Back pain | The causes, symptoms and treatments

If you’ve got questions about back pain or you’re wondering where to turn next, keep reading. In this article, Triage Team Lead and Physiotherapist Bridget Bazell answers all your questions about the most common causes, symptoms, and treatments around back pain.

How common is back pain?

Back pain is extremely common. In fact, around 4 out of 5 of us will experience back pain at some point in our lives.

This pain can affect people of any age and background, although there are certain things that can make us more susceptible. These risk factors include obesity, physical inactivity, genetic factors, occupational factors (such as repetitive heavy lifting, bending, or twisting), stressful life events, and depression.

In most individuals, back pain is caused by a combination of these factors rather than one single event or symptom.

What can cause back pain?

There is often no specific cause of pain in the back. In fact, around 90% of back pain cases are what is known as ‘non-specific’. This is where it’s not possible to identify a specific disease or structural reason for the pain that we experience. This can make treatment and diagnosis difficult for professionals.

In the other 10% of cases, there may be a more specific cause of back pain. It might be caused by a muscle strain from a specific event, or an underlying disease, although cases where there is an underlying disease are rare. More serious causes of back pain are very rare and only account for around 1% of cases. This small portion of cases includes causes like infection, underlying inflammatory disease, fracture, or malignancy (cancer). 

Signs of more worrying causes can include:

• Severe pain that is constant in nature
• Sleep disturbance
• Weight loss
• Generalised feelings of illness
• Changes in the sensation or control of your body

If you are concerned about any of your symptoms, then contact your GP or an alternative healthcare professional.

What areas are most common for back pain?

When discussing pain, the back is generally split into three different areas. These are:

• The neck (cervical spine)
• The mid-back (thoracic spine)
• The lower back (lumbar spine)

Typically people experience pain in one part of their back, but it is also common to have pain in more than one area at the same time. Pain can sometimes travel down into the arms or legs, however this usually occurs on only the left or right side of the body at any given time. If you are experiencing pain in both arms or both legs at the same time, seek medical advice quickly, as this may require urgent medical intervention.  

What about pain or symptoms in my arms or legs?

Pain or changes in sensation that affect the arms or legs can sometimes occur when there is irritation or compression of the nerves in our back or in the arm or leg itself. This can cause tingling, numbness, weakness, burning, or a ‘shooting-like’ sensation.

If you are experiencing symptoms like this, you will need to discuss them with your GP or physiotherapist to unearth their root cause. This is because without an examination, it can be hard to tell what the cause of the symptoms is. Pain can manifest in one area of the body, when it is actually caused by an issue in another. In some cases, these symptoms are a result of our pain system being very sensitive rather than an actual injury to our nerves.

I’ve been told I’ve got sciatica – what is that?

Sciatica is often used as an umbrella term to describe pain that goes down the back of the leg and may or may not involve compression or irritation of the sciatic nerve.

If you are suffering from sciatica, you may experience pain, numbness, or pins and needles running down your leg. Irritation of the nerves or muscles in the lower back can cause sciatica-like symptoms like lower back pain, however, sciatica is a symptom of lower back problems rather than a direct cause of back pain.

Ways to treat back pain

Movement after an injury

If you’re living with back pain, we will typically advise you to try and keep moving. During the acute phase (early stage) of an injury, it’s likely movement will start at a lower rate or pace than you are used to, especially if you’re an active individual to start with.

The main aim during the initial recovery stage is to try and avoid staying in any one position for too long. In short, moving little and often is key. It’s also important to remember that the back is a very robust structure that you are unlikely to injure while performing everyday movements. However, your back can quickly become sensitive to these movements when you are already experiencing pain.

Lastly, keep in mind that ‘hurt’ doesn’t always equal ‘harm’. The presence of pain during movement doesn't usually mean you are injuring your back further.

Hot and cold therapy

There’s a lot of conflicting information about hot and cold therapy out there.

When it comes to back pain, we recommend trying to alleviate your symptoms using heat or ice on the affected area. This could mean applying a hot water bottle or heated blanket to the affected area or taking a long soak in a hot bath to relax your body and find relief that way. If you prefer, you can also try applying an ice pack or cold spray to the areas where pain is most localised.

When it comes to one or the other, it’s a case of personal preference. Neither is better than the other when it comes to acute or chronic problems and it’s all really about finding a treatment option that works for you. Whichever option you choose, it’s a good idea to wrap your pack in some sort of thin towel to avoid burning or agitating your skin.

Pain relief and medication

Medication (both prescription and over-the-counter) can help soothe and ease back pain. Remember that instructions are there to be followed and you should never self-medicate or ‘guess’ when it comes to pain relief medication. Strong painkillers and opioids can have damaging long-term effects and should only ever be taken following a consultation with a professional.

If you have questions about painkillers or pain-relief medication, we advise speaking to your local pharmacist or GP. Pharmacists are well trained to discuss pain medications and your GP will be able to assess your need for medication and potentially prescribe other treatments, including physical therapy.

Are corsets and braces safe?

Research around postural devices like corsets and braces shows that they have no significant benefit in the long term. Purchasing a posture-correcting brace that’s not specifically suited to your unique condition could actually end up doing more harm than good in the long run.

If you’re suffering from back pain, we would always advise visiting a physiotherapist, who can assess your condition and build a treatment plan around your specific condition.

What about office-based work?

At work, we need to make sure we’re regularly changing positions. This is just as important for office-based workers who are sat down in front of a computer for long periods as it is for manual labour professionals who do a lot of heavy lifting.

The bottom line when it comes to sitting at a desk is that sitting in a static and sedentary position can cause long-term health problems for your back. If you struggle to remember to take movement ‘snacks’, try matching them up alongside things that happen regularly throughout the day. For example, setting alarms, using phone call opportunities, and making a cup of tea are some great excuses to get up and get moving.  Alternatively, some people find it useful to set a timer every hour to remind themselves to get up and move about.

Some people find standing desks help with back pain when working at a desk for more than a few hours at a time. Standing for short periods is fine, but standing all day is not advisable, so we would recommend alternating periods of standing and sitting.

A great saying to keep in mind is “your best posture is your next posture!”

Is it normal to feel worried about my pain?

Consistent or chronic pain can affect how we process thoughts, feelings, and emotions. People living with chronic pain may think a lot about the future and whether they’ll ever be free from pain again. This can also lead to anxiety and intense questioning about your back pain.

We know that what we think and feel can amplify or decrease the amount of pain we’re in. A great piece of advice is to control what you can. Make sure you’re taking care of your general health and wellbeing and try to reduce stress and worry in the areas of your life where you feel you can.

How we do this will differ from person to person, so choose self-care activities and relaxation techniques that work for you. This might mean laying on your bed in a comfortable position and listening to music, going for a walk, or taking a long, hot bath.

Can stress and anxiety cause back pain?

Stress and anxiety can absolutely cause back pain. We know that there is a mental health component to physical pain and that it is possible to have physical responses to our emotions. This is similar to how we might cry when we get upset.

The link between stress and heart attacks is just as well known, but what’s less talked about and explored is the connection between emotions like stress and physical sensations like back pain.

Does back pain get worse if I'm pregnant?

Back pain is very common during pregnancy. What’s important to note is that back pain doesn’t automatically get worse and that certain symptoms could be a sign of a bigger problem. On the other hand, some women find their back pain improves when they’re pregnant because of the way the body adjusts and restructures to facilitate carrying a baby.

As pregnancy progresses, our centre of gravity can change along with the way we carry out everyday tasks. This can put new and different requirements on our body which may in turn give rise to pain. In addition, hormonal changes during pregnancy allow more laxity around the ligaments and joints as the body prepares for childbirth.  

If you are pregnant and experiencing back pain, we advise you discuss this with your midwife. Once any relevant pregnancy-related checks have been completed, they may be able to give further advice or refer you to a physiotherapist for a more tailored assessment. Gentle exercises/physical activity management may be advised during your assessment, although it is not recommended you start a new or intense exercise regime if you were not already doing it before getting pregnant.

How physiotherapy can help

Seeing a physiotherapist is by far the most effective way for you to understand more about your back and treat the source of your pain and discomfort.

When you see a physio for the first time, they’ll start by assessing your current physical condition and asking you a few questions about your routine and your activity levels to get a better understanding of what might be causing the pain.

They’ll also walk you through some exercises and movements that are geared towards mobilising and strengthening the area in question.

Interested in seeing one of our physios? Click here to get started

Our expert authors

This article was written by Bridget Bazell and the Physiotherapy Triage Team at Nuffield Health, with assistance and expert information being provided by:

• Sally Lynch
• Katrine Ross
• Paul Staines
• Lauren Broome
• Lianne Price
• Jo Baxter

Last updated Wednesday 7 August 2024

First published on Wednesday 7 August 2024