Low Back Pain

What is it?

Low back pain is pain felt in the area between the lower edge of the ribs and the creases of the buttocks. Most adults have it at some point in their lives, and in most cases it improves noticeably within a few weeks.

Doctors usually describe it by how long it has lasted: acute (less than six weeks), subacute (six to twelve weeks) and chronic (more than three months). Chronic low back pain is treated as a health problem in its own right, because it can affect sleep, work and mood as much as the back itself.

What causes it?

In many people no single structure can be identified as the cause; this is known as "mechanical" or "non-specific" low back pain. The main structures that can generate pain are:

• Muscles and ligaments: strain after lifting, a sudden movement or long periods in one position.
• Facet joints: the small joints linking the vertebrae at the back of the spine. Pain from wear in these joints is often worse when leaning backwards or twisting.
• Discs: age-related wear of the cushions between the vertebrae, or a lumbar disc herniation.
• Sacroiliac joint: the joint between the spine and the pelvis, which can cause pain spreading into the buttock.
• Narrowing of the spinal canal: spinal stenosis, which typically causes pain and heaviness in the legs when walking.
• Trigger points: tight, tender spots within muscles (myofascial pain syndrome).

Inactivity, excess weight, smoking, physically demanding work and stress make back pain more likely and can make it last longer. Less commonly, infection, fractures, inflammatory arthritis or tumours are responsible, which is why these possibilities are always considered during the assessment.

How is it diagnosed?

Diagnosis starts with a careful history and physical examination. The doctor asks how the pain began, what makes it worse, whether it spreads into the leg and whether any warning signs are present. The examination checks spinal movement, muscle strength, reflexes and sensation.

Imaging is not always needed when there are no warning signs. An MRI scan is usually reserved for pain that lasts longer than expected, findings that suggest nerve compression, or when an interventional treatment is being planned. Not every change seen on an MRI is a source of pain: age-related disc changes are common in people with no symptoms at all, so scan results are always interpreted alongside the examination.

When facet joint pain is suspected, diagnostic blocks (test injections with a small amount of local anaesthetic) can help confirm where the pain is coming from.

Treatment options

Treatment is tailored to the source of the pain, how long it has lasted and how much it affects daily life. It usually follows a stepwise approach.

Conservative care

• Information and staying active: prolonged bed rest is not recommended. Continuing everyday activities as far as the pain allows supports recovery.
• Exercise and physiotherapy: individually tailored programmes that strengthen the trunk and improve flexibility are the cornerstone of care, especially for chronic pain.
• Medication: short courses of anti-inflammatory painkillers and, where appropriate, muscle relaxants may be used. The choice takes other health conditions and possible side effects into account.
• Psychological support: for longer-lasting pain, cognitive behavioural approaches can make the pain easier to live with and manage.

Interventional pain treatments

If pain persists despite conservative care, procedures aimed at an identified source of pain may be considered:

• Facet joint injection: used mainly to confirm whether the facet joints are the source of pain; some people also get a period of relief.
• Radiofrequency treatment: applied to the small nerve branches that carry pain signals from the facet joints, once a diagnostic block has confirmed the source.
• Epidural steroid injection: considered when pain spreads down the leg because of nerve root irritation; it is not routinely recommended for back pain alone.
• Trigger point injection: may support an exercise programme when clear trigger points are present in the back muscles.

In suitable patients these procedures can provide a meaningful reduction in pain, but how much relief they give and how long it lasts varies from person to person. Each procedure carries its own risks, which are discussed with you before any decision is made.

When is surgery considered?

Surgery is considered together with a neurosurgeon or an orthopaedic spine surgeon in situations such as progressive weakness, loss of bladder or bowel control, or significant nerve compression that does not respond to other treatments.

When should you see a doctor?

See a doctor if your back pain is not easing after a few weeks, is getting worse, is disturbing your sleep or work, or is spreading into your leg. An algology (pain medicine) specialist will assess where the pain is coming from and plan the next steps with you; you can request an appointment through our contact page.