Waking up with a seized-up lower back or a dull ache that shoots through your hips ruins your whole day before it’s even started.
It wrecks your sleep, saps your energy, and makes simple things like tying your shoelaces or sitting through a film feel like hard work. It’s easily one of the most common complaints on the planet, and almost every one of us will end up clutching a hot water bottle and groaning on the floor at some stage.
The frustrating part is how much bad advice surrounds the whole thing, from being told to lie flat on your back for a fortnight to blaming the way you pick up a mug. Most of those old-school rules end up making the problem worse; looking at what your spine actually needs to heal clears away the nonsense, showing straightforward ways to get moving again without the fear of doing yourself an injury.
Back pain is more common than ever.
Around the world, about 619 million people live with back pain, which is roughly one in every 13 of us. That number is expected to climb to around 843 million by 2050. It’s now the leading cause of disability across the globe, and a major medical journal has called it a global epidemic.
In the UK, the cost to the NHS is around £5 billion a year, and that doesn’t count the days lost from work. More of us sit for long periods, move less, and spend more time on screens, and that’s thought to be a big part of the rise. The good news is that there is a lot you can do about it, and much of it is simpler than you might think.
Pain doesn’t always mean damage.
Many people assume that a sore back must mean something is broken or worn out. In most cases, that’s not true. More pain doesn’t mean more damage, and pain by itself isn’t proof of an injury. Accidents and falls can cause sprains or fractures, and in fewer than one in a hundred cases there is an underlying illness such as an infection, arthritis, or cancer.
For the vast majority of people, tests find nothing wrong with the structure of the spine. Doctors call this non-specific back pain. Short bouts are a normal part of life, much like a headache or a low day. A sudden episode usually settles by itself within weeks to months. Pain that lasts longer than three months is called chronic, and somewhere between 4 and 25 per cent of people with a short-term episode go on to develop it.
When to see a doctor
If you have back pain and no other symptoms, you can usually wait four to six weeks before seeing your GP. In the meantime, keep moving as much as you can. Over-the-counter pain relief such as ibuprofen can help, though ask your pharmacist whether it suits you, especially if you have stomach problems, asthma or take other medicines. A bag of frozen peas wrapped in a towel can ease pain and swelling, and a hot water bottle can help with stiffness or muscle spasms.
Some warning signs need attention straight away. They include numbness or tingling in the lower body, trouble passing urine, chest pain, unexplained weight loss and a fever that won’t go away. These can point to a different problem, so don’t wait. Most back pain isn’t serious, so these signs are the exception rather than the rule.
Scans can actually work against you.
It seems sensible to want a scan when your back hurts. X-rays show up broken bones, and MRI scans give a detailed picture of bones and soft tissue. Scans are useful for ruling out rare problems such as nerve conditions or cancer. They can also cause confusion because our spines change with age, just as hair turns grey and skin wrinkles.
MRI scans are so sensitive that they pick up all of these normal changes, including wear and tear and bulging discs. These findings are often described as faults that need fixing, yet they are just as common in people without back pain. When they’re not explained well, they can frighten people, who then move less, which makes the pain worse. A large study of hundreds of thousands of patients found that those who had a scan were more likely to take strong painkillers and have surgery, and they had more pain a year later.
Move, even when it hurts.
Staying active both prevents back pain and eases it. There is no evidence that any single exercise is better than another, and the best one is whichever you will actually do. If you hate swimming, there is no point recommending it, and the same goes for the gym. Choose something enjoyable, easy to get to and affordable, and even regular walking counts.
Many people avoid exercise because they fear it will make things worse, but it’s safe to move even when you’re sore. If movement is painful at first, simple pain relief can help you get started. Begin with what you can manage, take breaks and build up slowly. Activity strengthens muscles and boosts the flow of blood and nutrients to the tissues of the back, which can reduce stiffness and speed up recovery.
What helps less than you think
A common belief is that back pain comes from sitting, standing or bending the wrong way. Slouching is blamed, and so is lifting heavy things. This idea has helped to build a whole industry selling special chairs, insoles and lifting gadgets, but there is little evidence that they make much difference.
Studies over the past 20 years have found no link between slouching and back pain, and no single posture seems to protect you. Lifting with a rounded back is no more likely to cause pain than lifting with a straight one. Training in “correct” lifting at work hasn’t been shown to reduce back injuries either. Lifting can even help to prevent pain because it strengthens muscles and bones.
How the brain shapes pain
All pain is created by the brain. When you break a bone, the brain produces pain to warn you. Sometimes it carries on sending the signal after the body has healed, which works like a false alarm. The pain is still real, but it doesn’t always mean there is danger, and that gives us more control than many people realise.
One approach, called pain reprocessing therapy, teaches people to understand this. In a trial, two thirds of those who had the treatment were pain-free or almost pain-free a year later, compared with about one in five of those who didn’t. Brain scans showed less activity in the pain areas. Patients learn to tell themselves a new story, shifting from “my back is damaged” to “my brain has raised a false alarm that I can change”.
Treating the whole person is vital.
Pain is affected by far more than bones and joints. Fear, worry, stress and poor sleep can make it worse, as can a poor diet and too little movement. Money worries, strain at work and problems at home play a part as well. Treating only the spine misses much of the picture.
Cognitive functional therapy is one approach that looks at all of these factors together. A therapist helps each person understand what influences their pain, offers guidance on sleep, eating and relaxation, and encourages safe movement. Patients set their own goals, such as walking the dog or tending the garden. In a large trial of nearly 500 people with long-term lower back pain, those who had it had less pain and fewer limits on daily life after a year than those given standard care. If your pain has lasted a long time, ask your GP or a physiotherapist about approaches like this.
