Overview of low back pain
Mō te mamae ki te tuarā o raro
Low back pain is very common. Around 80% of people have it at least once in their life and approximately 10% of the world's population have back pain at any one time.
In many cases we do not know exactly what is causing your back pain. This is called non-specific low back pain.
Understanding your back
Your spine is made up of bones called vertebrae. There are discs between the vertebrae, which act as shock absorbers and allow your spine to be flexible.
Strong bands of tissue called ligaments support your spine, and muscles make it move. Joints between the vertebrae, called facet joints, guide the way it moves.
Your spine protects your spinal cord, which contains nerves to and from your brain. Nerves from your spinal cord come out from between the vertebrae and continue to other parts of your body.
The medical name for your lower back is your lumbosacral (lum-bo-sak-ral) spine.
Non-specific back pain
Pain is your body's way of letting you know that something is not right.
Low back pain is usually mechanical, which means something inside your lower back has been disturbed, but not necessarily damaged.
Most cases of lower back pain are known as non-specific, meaning they aren't caused by serious damage or disease. We'll never know which part of your back is causing your pain, but that’s okay as we do not need to know that for you to get better.
The intensity of non-specific back pain can range from mild to severe.
The pain is usually in your lower back, but it might spread to your buttocks, thighs, lower legs or feet. Lying down flat, standing or gently walking usually eases the pain. Bending forwards, lifting, coughing, sneezing, getting up from sitting or sitting for too long often makes it worse.
If you have any concerns about your back pain, or it is not improving, see your GP or physiotherapist. They will be able to assess what is happening and give advice about treatment.
Sometimes, back pain is caused by damage to parts of your spine, such as:
- A slipped (herniated) disc – a disc bulges out, which can irritate or press on your spinal nerves causing pain. The pain can then travel (radiate) down your leg. This is sometimes called sciatica.
- A fracture – a crack or break in one of the bones in your back. This could be due to osteoporosis, a fall from a height (for example, from a ladder) or a sporting accident.
- Inflammatory lower back pain, caused by a condition such as ankylosing spondylitis.
- Cauda equina syndrome – this is a rare disorder where the nerves at the bottom of your spine are squashed (compressed). Cauda equina syndrome can cause low back pain plus problems with going to the toilet, numbness around your back passage or anus and weakness in one or both legs.
- Cancer or infection – If you have or have had cancer anywhere in your body, your low back can be a site for secondary cancer. You can get an infection in your lower back if you have a poor immune system (for example, you're having chemotherapy or have HIV or Aids) or you've had a recent open wound.
Diagnosing low back pain
Your doctor or physiotherapist will ask you questions and examine you to help diagnose the cause of your low back pain.
If you have non-specific back pain, you're unlikely to need any tests such as X-rays or scans in the first few weeks. If your pain doesn't get better as expected or your doctor or physiotherapist is concerned about a specific cause of the pain, you may need X-rays or scans such as MRI. Or you might need to see a specialist.
Treating low back pain
Most low back pain gets better with self-care but sometimes you'll need help from a health professional.
HealthInfo recommends the following videos
On the next page: Preventing low back pain
Written by HealthInfo clinical advisers. Last reviewed May 2022.
Sources
The information in this section comes from the following sources, some of which may be clinically complex or not available to the general public
ACC – Non-specific acute low back pain, part 3 – return to work (http://www.acc.co.nz/PRD_EXT_CSMP/groups/external_providers/documents/guide/prd_ctrb113162.pdf), retrieved March 2017
Bell J.A., & Burnett A. (2009). Exercise for the primary, secondary, and tertiary prevention of low back pain in the workplace: a systematic review. Journal of Occupational Rehabilitation. 19:8-24. DOI: 10.1007/s10926-009-9164-5
Choi B.K.L., Verbeek J.H., Tam Wai-San, Jiang J.Y. (2010) Exercises for prevention of recurrences of low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD006555. DOI: 10.1002/14651858.CD006555.pub2
Christiansen D., Larsen K., Kudsk J.O., Vinther N.C. Pain responses in repeated end-range spinal movements and psychological factors in sick-listed patients with low back pain: is there an association? J Rehabil Med 2009; 41: 545-49.
Wong J.J., Coté P., Sutton D.A. et al. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain 2016; 21: 201-16.
Hides J., Jull G., Richardson C. Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine 2001; 11: e243-e248
Larsen K., Weidick F., & Leboeuf-Yde C. (2002) Can passive prone extensions of the back prevent back problems? Spine. 27(24):2747-52
Martimo et al (2008) Effect of training and lifting equipment for preventing back pain in lifting and handling: systematic review. British Medical Journal published online 31 Jan 2008; doi:10.1136/bmj.39463.418380.BE
Muller et al (1999) The influence of previous low back trouble, general health, and working conditions on future sick-listing because of low back trouble. Spine. 24(15):1562-1570
Roffey D.M., Wai E.K., Bishop P., Kwon B.K., Dagenais S. Causal assessment of occupational sitting and low back pain: results of a systematic review. Spine J 2010; 10: 252-261
Stanton T.R. et al (2008). After an episode of acute low back pain, recurrence is unpredictable and not as common as previously thought. Spine . 33(26):2923-2928
Williams M.M. & Grant R.N. A comparison of low back and referred pain responses to end range lumbar movement and position. 1992
Image and embedded video sources
Arching back image – From iStock (image ID 20844690). January 2016.
Manual therapy image – From Shutterstock (image ID 1202838715). May 2022.
Modified push-up, back bend lying, back bend standing, sitting, lifting images – Provided by Richard Hopkins physiotherapist. January 2017.
Normal spine image – From Shutterstock (image ID 65496961). Image labels added. July 2014.
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