Clinical health information Back pain August 15 2019
Judith Ngai Judith Ngai Health writer

We look at different kinds of back pain, how it may be caused and different ways to manage.

Back pain usually affects the lower back, but it can occur anywhere along the spine. It can be short-term, lasting a few days or weeks, or, for some people, a long-term condition. Many people will have some form of back pain at some stage in their lives.

About back pain 

Back pain is very common and is a leading cause of disability around the world. In the 2017–2018 National Health Survey, 4 million Australians reported having back problems. And it’s estimated that about 70–90% of people will experience low back pain are affected at some point in their lifetime. Anyone can get back pain at any age, but it tends to be more common in people as they get older.

Your back has many interconnecting structures including bones, joints, muscles, ligaments and tendons. Its main support structure is the spine, which is made up of bones called vertebrae, plus the bones of the sacrum and coccyx. Between the vertebrae are discs that act as shock absorbers and allow your spine to bend. Your spinal cord threads down through the central canal of each vertebra, connecting your brain to nerves in the rest of your body.

You may experience low back pain as tension, soreness or stiffness in your lower back area. This pain is often referred to as 'non-specific' back pain and may improve on its own within a few days.

Back pain may be called either 'acute' or 'chronic' depending on how long your symptoms last. You may have:

  • Acute back pain — lasting less than six weeks
  • Sub-acute back pain — lasting six weeks to three months
  • Chronic back pain — lasting longer than three months.

Your doctor may recommend treatment options based on whether you have acute, sub-acute or chronic back pain. Alternatively, they may look at your individual risk factors. Depending on whether you are considered at low, medium or high risk of poor outcomes, you may be matched with simpler or more intensive treatment options. 

Causes of back pain 

It can be difficult to know exactly what causes back pain. It’s often thought to be related to a sprain or strain in one of the interconnecting structures in the back, rather than a nerve problem. For most people with back pain, there isn't any specific underlying problem or condition that can be identified as the cause of the pain. However, there are a number of factors that may increase your risk of developing back pain or aggravate it once you have it. These include:
  • lack of exercise, or standing, sitting or bending down for long periods
  • lifting, carrying, pushing or pulling loads that are too heavy, or going about these tasks in the wrong way
  • having a trip or a fall
  • being stressed or anxious (which can increase muscle tension)
  • being overweight
  • having poor posture. 

There may be other, more serious underlying causes of back pain, but these are less common. They may include:

  • fracture — a crack or break in one of the bones in the back
  • osteoporosis — a condition where bones become weak, brittle and are more likely to break
  • a slipped disc — when a disc bulges out and presses on a spinal nerve
  • spinal stenosis — a narrowing of the spinal canal through which the spinal cord passes
  • spondylolisthesis — when one of the vertebrae slips forward and out of position
  • degenerative disc disease — when the discs in the spinal cord gradually become worn down
  • osteoarthritis — a wear-and-tear disease affecting the joints between the vertebrae
  • rheumatoid arthritis — an inflammatory condition in which the immune system causes inflammation of the lining of the joints and surrounding structures.

Back pain may also be caused by other problems including an infection or cancer, but this is rare.

Red flags

See your GP as soon as possible if you experience back pain and any of the following:
  • loss of bladder or bowel control (incontinence) or difficulty urinating
  • numbness or tingling around your genitals or buttocks (particularly in a shape like a saddle)
  • numbness, pins and needles, or weakness in one or both legs (including below the knees), your back or anywhere else
  • chest pain
  • a fever (high temperature)
  • unexplained weight loss
  • redness or swelling on your back
  • pain that doesn’t improve after resting or gets worse, particularly at night
  • pain that starts after a fall or injury.

These symptoms are known as red flags and they could be a sign of something more serious.

Diagnosis of back pain 

If you see a GP, they may ask you questions about your symptoms, medical history and lifestyle. They will also likely do a physical examination to check your general range of movement (e.g. how you walk, sit, stand, bend). It may help to think about answers to the following questions about your back pain before the appointment: 
  • When did the pain start?
  • Where is the pain?
  • Can you describe what the pain feels like?
  • Have you had back problems in the past?
  • Does anything make the pain better or worse?

If you have back pain, further testing is not normally useful or recommended unless your symptoms don’t improve after a few weeks or if you have any red flags [see above]. If your GP does send you for tests, they may include:

  • an X-ray 
  • a CT scan — a test that uses X-ray equipment and computer software to create images of the inside of the body
  • an MRI scan — a test that uses magnets and radio waves to produce images of the inside of the body
  • blood tests. 

These tests are used to find out if there could be a more specific, underlying cause for your back pain.

Treatment of back pain 

Self-help measures are often very helpful in people with back pain and are encouraged. If your back pain is severe or chronic your GP may initially refer you for manual (physical) or psychological therapies, along with exercise. If these are not successful, they may prescribe appropriate medicines. If an underlying cause of back pain is suspected, your GP may refer you to a back or pain specialist or clinic for diagnosis and specialised treatments. 

Self-help
Self-help is an important part of the recovery process. There are many things you can do to help with low back pain, for example:

  • Stay active and continue your daily activities as normally as you can. This includes staying at work or returning as soon as you’re able. Prolonged bed rest may make back pain worse, so after the first day or two, it’s recommended to limit time in bed.
  • Try some simple back exercises or stretches (ask your GP or physiotherapist if you need advice). 
  • Learn how to safely lift and carry items, and avoid heavy lifting and twisting. 
  • Apply heat or cold to the affected area. Some people find that this may help in the short term. You can buy specially designed heat or cold packs from most pharmacies. You could also try a warm bath or applying a hot water bottle or cold compress (e.g. ice or a bag of frozen peas wrapped in a towel). But don't let ice or anything too hot directly touch your skin. 
  • Try to relax and stay positive – muscle tension caused by worrying may make things worse.

Medicines
For temporary pain relief, an over-the-counter anti-inflammatory medicine (such as ibuprofen) is often enough to help ease acute low back pain. Paracetamol on its own is not recommended for low back pain. 

You could also try creams, lotions and gels that contain anti-inflammatory ingredients. But make sure you don’t apply an anti-inflammatory cream as well as taking an anti-inflammatory tablet or capsule as they can interact. Talk to your GP or pharmacist for more advice about using anti-inflammatory medicines.

If your pain is severe or chronic, your GP may prescribe stronger medicines.  

Always read the accompanying consumer medicine information leaflet and if you have any questions, ask your GP or pharmacist for advice.

Manual (physical) therapies
Manual (physical) therapies may be recommended as part of a treatment program for back pain. This may involve things like exercises, posture advice or massage.

Surgery
Back pain can usually be managed with some of the simple treatments listed above, but a small percentage of people may have ongoing problems. Back surgery is usually a last resort in people who have an underlying cause for their pain. 

Complementary therapies
You could try a pain-management program to help you better deal with and manage your symptoms.

You should always talk to your GP before trying any complementary therapy.

For more information download our back pain health guide.

Prevention of back pain 

Good back care can help reduce your risk of getting low back pain. To help look after your back, make sure you:

  • take regular exercise — walking and swimming are often recommended
  • try relaxation techniques to help keep your stress levels to a minimum
  • learn how to lift and carry objects (or children) safely — squat down, hold the object close to your body and lift with your legs, always keeping your back straight; and get help or use equipment if a load is too heavy 
  • maintain good posture — keep your shoulders back and don't slouch. 

Further information 

Musculoskeletal Australia
msk.org.au

Pain Australia
painaustralia.org.au 

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