Back pain is common and affects most people at some point in their life. It usually feels like an ache, tension or stiffness in your back.  

The pain can be triggered by sitting badly, bending or sitting awkwardly, or lifting incorrectly. 

Back pain is not generally caused by a serious disease and, in most cases, gets better within 12 weeks. It can usually be treated successfully by taking painkillers and keeping mobile.

Find out more about what can cause back pain.

Types of back pain

Backache is most common in the lower back, although it can be felt anywhere along your spine, from your neck down to your hips. You can find information on specific types of back pain on the following pages:

• neck pain 
• whiplash
• shoulder pain 
• frozen shoulder
• ankylosing spondylitis
• slipped disc
• sciatica

Read more about the symptoms of back pain.

Treating back pain

If you have back pain, try to remain as active as possible and continue with your daily activities. In the past, doctors advised rest for back pain, but most experts now agree that being inactive for long periods is actually bad for your back. In fact, moderate activity, such as walking or doing everyday tasks, will help recovery. 

Take painkillers, such as paracetamol or ibuprofen, if you feel the need to.

Hot or cold compression packs may also help reduce the pain. You can buy compression packs from your pharmacy, or a bag of frozen vegetables and a hotwater bottle will work just as well.

Your state of mind can play an important role too. Living with the pain can make it hard to be cheerful, but research has shown that people who remain positive tend to recover faster than those who get depressed.

Some people choose to have manual therapy, such as physiotherapy or osteopathy, as soon as the pain starts. Private appointments cost around £40.

For back pain lasting for more than six weeks (which doctors describe as chronic), treatment typically involves a combination of painkillers and either acupuncture, exercise classes or manual therapy.

Spinal surgery is usually only considered when all else has failed.

Read more about treating back pain.

When to see your GP

Most cases of back pain get better on their own and you don't need to see a doctor.

However, you should contact your GP if you're worried about your back or struggling to cope with the pain.  

Find out more about diagnosing back pain.

You should seek immediate medical help if your back pain is accompanied by:

• fever
• unexplained weight loss
• swelling in the back
• pain in other parts of your body
• loss of bladder or bowel control
• numbness around your genitals
• pain that is worse at night 

These are what are known as red flag symptoms and could be a sign of something more serious.

Preventing back pain

How you sit, stand, lift and lie down can have an important effect on the health of your back. Our back pain guide shows you how to sit, stand and lift correctly to avoid backache.

You should try not to place too much pressure on your back and ensure your back is strong and supple. Regular exercise, such as walking and swimming, is an excellent way of preventing back pain. Activities such as yoga or pilates can improve your flexibility and the strength of your back muscles.

Find out more about:

• preventing back pain 
• exercises for back pain
• treating back pain
• how to lift safely

Back pain is most commonly felt as soreness, tension or stiffness in the lower back (the area between the bottom of the ribs and the top of the legs) but it can also be felt in the neck, shoulders, buttocks and thighs.

The pain sometimes develops suddenly after lifting something heavy or twisting your back awkwardly, or it can develop gradually as a result of years of poor posture.

Sometimes the pain develops for no apparent reason. Some people just wake up one day with a sore back. Typically, the pain eases when you lie down flat, whereas moving, coughing or sneezing makes it worse.

When to get medical help

Most cases of back pain usually improve without you having to get medical help, but if your condition does not get any better within three days see your GP. You should also see your GP if you suffer regular episodes of back pain for more than six weeks.

There are several warning signs, known as red flag signs, that may indicate that your back pain is caused by a more serious condition that requires immediate medical help. These include:

• a fever of 38ºC (100.4ºF) or above
• unexplained weight loss
• swelling of the back
• constant back pain that does not ease after lying down
• pain in your chest or high up in your back
• pain down your legs and below the knees
• pain caused by a recent trauma or injury to your back
• loss of bladder control
• inability to pass urine
• loss of bowel control
• numbness around your genitals, buttocks or back passage
• pain that is worse at night

If you have any of these signs, see your GP straight away. If this is not possible, telephone NHS Direct on 0845 4647.

Other types of back pain

Pain in the upper back, legs, neck and shoulders can also be felt as back pain but it may be caused by another condition:

• pain in the lower back that moves down the buttocks into one or both of the legs may be a symptom of sciatica
• soreness in the lower back, muscle weakness, tight muscles and loss of bladder control may be the result of a slipped disc
• back pain, buttock pain, swollen joints and tendons and extreme tiredness are common symptoms of ankylosing spondylitis
• pain in the joints (including the back) when walking and stiffness first thing in the morning are symptoms of arthritis
• painful stiffness of the shoulder, which makes it very difficult to dress, drive or sleep, may be a sign of frozen shoulder
• neck pain and stiffness, headaches and lower back pain following an accident are common symptoms of whiplash

Find out about the causes of back pain.

Anus

The anus is the opening at the end of the digestive system where solid waste leaves the body.

Bladder

The bladder is a small organ near the pelvis that holds urine until it is ready to be passed from the body.

Chemotherapy

Chemotherapy is a treatment of an illness or disease with a chemical substance, for example in the treatment of cancer.

Fever

A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37°C (98.6°F).

Immune system

The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.

Your back is a complex structure made up of bones, muscles, nerves and joints, so pinpointing the exact cause of the pain can often be difficult.

However, most cases of back pain are not caused by serious damage or disease but by sprains, minor strains, minor injuries or a pinched or irritated nerve.

Back pain can be triggered by everyday activities at home and at work, or it can develop gradually over time as a result of sitting, standing or lifting badly. Back pain causes include:

• bending awkwardly
• lifting, carrying, pushing or pulling incorrectly
• slouching in chairs
• standing or bending down for long periods
• twisting
• over-stretching
• driving in a hunched position
• driving for long periods without taking a break
• overuse of the muscles, usually due to sport or repetitive movements (repetitive strain injury) 

Sometimes the pain develops suddenly for no apparent reason. Some people just wake up one morning with back pain and have no idea what has caused it.

Risk factors

Some risk factors increase the risk of developing back pain. These include:

• Being overweight – the extra weight puts pressure on the spine. Use the healthy weight BMI calculator to find out if you need to lose weight. 
• Smoking – this could be due to tissue damage in the back caused by smoking or the fact that smokers tend to have unhealthier lifestyles than non-smokers. Get help quitting. 
• Being pregnant – the excess weight of carrying a baby can place additional strain on the back.
• Long-term use of medication that is known to weaken bones, such as corticosteroids.
• Stress – it is thought that stress can cause tension in the muscles of the back, which can result in back pain.
• Depression – back pain can make people feel depressed, which can sometimes result in weight gain leading to more severe pain and worsening depression.

Find out about medical tests for back pain.

In a small number of cases, back pain is caused by a specific medical condition. These conditions include:

• neck pain 
• whiplash
• shoulder pain 
• frozen shoulder
• ankylosing spondylitis
• slipped disc
• sciatica

Now read about treating back pain. 

Bladder

The bladder is a small organ near the pelvis that holds urine until it is ready to be passed from the body.

Kidney

Kidneys are a pair of bean-shaped organs located at the back of the abdomen that remove waste and extra fluid from the blood and pass them out of the body as urine.

Obesity

Obesity is when a person has an abnormally high amount of body fat. 

Spine

The spine supports the skeleton, and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called the vertebrae.

Most cases of back pain don’t require medical attention and can be treated with over-the-counter painkillers and self-care.

However, you should contact your GP if you’re worried about your back or struggling to cope with the pain.

During your first appointment your GP will discuss your back pain symptoms with you and examine your back.

The examination will usually assess your ability to sit, stand, walk and lift your legs as well as test the range of movement in your back.

Your doctor may ask questions about any illnesses or injuries you may have had, your lifestyle and work to help find a cause. Your back is a complex structure so finding the exact cause of the pain can often be difficult.

Below are some of the questions a doctor may ask and it may be helpful to consider these ahead of your appointment.

• When did the back pain start?
• Where are you feeling pain?
• Have you had any back problems before?
• Can you describe the pain?
• What makes the pain better or worse?

Your GP will initially want to make sure your pain isn’t caused by a more serious condition. They will ask relevant questions to rule out cancer, a fracture or an infection, although these conditions are uncommon.

If your GP thinks there may be a more serious cause you will be referred for further tests, such as an X-ray or MRI scan.

Otherwise, you won’t need an X-ray or an MRI scan, because they won’t help to find the cause of your back pain or in deciding how best to treat it.

You will be offered information on what you can do to reduce the effects of the pain.

If your back pain lasts for more than six weeks (chronic back pain), your GP may refer you to a specialist trained in providing a particular treatment. This may be a physiotherapist, osteopath, chiropractor, psychologist or an acupuncturist.

Some people choose to go straight to one of these types of specialist practitioner as soon as the pain starts. However, in these circumstances, you would have to pay for this care privately.  

If you're not happy with your GP's diagnosis or if your symptoms keep coming back, go back to your GP or get a second opinion.

Find out about treating back pain. 

Treatments for back pain will vary depending on how long you've had the pain, how severe it is and your individual needs and preferences.

Short-term back pain

Most cases of back pain that last no longer than six weeks can be treated with over-the-counter painkillers and home treatments.

Painkillers

Paracetamol is effective in treating most cases of back pain. Some people find anti-inflammatory drugs such as ibuprofen more effective. A stronger painkiller such as codeine is an option and is sometimes taken in addition to paracetamol.

If you also experience muscle spasms in your back, your GP may recommend a short course of a muscle relaxant, such as diazepam.

Painkillers can have side effects, some can be addictive and others may not be suitable depending on your state of health. Your GP or a pharmacist will be able to advise you on the right type of medication to try. For more information, go to medicines for back pain.

Hot and cold treatments

Some people find that heat, for example a hot bath or a hot water bottle placed on the affected area, helps ease the pain. Others find cold, such as an ice pack or a bag of frozen vegetables applied to the painful area, is also effective. Don’t put the ice directly on your skin as it might cause a cold burn. Wrap the frozen pack in a wet cloth before applying to the affected area.

Another option is to alternate between hot and cold using ice packs and hot compression packs. Hot compression packs can be bought at most larger pharmacies.

Sleeping position

By changing your sleeping position you can take some of the strain off your back and ease the pain. If you sleep on your side, draw your legs up slightly towards your chest and put a pillow between your legs. If you sleep on your back, placing a pillow under your knees will help maintain the normal curve of your lower back.

Relaxation

Trying to relax is a crucial part of easing the pain as muscle tension caused by worrying about your condition can make things worse. Research suggests that people who manage to stay positive despite the pain tend to recover faster and avoid long-term back pain.

Keep moving

Most experts now agree that staying in bed, lying down or being inactive for long periods is actually bad for your back. People who remain active are likely to recover more quickly. This may be difficult at first if the pain is severe but try to move around as soon as you are able and aim to do a little more each day.

Activity can range from walking around the house to walking to the shops. You will have to accept some discomfort but avoid anything that causes a lot of pain.

There is no need to wait until you are completely pain-free before returning to work. Going back to work will help you to return to a normal pattern of activity, and it can often distract you from the pain.

Lifestyle

Try to address the causes of your back pain to prevent further episodes. Common causes include being overweight, having poor posture and stress.

Regular exercise and being active on a daily basis will help to keep your back strong and healthy. Walking, swimming and yoga are popular choices. The important thing is to choose an enjoyable activity that you can benefit from without feeling pain. Get tips on raising your activity levels.

Find out more about preventing back pain.

Long-term back pain

For back pain lasting more than six weeks (known as chronic back pain), your GP will advise you on what painkillers to take and recommend the following treatments:

• Exercise programme: this should involve up to eight sessions over a period of up to 12 weeks. It will usually be a group class supervised by a qualified instructor. The classes may include exercises to strengthen your muscles and improve your posture, as well as aerobic and stretching exercises.
• Manual therapy: there are different types of manual therapy, including manipulation, mobilisation and massage, usually performed by chiropractors, osteopaths or physiotherapists. If you choose a course of manual therapy, this should include up to nine sessions over a period of up to 12 weeks.
• Acupuncture, which involves inserting fine, solid needles at different points in the body, has been shown to help reduce low back pain. If you choose a course of acupuncture, this should include up to 10 sessions over a period of up to 12 weeks.

These treatments are often effective for people whose back pain is seriously affecting their ability to carry out daily activities and who feel distressed and need help coping.

Antidepressants

If the painkillers do not help, you will probably be put on tricyclic antidepressants (TCAs), such as amitriptyline. TCAs were originally intended for depression, but they are effective at treating some cases of persistent pain.

Some TCAs can have serious side effects, including suicidal thoughts, although this is rare. If this happens to you, contact your GP or go to your nearest hospital immediately. You may want to tell someone close to you that you are on amitriptyline and ask them to let you know if they notice any changes in your behaviour. For more information, go to medicines for back pain.

Counselling

If the treatments listed above are not effective, you may be offered some counselling to help you deal with your condition.

While the pain in your back is very real, how you think and feel about your condition can make it worse. Cognitive behavioural therapy (CBT) works by helping you to manage your back pain better by changing how you think about your condition.

Studies have shown that people who have had CBT later reported lower levels of pain. They were also more likely to remain active and take regular exercise, further reducing the severity of their symptoms.

Surgery

Surgery is usually only recommended as a treatment option when all else has failed.

One common procedure, called spinal fusion surgery, fuses the joint that is causing pain to prevent it moving.

Bone is a living tissue, which makes it possible to join two or more vertebrae together by placing an additional section of bone in the space between the vertebrae. This helps to prevent the damaged vertebrae from irritating or compressing nearby nerves, muscles and ligaments, and reduces the symptoms of pain.

However, spinal fusion is a complicated procedure and the results are not always satisfactory. You may still experience some degree of pain and loss of movement after surgery.

Other treatments

Several treatments are sometimes used to treat long-term back pain, but they are not recommended by NICE due to a lack of evidence about their effectiveness. They include:

• Low level laser therapy – low energy lasers are focused on your back to try to reduce inflammation and encourage tissue repair.
• Interferential therapy (IFT) – a device is used to pass an electrical current through your back to try to accelerate healing while stimulating the production of endorphins (the body’s natural painkillers).
• Therapeutic ultrasound – ultrasound waves are directed at your back to accelerate healing and encourage tissue repair.
• Transcutaneous electrical nerve stimulation (TENS) – a machine delivers small electrical pulses to the back through electrodes that are placed on the skin. The pulses stimulate endorphin production and prevent pain signals travelling from your spine to your brain.
• Lumbar supports – cushions, pillows and braces are used to support your spine.
• Traction – a pulling force is applied to your spine.
• Injections – painkilling medication is injected directly into your back.

Acute

Acute means occurring suddenly or over a short period of time.

Anti-inflammatory

Anti-inflammatory medicines reduce swelling and inflammation.

Inflammation

Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Physiotherapy

Physiotherapy is a treatment that uses physical movements, massage and exercise to relieve illness or injury.

 

To avoid back pain, you must reduce excess stresses and strains on your back and ensure that your back is strong and supple.

If you have recurring bouts of back pain, the following advice may be useful:

• Lose any excess weight – you can use the body mass index (BMI) healthy weight calculator to find out whether you are a healthy weight for your height.
• Wear flat shoes with cushioned soles, as these can reduce the stress on your back.
• Avoid sudden movements or muscle strain.
• Try to reduce any stress, anxiety and tension.

Posture

How you sit, stand and lie down can have an important effect on your back. The following tips should help you maintain a good posture.

Standing

Stand upright, with your head facing forward and your back straight. Balance your weight evenly on both feet and keep your legs straight.

Sitting

You should be able sit upright with support in the small of your back. Your knees and hips should be level and your feet should be flat on the floor (use a footstool if necessary). Some people find it useful to use a small cushion or rolled-up towel to support the small of the back.

If you use a keyboard, make sure that your forearms are horizontal and your elbows are at right angles.

Driving

Make sure that your lower back is properly supported. Correctly positioning your wing mirrors will prevent you from having to twist around. Foot controls should be squarely in front of your feet. If driving long distances, take regular breaks so that you can stretch your legs.

Sleeping

Your mattress should be firm enough to support your body while supporting the weight of your shoulders and buttocks, keeping your spine straight. If your mattress is too soft, place a firm board – ideally 2cm thick – on top of the base of your bed and under the mattress. Support your head with a pillow, but make sure that your neck is not forced up at a steep angle.

Exercise

Exercise is both an excellent way of preventing back pain and reducing any back pain you might have. However, if you have chronic back pain (back pain that has lasted more than three months), consult your GP before starting any exercise programme.

Exercises, such as walking or swimming, strengthen the muscles that support your back without putting any strain on it or subjecting it to a sudden jolt.

Activities such as yoga or pilates can improve the flexibility and the strength of your back muscles. It is important that you carry out these activities under the guidance of a properly qualified instructor.

There are also a number of simple exercises you can do in your own home to help prevent or relieve back pain.

• Wall slides: stand with your back against a wall with your feet shoulder-width apart. Slide down into a crouch so that your knees are bent to about 90 degrees. Count to five, then slide back up the wall. Repeat five times.
• Leg raises: lie flat on your back on the floor. Lift each heel in turn just off the floor while keeping your legs straight. Repeat five times.
• Bottom lifts: lie flat on your back on the floor. Bend your knees so that your feet are flat on the floor. Then lift your bottom in the air by tightening your stomach muscles while keeping your back straight. Repeat five times.

At first, do these exercises once or twice a day, then gradually increase to six times a day, as your back allows.

These exercises are also useful for 'warming up' your back. Many people injure their back when doing everyday chores at home or work, such as lifting, gardening or using a vacuum cleaner. 'Warming up' your back before you start these chores can help to prevent injury.

See the Live Well section of the website for more information and advice about Exercises for back pain.

Lifting and handling

One of the biggest causes of back injury, especially at work, is lifting or handling objects incorrectly. Learning and following the correct method for lifting and handling objects can help to prevent back pain.

• Think before you lift: can you manage the lift? Are there any handling aids you can use? Where is the load going?
• Start in a good position: your feet should be apart, with one leg slightly forward to maintain balance. When lifting, let your legs take the strain – bend your back, knees and hips slightly, but do not stoop or squat. Tighten your stomach muscles to pull your pelvis in. Do not straighten your legs before lifting as you may strain your back on the way up.
• Keep the load close to your waist: keep the load as close to your body for as long as possible with the heaviest end nearest to you.
• Avoid twisting your back or leaning sideways, especially when your back is bent. Your shoulders should be level and facing in the same direction as your hips. Turning by moving your feet is better than lifting and twisting at the same time.
• Keep your head up: once you have the load secure, look ahead, not down at the load.
• Know your limits: there is a big difference between what you can lift and what you can safely lift. If in doubt, get help.
• Push rather than pull: if you have to move a heavy object across the floor, it is better to push it rather than pull it.
• Distribute the weight evenly: if you are carrying shopping bags or luggage, try to distribute the weight evenly on both sides of your body.

Back pain was agony for Anne Parker, 68, from Berkshire, but thanks to the right diagnosis she’s now walking tall.

“My bad back started 12 years ago with pains in my right buttock. When I saw my GP, he said the problem was actually my back, and he gave me painkillers. I do orienteering, so I tried to move and stretch more, but the pain got worse. Then I saw an osteopath, who said I should rest.

“One morning, when I was getting up, I rubbed the bad spot on my spine. It triggered a sciatic spasm that left me immobile and screaming in pain. My GP gave me stronger painkillers and anti-inflammatories, which improved things when I was lying down or standing up, but sitting was agony. I still went walking, though. Now it’s recognised that exercise is one of the best things for certain kinds of back pain.

“A year later, I had an X-ray and an MRI scan. I discovered that I had a lateral stenosis, which is a build-up of tissue that blocks the spinal canal. The treatment was an injection of steroids into my spine. It took away the constant, gnawing pain. Three months later I was able to go orienteering again.”

Kiran Mohan, a 42-year-old teacher, has suffered from lower back pain for the past seven years.

"My back problems started in 1999 when I developed a severe pain in the heel of one of my feet, which gradually progressed to the other foot. It was incredibly painful and badly affected my walking. It was eventually diagnosed as plantar fasciitis, a condition where the heels and surrounding joints become inflamed. This condition means that I walk with a limp, which in turn kicked off my lower back pain. 

"Because I’m a teacher, I can't remain seated for most of the day to take the weight off my feet. This can make the problem much worse. My doctor recommended a lower back exercise class, which was a six-week course of relevant exercises. It helped, and I found that the exercises gave me some relief. But over the years I’ve also privately seen an osteopath, had acupuncture and tried Pilates. Because of my limping, I’ve also had a couple of falls, which have caused whiplash and made my lower back pain much worse.

"In 2002, after trying just about everything, I started to see a chiropractor. Since doing so I have seen a significant improvement. Unfortunately, my everyday activities mean that I can't rest as much as I would like. No doubt this affects the rate of my recovery. Chiropractic treatment has certainly improved my quality of life and, with a few treatments along the way, I can continue going about my daily life.