What is low back pain?

Low back pain is pain that you feel in your lower back or lumbar spine area. Your lumbar area is the part of your back below your ribs.

Pain in your lower back is a very common problem. Usually, low back pain gets better after a few weeks without medical help.

What symptoms are related to low back pain?

People experience low back pain in different ways. You might have:

• pain and soreness — which could feel like a sharp pain or a dull ache or spasms
• stiffness — you may feel stiff or find it hard to turn or bend in certain directions
• sciatic pain that travels down one or both of your legs

Back pain can also impact your emotional state. You may:

• feel irritable or short-tempered
• worry that the pain will never get better
• experience feelings of helplessness

Low back pain that lasts longer than 12 weeks is a form of chronic pain.

CHECK YOUR SYMPTOMS — Use the Symptom Checker and find out if you need to seek medical help.

What causes low back pain?

Your spine (backbone) is a complex structure. It's made up of 24 small bones called vertebrae that are stacked on top of each other.

Discs sit between each vertebra to act as cushions or shock absorbers and give your spine flexibility.

The vertebrae are joined together by small joints called 'facet' joints. These joints allow you to move and bend your back.

A mesh of ligaments and muscles hold your spine together and provide structural support, which allows you to move.

Non-specific low back pain

About 8 in 10 people will have low back pain that is not caused by a particular condition at some time during their life. This is called 'non-specific low back pain'.

Non-specific low back pain is most common in people aged 35 to 55 years, but can affect people of all ages.

Some things that make non-specific low back pain more likely to happen are:

• heavy physical work
• frequent twisting, bending or lifting
• poor posture
• weakness in your back and abdominal muscles
• sitting for long periods each day, such as office work
• too little physical activity
• being overweight

How is low back pain diagnosed?

Your healthcare professional will assess your low back pain. They will examine you and may ask questions from the list below.

• When did your back pain begin?
• Where is the pain?
• What activities were you doing differently before your back pain started?
• How would you describe the pain?
• Is there tingling or numbness?
• What makes the pain better or worse?
• Do you have pain elsewhere, such as in your legs?

They will also ask how the pain makes you feel and if it is affecting your daily activities.

Your doctor will ask you about any other health conditions.

If you have had back pain for a while, or have other medical problems, your doctor may refer you for tests. Tests can include blood tests or imaging tests.

However, imaging such as x-rays, CT scans or MRI scans are not always helpful, unless you have an obvious injury or strain. Unnecessary imaging tests can also be expensive.

Scan reports sometimes mention changes that reflect the normal passage of time, rather than damage to your spine. Ask your doctor to explain your test results.

More information about imaging for lower back pain is available from the Royal Australian College of General Practitioners (RACGP).

When should I see my doctor?

You should see your doctor or other healthcare professional for further advice if:

• your low back pain bothers you a lot
• your back pain doesn't improve after a few weeks or gets worse
• you have symptoms such as weight loss, tingling or numbness in the legs, or problems with bladder or bowel control
• you have osteoporosis
• you have a serious underlying medical condition

When should I seek urgent medical care?

You should see your doctor about your back pain as soon as possible if you:

• have a history of cancer
• are prone to infections
• develop a fever (temperature above 38 ℃)
• use intravenous drugs

For most people, lower back pain will resolve in a few weeks.

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How is low back pain treated?

You can do several things to manage low back pain. Your treatment should reduce pain and maintain your ability to do daily tasks. It will also limit how much time you need away from work and your usual activities.

Talk with your doctor or physiotherapist about any concerns you may have. They can help you to understand your treatment plan.

Self-care at home

Most people with non-specific low back pain get better quickly. Here are some things you can do.

Try to keep active and return to some physical activity or regular work as soon as you can. Your back is designed to move, so don't rest your back for more than a day or 2.

Apply heat to your back to help:

• improve blood flow
• reduce pain
• your muscles relax and move more freely

Exercise can help you to manage back pain. Walking, water-based walking (in a pool), swimming and floor stretches are good ways to start.

Check with your doctor or physiotherapist if you are not sure about which exercises are best.

You can increase how often and how hard you exercise over time. You may start squats or lunges, or programs such as:

• yoga
• Pilates
• cycling

If you are overweight or living with obesity, losing weight can help relieve low back pain.

Try managing your emotional response to pain with a mindfulness practice. Ask your doctor to refer you to a provider or use a smartphone application. Your doctor may refer you to a psychologist for help with chronic low back pain.

Medicines for low back pain

The goal of taking medicines for back pain is to help you stay active. Use pain-relief medicines to keep your body moving. Don't expect the medicine to stop your pain altogether.

You can take non-steroidal anti-inflammatory drugs (NSAIDs) for short-term relief of non-specific low back pain. Check with your doctor or pharmacist about side effects.

If NSAIDs (such as ibuprofen tablets) are not suitable for you, try a NSAID gel, or take paracetamol.

Use the lowest dose that helps you manage your back pain, for the shortest time possible.

Strong pain medicines like opioids are not usually recommended for back pain. Research shows strong pain medicines provide limited benefit and can cause side effects such as drowsiness, sedation and addiction.

If you have severe back pain and your current medicine is not helping, talk to your doctor about a treatment plan.

Other treatment options

A qualified physiotherapist can assess your pain. They can give you a massage and suggest exercises to keep your back moving.

Your doctor might also refer you to a psychologist. Psychological treatment can help you manage long-term pain.

Cognitive behavioural therapy may help you develop coping strategies to manage your pain.

Managing stress and getting treatment for conditions such as anxiety and depression can also help you recover.

Let your healthcare team know about any complementary therapy or other treatments you are using.

Can lower back pain be prevented?

Healthy lifestyle choices can help prevent some causes of back pain.

Exercise can help prevent non-specific low back pain. Keeping to a healthy weight will also help.

Exercising helps to keep your back flexible and strong. It improves your posture and helps your muscles to support your spine. Try:

• low-impact aerobic exercise, such as walking, tai chi or swimming
• strengthening exercises, such as lifting weights
• strengthening and stretching exercises, such as Pilates and yoga

Maintaining a good posture is important when you sit at home, in your workplace, or in your car.

• Try not to slouch.
• Use equipment that supports your back, such as a lumbar support or footstool if you need.

Practise safe lifting in your home and workplace. Whenever you pick up a heavy load, squat down, hold the object close to your body, and lift with your legs.

It may also help to:

• quit smoking or vaping, as smoking is associated with low back pain
• learn relaxation techniques and mindfulness, which can help to reduce stress and muscle tension in your back

Complications of low back pain

Most people recover from non-specific low back pain within a few weeks. See your doctor if you experience additional symptoms, such as:

• loss of bowel or bladder control
• severe pain that gets worse over time
• problems passing urine (wee) or bowel movements (poo)
• numbness or a 'pins-and-needles' sensation in your legs, back or elsewhere
• unexplained weight loss

For some people, back pain becomes an ongoing problem. Possible complications that come with long-term back pain include:

• depression
• dependence on strong pain medicines, such as opioids
• reduced quality of life
• difficulty working and keeping active

See your doctor if your back pain limits your movement and activities. Your doctor can help you find ways to manage your chronic pain and regain a better quality of life.

Resources and support

MyBackPain has tips on managing back pain.

For more information and support, visit the Pain Australia website and find a support group or online community for people living with chronic pain.

Pain Australia suggests several apps that can help you understand and manage your pain better.

Other languages

The following resources are available in languages other than English:

• The NSW Multicultural Health Communication Service has factsheets on living with chronic or persistent pain and videos on understanding pain.
• The NSW Government has a factsheet on managing low back pain.
• You will find more translated information on back pain at Health Translations.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.