One of the most important things is to try not to worry. Lower back pain can be quite upsetting, but as we’ve mentioned before, most people (98-99%) have ‘normal’ back pain that is likely down to muscle, joint or similar issues.
Recent Lower Back Pain (Less Than 3 Months)
This page has been designed to provide you with the right information about recent lower back pain (less than 3 months) and the rehabilitation that may help you in your recovery.
What is lower back pain?
The term lower back relates to discomfort in and around the lumbar spine region (i.e. the lower back region).
Your lower back (lumbar spine) is an incredibly strong, robust and amazingly resilient part of your body. It is capable of lifting heavy loads, tolerating hard work and being put into all manner of positions.
Is it the same as lumbago or sciatica?
Lumbago tends to be considered an older way to describe lower back pain but essentially, it is the same thing.
Lower back pain is, however, not the same thing as sciatica. Sciatica is an irritation of the sciatic nerve which will normally cause leg pain. For most people, lower back pain tends to be felt in the lumber spine or pelvic region, but as with most pains, it can sometimes travel to other parts of the body. It is very common to have lower back pain without sciatica, therefore you wouldn’t use the term sciatica to describe pain that is just in your back.
If you would like to know more about sciatica and how to manage it, click here: Sciatica
Who can get lower back pain?
Lower back pain is very common. Most research (experiments and clinical studies) suggest that approximately 80-90% of people will have back pain at some point in their lives. Anyone can find themselves with lower back pain regardless of age, gender or work role.
What causes lower back pain?
In a lot of cases, lower back pain can follow something easily identifiable, like a twist or picking something up, however sometimes it just seems to come out of the blue for no obvious reason. In the vast majority of cases, lower back pain is not something to be worried about, even though it can be quite sore and interfere with your activities.
As mentioned before, your lower back is unbelievably strong and robust, therefore it is very difficult to damage. This doesn’t mean that it can’t be sore from time to time, but most lower back complaints have nothing to do with any damage - even the really sore ones.
Will it get better?
For most people, an episode of back pain can be a bit like spraining an ankle. You will find things sore, awkward and difficult to move for a few weeks. You may find things that you would have done quickly and easily before your back pain now a bit more challenging and frustrating. Given that back pain will not cause any outwards signs i.e. bruises or swelling and you won’t actually be able to ‘see anything’, it can sometimes be hard to convince other people that your symptoms are as difficult as you feel they are. This often only serves to add to the frustrations of having a back issue which in turn can make things more sore.
However the good news is that, just like with a twisted ankle, you will hopefully find that your symptoms will start to settle and ease over approximately 6-8 weeks.
Is there anything that I need to look out for?
Most low back pain is caused by an irritation of certain structures around your lumbar spine region, however it is very important to be aware of certain symptoms that are less common with back pain and what you should do if you have any:
-
New (within the last 2 weeks) altered bladder function (difficulty starting, stopping, maintaining a wee or even knowing that you need to go).
-
New (within the last 2 weeks) altered bowel function (incontinence or leaking or not knowing when your bowel is full).
-
New (within the last 2 weeks) altered sensation around your genitals, anus or inner thighs (a change in the feeling or ability to feel temperature around where you would sit on a bike or horse saddle).
-
New (within the last 2 weeks) difficulty coordinating your legs/rapid loss of leg strength (‘jelly-legs’ or that your legs won’t go where you want them to)
-
New (within the last 2 weeks) altered sexual function (men: unable to achieve an erection or ejaculate; women: altered feeling during penetrative or oral sex)
-
New (within the last 2 weeks) pain going into both legs
If you suddenly develop any or a combination of the symptoms listed above, you may need urgent medical assessment and you should attend A&E as soon you can. |
This information can be accessed in a variety of different languages here.
A summary of this information can be found in this short animation:
Is there anything else I should be looking out for?
The list above are the things that are most important for you to be aware of if you are dealing with back pain. However, there are a few other things that you should be aware of that are not dangerous, damaging or worrying, but might just mean that a different type of treatment will suit you better.
Along with your back pain, if you have any of the following symptoms (or more than one), you should discuss them with your physiotherapist or GP:
- Having a temperature or fever alongside your lower back pain
- Inability to lie flat due to your back pain
- A history of cancer and/or loss of weight alongside your lower back pain
That sounds really worrying, should I be concerned?
When you read a list like the one above, it can sound frightening, however it is very important for you to know that serious problems (like cancer/bone infections) only account for about 1-2% of people (Greenhalgh et al, 2018). In other words, 98-99% of people have back issues because of muscle, joint or similar issues.
OK, but how can you tell mine isn’t serious?
That is a very good question. If you are concerned about your back issues, we would encourage you to refer yourself to our Physiotherapy service. You can do so here: Refer Yourself
As we mentioned above, the vast majority of lower back issues might be sore, frustrating and really annoying, but they are not from anything nasty. If you choose to refer yourself to Physiotherapy, it is important to know that it is our first job to make sure that you are safe and that your back complaint is not something serious. Whether your assessment is over the internet, phone, video call or face-to-face, you will be thoroughly reviewed to make sure that everything is checked as comprehensively as possible and that you are able to start your rehabilitation in confidence.
Shouldn’t I have a scan to help find out what is wrong?
Scans and X-rays are a very important part of healthcare, however, for most people they are not required to work out what might be causing your pain. A detailed assessment including asking some specific questions, or a physical assessment where you’re asked to show some movements etc. can often be enough to confirm that your symptoms are nothing nasty and that rehabilitation is the right thing to help you get better.
Interestingly, the National Institute for Health and Care Excellence (NICE) recently updated their guidelines for the management of low back pain and sciatica in over 16s to state that imaging (MRI/ CT and X-rays) should not be routinely offered to people suffering with back pain (NICE, 2016).
Interestingly, there is a growing body of evidence (research/clinical studies) that suggest that some things found on MRIs/ in X-rays and labelled as ‘abnormal’ are just as common in people with pain as they are in people without pain. To help demonstrate this, Brinjikji et al. (2015) completed a study of over 3000 people who had NO BACK PAIN and found that 50% of 40-year-olds had disc bulges; 50% of 60-year-olds had age-related changes (otherwise known as osteoarthritis), and nearly 100% of people in their 80s had disc changes. In other words, some of these ‘abnormalities’ can be considered as normal signs of ageing, as they are there whether you are in pain or not. This doesn’t mean that X-ray or MRI findings don’t matter, but it means that they might only form part of an assessment and shouldn’t be relied upon alone.
If you have had a scan and are finding yourself worrying about the results, it’s very important to discuss these with your physio, as they may be able to explain the results in a way that makes them easier to understand and/or less worrying. It is really important to know that an MRI does not predict your future either. In other words, if you’ve had an MRI scan, the results don’t mean that you will be worse as you get older. In a recent study, Saakksjarvi et al. (2020) followed up 26 patients who had had an MRI of their lower back in 1987 and found that although the changes found on MRI were more obvious on the repeat scan in 2017 (30 years later), the changes were not associated with worsening of pain or disability. In simple terms, although some changes were found on MRI when these patients were younger, it didn’t mean that they were in more pain or had more difficulties as they got older.
I’ve been told that I’ve slipped a disc, is that why my back hurts?
The term ‘slipped disc’ is another one of the misleading terms that seems to be used frequently when dealing with back and/or leg pain. The main reason that it is a misleading and unhelpful way of describing some normal disc changes, is that your disc cannot slip out of place. Your discs are part of your spine and are so firmly attached to the vertebrae (spinal bones) that they do not come in and out of place.
“A disc is so firmly attached to its vertebrae that it can never, ever slip”
Professor Lorimer Moseley
So why have I been told I’ve got a slipped disc then?
This is a good question and the answer is likely to be a little complicated and different for each person. Words matter because they help us understand things, they can help reassure or reduce worry but equally, can have the opposite effect and make you concerned, lost or anxious. Some words and phrases, good or bad, can stick and the term ‘slipped disc’, albeit misleading and not helpful, seems to have stuck over many years. It is likely that you have come across the phrase talking to friends, family, searching the internet or even talking to healthcare professionals. Although not dangerous itself, the term ‘slipped disc’ and more importantly, the impression or image it might conjure up for people, is the reason why it can be harmful.
A different and perhaps better way to think about discs is by thinking about the last time you had a big meal. After a large lunch, your stomach will be full and can feel bigger and change shape (making you need to loosen your trousers in some cases!) A disc is designed as a shock absorber for the spine and therefore is able to adapt and change to allow you to cope with everyday things like lifting, walking and carrying things. Your discs can change shape (often seen on MRIs and labelled as ‘disc bulges’ or ‘disc protrusions’) and just like your stomach they can settle and ‘change back’ after a period of time. In a review conducted by Chiu et al (2014), it was found that approximately 41% of disc protrusions (when the disc can change shape) will heal by themselves within 3 to 12 months.
I’ve been told so many different things about back pain and it’s all a bit confusing.
This is actually a very interesting point as a lot of people with back pain find themselves somewhat lost in all the information and opinions that tend to get offered by people trying to help.
Knowing the facts about what back pain is and, more importantly what it isn’t, is key to starting your recovery off on the right foot. This is why we’ve written a dedicated page all about giving you the facts about back pain which you can find here: Back Pain: Myth-busting
Don’t forget to come back to this page afterwards to see what you can do to help get your rehabilitation and recovery started.
Is there anything I can do to help myself?
Whether you want to refer yourself to physio or not, there are lots of things you can do to help yourself with your lower back complaint, and lots of people will get better even if they don’t see a physiotherapist or their GP.
Once I’ve got myself moving again, is there anything else I can do to help my back?
Once you feel that your movement is easing and your confidence to use your back is returning, a very useful addition to your rehabilitation is strength training. Some people find themselves feeling a bit nervous about strength training for their back, and it is understandable when you’re surrounded by messages that ‘the back should be protected’ or ‘your back is fragile and you should look after it’, however these statements simply are not true.
Even though it might have been (or still is) sore, your back is strong, robust and designed to be used for lifting things. To help improve your back issue and reduce the likelihood of it coming back again, adding strength training into your rehabilitation programme is important, just like it would be if you were trying to get your knee or shoulder better. An interesting review of the evidence regarding back issues and the effect of strength training by Tataryn et al. (2021) found that using resistance exercises (pulling/pushing/lifting things) led to a significantly positive effect on people’s pain levels, level of disability and strength. In other words, getting your back strong can help reduce pain levels, improve your ability and help your recovery.
We’ve added a series of strengthening exercises for you to explore below.
Exercise tip:
Try to explore these exercises little and often throughout the day. Do as much or as little of the exercise as you feel comfortable. It is ok to feel a little sore whilst doing (or after doing) the exercise/s.
Exercises to help you get moving:
Exercises to help you get yourself stronger:
Once your back starts to feel easier and more settled, you can start to explore some of the following exercises to help gain some strength around your back.
We recommend that you start with exercises that feel slightly easier/that you feel more confident with to begin with, but feel free to explore any of the options below.
Aim to complete the exercises (perhaps 2 or 3) between 3-4 times per week. Try to complete between 8-12 repetitions per exercise, have a brief rest (1 minute) and repeat a further 3-4 times.
If you’ve only got 1 minute to spare, here is a useful video that summarises lots of good points about managing your back pain.
References:
Belavy, D.L., Albracht, K., Bruggermann, G.P., Vergrosen, P.P.P and van Dieen, J. (2016). Can exercise positively influence the intervertebral disc? Sports Medicine. 46(4):473-85. doi: 10.1007/s40279-015-0444-2. Accessed: 07/07/2021.
Brinkjikji, W., Luetmer, P.H., Comstock, B., Bresnahan, B.W., Chen, L.E., Deyo, R.A., Halabi,S. and Turner, J.A. et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology. 36(4):811-6. doi: 10.3174/ajnr.A4173. Accessed: 01/07/2021.
Greenhalgh, S., Finucane, L., Mercer, C. and Self, J. (2018). Assessment and management of cauda equina syndrome. Musculoskeletal Science and Practice. doi: 10.1016/j.msksp.2018.06.002. Accessed: 29/06/2021.
National Institute for Health and Care Excellence (2021). Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. (NG193). Available at: https://www.nice.org.uk/guidance/ng193 . Accessed 05/07/2021
Sääksjärvi, S., Kerttula, L., Luoma, K., Paajanen, H. and Waris, E. (2020). Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study. Spine. 45(19):1341-1347.doi: 10.1097/BRS.0000000000003548. Accessed: 01/07/2021.
Tatryn, N., Simas, V., Catterall, T., Furness, J. and Keogh, J.W.L. (2021). Posterior-Chain Resistance Training Compared to General Exercise and Walking Programmes for the Treatment of Chronic Low Back Pain in the General Population: A Systematic Review and Meta-Analysis. Sports Medicine Open Access. 8;7(1):17. doi: 10.1186/s40798-021-00306-w. Accessed: 02/07/2021.