What Is Lower Back Pain?
Low back pain is the leading cause of disability worldwide. Around 80% of adults experience it at some point and most episodes settle within 6 weeks.
The vast majority — over 90% — is “non-specific low back pain”, meaning no single dangerous cause is found. About 5–10% involves nerve-root pain (sciatica). Less than 1% comes from a serious cause like cancer, infection or fracture.
Modern guidelines all agree: keep moving, stay at work where possible, avoid bed rest, use imaging only when red flags are present, and treat psychological and social factors that drive persistence.
Common Causes
- Non-specific low back pain (Common): Diffuse pain in the lumbar region without clear nerve involvement. Most cases resolve in 4–6 weeks.
- Lumbar radiculopathy (sciatica) (Specific): Pain radiating down a leg in a specific nerve pattern, often with pins and needles or weakness.
- Spinal stenosis (Specific): Leg pain or heaviness with walking, eased by sitting or leaning forward. Common in older adults.
- Facet joint pain (Specific): Localised back pain worse with extension and rotation.
- Sacroiliac joint pain (Specific): Pain in the buttock, often after pregnancy, trauma or asymmetric loading.
- Serious causes (Rare): Cauda equina, fracture, infection, cancer, ankylosing spondylitis. Less than 1% of presentations.
Treatments
- NSAIDs first-line
- Short-course muscle relaxants for acute spasm
- Selective nerve-root injections for radiculopathy
- Radiofrequency ablation for facet joint pain
- Spinal cord stimulation in selected chronic cases
- Surgery for cauda equina, progressive deficits, refractory radiculopathy
- Exercise therapy — any modality the patient enjoys
- Manual therapy as adjunct, not standalone
- Yoga, Pilates and Tai chi (all evidence-supported)
- Graded exposure for movement fear
- Cognitive behavioural therapy (strong evidence)
- Pain neuroscience education
- Acceptance and commitment therapy (ACT)
- Mindfulness-based stress reduction
Red Flags — When to Seek Care Now
- Saddle numbness, new bowel or bladder problems, or sexual dysfunction
- Progressive leg weakness or numbness in both legs
- Significant trauma, especially with osteoporosis
- Fever, IV drug use, recent infection, immunosuppression
- Unexplained weight loss, history of cancer
- Severe night pain unrelieved by position change
Dos and Don’ts
- Stay active — walking, swimming, cycling within comfort
- Stay at work, modifying duties if needed
- Build daily movement variety — sitting, standing, walking
- Address sleep, stress and mood — they powerfully affect pain
- Don’t go on bed rest beyond 1–2 days
- Don’t avoid all bending and lifting — this trains fear, not safety
- Don’t rely on opioids for chronic back pain
- Don’t catastrophise a flare — they happen, and they pass
Frequently Asked Questions
I’ve had back pain for 3 days — should I get an MRI?
No. Without red flags, imaging in the first 4–6 weeks doesn’t change treatment and can show “findings” that are part of normal ageing.
Should I wear a back brace?
Bracing isn’t recommended for routine non-specific back pain. It can give short-term comfort but doesn’t speed recovery and can encourage avoidance.
When is surgery appropriate?
Cauda equina syndrome (an emergency), progressive nerve weakness, or severe radiculopathy that hasn’t responded to good conservative care for 6–12 weeks.
Educational use only. This content summarises peer-reviewed research and is not a substitute for personalised medical advice.