Back Problems

Back pain affects 8 out 10 of us at some point in our life. Back Pain symptoms are a very unpleasant but normal part of life. Some people also get symptoms from the back that spread into areas of the leg, commonly known as Sciatica. In many cases, back pain symptoms will improve over a short period of time, but some people can experience back pain which lasts much longer.  This is known as Persistent (long-lasting) Back Pain.  You can find more information in our ‘Persistent MSK Pain’ information section. 

Here is some more information on low back pain and upper back pain, including advice on what you can do, some exercises to try, and information on when you should seek medical care.

• QAbout low back pain

  Back pain is very common: 80% of the UK population get back pain at some point in their lives. Most back problems start for no obvious reason, which can be very frustrating. Back pain can start suddenly or come on gradually.  You may feel aching, hot, burning, shooting or stabbing pains in your back and sometimes into one or both of your legs. You may also get pins and needles.  The pain can be worse with certain movements and can vary from day to day.

  Back pain can be worrying but is very rarely due to any serious disease or damage. 

  Less than 1% of people with back pain have serious disease/damage or what we call specific back pain.  We know that the spine is very strong and robust and is rarely damaged or seriously injured. Around 90% of back pain settles within 6-12 weeks.

• QWhat I can do to help my low back pain
  • Keep moving, even if slowly at first.
  • Keep living and working normally. This is important and is the best way to get better.
  • Don’t worry if your back still hurts at work, consider doing light tasks at first, speak to your manager about work concerns that you may have.
  • Don’t sit down for too long, change positions regularly wherever you are.
  • Avoid bed rest during the day.
  • Stay active and remember to re-introduce activities like heavy lifting gradually.
  • Exercise really helps your back and can relieve pain. Start with light fitness training.
  • Moving will make you stronger and keeping active is the best thing you can do.

  It is important to stay active and return to normal activity as quickly as possible. This will help the recovery process and will help to stop your muscles getting weak and your back getting stiff.  

  What about pain relief?

  If you need pain relieving medication to help you to keep moving and gradually return to your normal activities, speak to your GP or a pharmacist. Although back pain is very unpleasant and may increase with certain activities, the pain does not mean that any damage is being caused.

  Do I need to see a doctor or a physiotherapist?

  Not usually – if you follow the right advice, your back problem should improve over time. If your back symptoms are still interfering with your ability to do normal things after 6 weeks, this is the time to seek further professional advice from either your GP or NHS Physiotherapist. 

  So, what is causing my back pain? 

  We know from many years of research that back pain is very unlikely to be due to one specific cause, that is why we use the term non-specific back pain.   We know X-ray and scans are really not very helpful for diagnosing non-specific back pain. 

  Back pain can be influenced by a variety of factors, including lack of exercise, or working the back too hard or too quickly. Being overweight, having poor sleep, high stress or anxiety levels, and previous experiences of back pain can all influence the onset of back pain and recovery. It is important that all these areas are considered as they may impact your back pain. 

  You may find this short YouTube video helpful for information on back pain. 

   

   

• QWhen to seek further advice or medical care - low back pain

  The majority of low back pain is not serious but it’s important to know what to look for, so that anything more serious is not overlooked.

  There are some things you should be aware of. If you develop any of the following symptoms, you will need to be seen by an emergency spinal specialist and you should go to accident and emergency immediately.

  • Loss of feeling/ pins and needles between your inner thighs or genitals.
  • Numbness in or around your back passage or buttocks.
  • Altered feeling when using toilet paper to wipe yourself.
  • Increasing difficulty when you pass urine.
  • Increasing difficulty when you try to stop or control your flow of urine.
  • Loss of sensation when you pass urine.
  • Leaking urine or recent need to wear pads.
  • Not knowing when your bladder is empty or full.
  • Inability to stop a bowel movement or leaking.
  • Loss of sensation when you pass a bowel movement.
  • Change in ability to achieve an erection or ejaculate
  • Loss of sensation in genitals during sexual intercourse.
• QAbout middle and upper back pain

  Pain and stiffness in the upper back (the thoracic spine) is very common, and can occur at any age. It can come on suddenly after an injury, but usually develops gradually over time.  Common causes of upper back pain include:

  • long periods spent working at a desk or computer.
  • long periods of inactivity.
  • carrying heavy bags.
  • sprains and strains.
  • stress and poor sleep.

   Pain and tightness can be felt in the muscles either side of the back and around your shoulder blades. You might feel pain and tightness in the muscles at the top of your shoulders or into your neck. People with postural pain sometimes develop a rounded posture, especially when sitting. This can result in your head poking forwards, and may lead to stiffness and weakness. 

  There is no one correct posture.  We all use different postures and positions. Our posture can also reflect how we feel, our mood. Sitting for long periods is not dangerous as our spines are strong and robust but regular movement and increasing our activity levels is good for our health generally. Aim to change position as regularly as you can, and get up and move around after 30 minutes. 

  What should I do for my upper back pain?

  Pain in the upper back is not usually serious and does not usually need any scans or investigations. For many people the pain will not last long and will often resolve by itself over about 6 weeks. Heat and massage (using a ball or foam roller) can help relieve any muscle tightness. Exercising to strengthen your muscles is likely to reduce the risk of your pain returning or of developing long-term pain.

  

  Regular stretches and changes in position can reduce stiffness and help your symptoms.

• QWhat I can do to help my middle and upper back pain

  Pain in the upper back is not usually serious and does not usually need any scans or investigations. For many people the pain will not last long and will often resolve by itself over about 6 weeks. Heat and massage (using a ball or foam roller) can help relieve any muscle tightness. Exercising to strengthen your muscles is likely to reduce the risk of your pain returning or of developing long-term pain.

  

  Regular stretches and changes in position can reduce stiffness and help your symptoms.

• QBack Exercises

  Remember movement, activity and a healthy lifestyle including mental wellbeing are all good for your back pain and that there is no one single exercise which is better for your back.  Below are a few exercises you could try:

  Here is a selection of exercises that you can do regularly to keep your back mobile.

  Try to do some mobility exercise every day. If you haven’t exercised recently, start with about 5 of each and build up to 10, making the exercises a little harder as your fitness and flexibility improves.

  
  Lie on your tummy, either on the floor or on a bed. Place your hands with palms on the bed/ floor either side of your ears.  Slowly push through your hands to straighten your elbows, keeping your hips on the bed/ floor, so that your back arches. Keep your hips down. Repeat.

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  Lie on your back, either on the floor or on a bed. Bring one knee to your chest, then the other, using your hands to pull your knees in to stretch your lower back. Repeat.

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  Kneel on all fours on the floor or a bed. Let the middle and lower part of your back relax into a neutral position. Next pull in your tummy and arch your back up toward the ceiling to feel a stretch in your back, then lower again. Repeat

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  Kneel on the floor or on a bed with your bottom on your heels.  Place your hands on the floor/ bed above your head reaching as far as you can to stretch. Repeat.

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  Sitting on a chair with a back, rotate your body slowly one way and use the back of the chair to pull yourself round for a good stretch. Repeat to the other side.

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  Sitting on a chair with a back, support your head with your hands and arch back over the chair-back to stretch. You can alter your position on the chair to stretch different parts of your back. 

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  Here is a selection of exercises to improve your muscles.

  Try to do some of these exercises twice or three times a week. If you haven’t exercised recently, start with about 5 of each and build up to 10 and so on. Over time you may be able to gradually build up the length of time you can hold each position, and/or the number of repetitions.

  Lying on your back on the floor or on a bed with your knees bent, raise your bottom up slowly and then lower back down slowly. Repeat.

   

  

   

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  Kneeling on all fours on the floor or on a bed, slowly raise one arm and the opposite leg, keeping balanced and without your back dropping into an arched position.

  Repeat with the other arm and leg.

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  Stand facing a wall, with your hands resting on the wall. Lean your weight on your hands and bend your arms slowly, then straighten them again slowly, so that you are doing a ‘push-up’ on the wall. Keep your back and legs straight the whole time.

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  Stand holding a small weight in each hand (the weight will depend on how strong you are, and can be increased as you get stronger). Bend your knees and lower the weights toward the floor slowly, then rise into a standing position again. Repeat. 

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  For your general fitness, choose an activity that you can do regularly such as walking, cycling, swimming or yoga.  The main thing is that you pick something you enjoy and stick to it! 

  You may want to look at some more exercise options on the NHS-fitness-studio

  Image credits: Physiotec

• QWhen to seek further advice or medical care - middle and upper back pain

  The majority of upper back pain is not serious but it’s important to know what to look for, so that anything more serious is not overlooked.

  Please seek further medical advice from your GP or healthcare professional:

  • If your pain is getting worse or not improving with simple advice and exercises.
  • If the pain follows a fall, trauma or a sudden severe onset.
  • If you experience any problems with balance, co-ordination, weakness or numbness of your legs please seek help urgently.
  • If you experience any new changes in your bladder and bowel control, please read the information highlighted in the red box for low back pain

  If you develop any of the following symptoms, you will need to be seen by an emergency spinal specialist and you should go to accident and emergency immediately:

  • Loss of feeling/ pins and needles between your inner thighs or genitals
  • Numbness in or around your back passage or buttocks
  • Altered feeling when using toilet paper to wipe yourself
  • Increasing difficulty when you pass urine
  • Increasing difficulty when you try to stop or control your flow of urine
  • Loss of sensation when you pass urine
  • Leaking urine or recent need to wear pads
  • Not knowing when your bladder is empty or full
  • Inability to stop a bowel movement or leaking
  • Loss of sensation when you pass a bowel movement
  • Change in ability to achieve an erection or ejaculate
  • Loss of sensation in genitals during sexual intercourse
• QSpinal fractures advice and exercise

  A common reason to have a spinal fracture or broken bone (it is the same thing) is osteoporosis. This is when your bones are weaker and can fracture after a minor trip or fall. The bones tend to ‘squash down’ rather than fracture and this can mean you lose height, your back can become more curved and can be very painful initially. The bone does not return to its original shape when healed and it can take some time for the muscles and ligaments to settle to this new shape. You would not usually need an operation and it is recommended you remain active. 

  An X-ray would show a fracture and your GP can consider if further investigations for your bone density are required and if any medication to improve your bone strength is required. This is to help with prevention of any future fractures.

  In most cases the fractures are stable, which means they don’t move and do not usually affect the nerves - you will be able to functional normally, but they can initially be very painful!

  Having osteoporosis does not stop the bone from healing. This usually happens between 6 and 12 weeks. You may initially need strong pain medication and then gradually reduce as the pain improves.  

  There are many risk factors that can lead to osteoporosis. Some of these include age, menopause, long term steroid use, excess alcohol, smoking, low weight or poor gut absorption (and there are many more). Making simple lifestyle improvements can help. 

  There are some excellent YouTube videos to watch on the Royal Osteoporosis Society website:
  Understanding your spinal fracture
  Living with spinal fractures
  Living with pain from spinal fractures

  Exercising after a spinal fracture

  You might feel worried about exercising after a fracture, but start gently and build up as you increase in confidence.

  Exercising after a spinal fracture can sometimes be painless but can also be very painful - begin exercising as soon as pain allows. Pain usually improves over 6-12 weeks.

  The Royal Osteoporosis Society have published an information sheet of exercises to do after a spinal fracture.

  Try to do these at least once a day. Move gently between the exercises and rest in between if needed. Hold for 3-5 secs and remember to breath and relax!

  Royal Osteoporosis Society website - further advice and exercises:

  Exercises to promote bone and muscle strength (fact sheet):
  theros.org.uk/exercise/Strength

  Include some exercises to help with posture (fact sheet):
  theros.org.uk/ exercise/Posture

  See the accompanying video to these exercises:
  theros.org.uk/exercise/BackPain

  Royal Osteoporosis Society contact details:

  Website: theros.org.uk
  Phone: 0808 800 0035 (Specialist Nurse Helpline)
  Email nurses@theros.org.uk
  Facebook, Instagram, X (Twitter) @RoyalOsteoSoc