. The Royal College of Psychiatrists says "CBT can help you to change how you think ('cognitive') and what you do ('behavioural')". For instance, CBT can help you make sense of what seem like overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you.

A recent piece of research showed that six 90 minute group therapy sessions helped people who had long-term back pain. The sessions based loosely around CBT and relaxation techniques helped them overcome worries about getting active again and learn how to avoid flare-ups. People said they were still feeling better a year after the programme.
EvidenceThere is good evidence that CBT and relaxation techniques can help you if you have long-term, persistent, low back pain. It probably helps in at least two ways: by helping people overcome their fear of getting active, and by teaching relaxation skills.
SafetyThese techniques are generally safe if carried out by or under the guidance of a qualified counsellor or psychologist.
CostIn most areas your GP can refer you for CBT or a psychological therapist in the NHS. There are often long waiting lists. A session of CBT or psychological therapy may cost between £20-£50. Frequency will depend on you and your therapist. A typical course of CBT lasts between 6-12 weekly sessions.
Find out moreIt is important to find a qualified counsellor or psychologist. Contact The British Psychological Society
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attendvisit Tai Chi

OverviewTai Chi is also known as 'moving meditation'. It is a series of slow, graceful, controlled movements, which develop strength, balance, posture and inner peace. It is a discipline that has to be learned in a class from a teacher and can then be practised at home.
EvidenceThere is some research suggesting that tai chi can help people cope with back pain and move more easily.
SafetyTai Chi is safe for most people. Though Tai Chi is slow and gentle, anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should avoid strenuous exercise and build up gently.
CostOnce you have learned the movements, you can do this at home, at no cost.
Find out moreClasses are run in most areas by both private tutors and by adult education services or you can contact the The Tai Chi Union.
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attendvisit Yoga

OverviewYoga, as taught in the UK, generally includes physical postures or stretches, breathing techniques, meditation and relaxation. There are several different types of yoga. Some of them are mainly based on the physical exercises (some types are much more strenuous than others). Others focus more on meditation.
EvidenceThree trials (one of which was a good-quality study) have compared yoga with other types of exercise. All three suggested that yoga can help with chronic low back pain.
SafetyYoga is generally safe when practiced appropriately and at the right level. Classes are run for different ability levels so look for one that is right for you. Yoga stretches should be increased slowly. If in doubt, check with your doctor, osteopath or physiotherapist. Avoid with severe osteoporosis or acute joint or back pain, or recent injuries.
CostOnce you have learned the techniques you can do this at home, at no cost.
Find out moreClasses are run in most areas by both private tutors and by adult education services. To find a qualified teacher near you see also the The Yoga Alliance
and the The British Wheel of Yoga.
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