Spinal pain

What causes spinal pain?

Spinal pain often has no single obvious cause, especially when it comes on with everyday movement rather than a specific injury.

• A muscle or ligament strain: From lifting, twisting, or a sudden movement, causing localised pain and stiffness
• A slipped (herniated) disc: Can press on nearby nerves, causing pain that spreads down your leg
• Sciatica: Irritation of the sciatic nerve, causing pain, numbness or tingling that runs from your back into your leg
• Ankylosing spondylitis: A condition that causes inflammation in the spine
• Osteoporosis-related fractures: Weaker bones can fracture in the spine, sometimes without an obvious injury
• Cancer that has spread to the spine: A rare cause, but one reason unexplained back pain sometimes needs checking
• A serious problem such as an infection or a broken bone: Very rare, but a reason to get certain symptoms checked urgently.

Are there different types of spinal pain?

Spinal pain can come from your muscles or from the structures of the spine itself, and each tends to feel a little different, though there can be overlap.

• Muscular pain: This is more common, usually stays in one specific area, often eased by rest, and typically settles within a few days to around 2 weeks
• Spinal (nerve-related) pain: This tends to spread further, for example into your buttocks or legs, and may come with numbness, tingling or weakness (sciatica)
• Acute 'locked back' or spasm: This is a sudden episode where your back muscles seize up and you get ‘stuck’ in one position – this always unlocks with time, and moving as soon as you're able helps it do so more quickly.

How is spinal pain diagnosed?

Most spinal pain does not need any tests. A doctor or physiotherapist will usually ask about your symptoms and examine your back, checking your movement, muscle tenderness, reflexes and sensation, to help rule out a nerve problem.

• Physical examination – of your posture, movement, muscle tenderness, strength, reflexes and sensation
• Imaging, such as an X-ray, MRI or CT scan – not usually needed for recent, straightforward back pain, but may be used if your symptoms are severe, persistent, or come with certain warning signs.

Scans often show changes such as disc bulges or general wear and tear that sound alarming but are common and don't necessarily explain your pain, which is one reason they're not routinely used for straightforward back pain.

How is spinal pain treated?

For most spinal pain, the aim is to control the pain enough to keep moving, rather than to rest completely.

• Staying active: Continuing your normal daily activities, rather than resting in bed, helps you recover faster
• Painkillers: Such as paracetamol (1 gram) and ibuprofen (400mg), taken regularly rather than only when the pain is severe, can help you keep moving (check with a pharmacist or GP if you’re unsure whether this is suitable for you)
• Heat or ice packs: Wrapped in a towel, for comfort and to ease muscle spasm or stiffness
• Exercises and stretches: Specific movements for back pain can help, and gentle activities such as walking, swimming, yoga and Pilates may also ease symptoms
• Physiotherapy or manual therapy: If pain does not improve after a few weeks
• Cognitive behavioural therapy (CBT): To help you cope with ongoing pain
• Surgery: In rare cases where another treatment, such as for a slipped disc, hasn’t helped.

When should you see a doctor?

See a GP if your back pain:

• does not improve after treating it at home for a few weeks
• is stopping you doing your day-to-day activities
• is worrying you, or you're struggling to cope
• comes with unexplained weight loss
• comes with a lump, swelling or a change in the shape of your back
• does not improve with rest, or is worse at night
• is worse when sneezing, coughing or going to the toilet
• is coming from the top of your back, between your shoulders, rather than your lower back.

Get an urgent GP appointment or call 111 if you have back pain and feel hot, cold, shivery or generally unwell, or if severe pain starts suddenly or is getting worse quickly. Call 999 or go to A&E if you have back pain with any of the following:

• pain, tingling, weakness or numbness in both legs
• a loss of feeling around your genitals or anus
• new difficulty peeing, or peeing or pooing without meaning to
• changes in how your penis or vagina feels during sex, or being unable to get or keep an erection, or unable to orgasm
• chest pain
• pain that started after a serious accident, such as a car accident.