Back pain guide
Types of back pain
Neck pain refers to any pain experienced in the area from the base of the skull to the shoulders and can spread to your upper back or arms.
This can include feelings of stiffness or tightness, as well as sharp pain and, in severe cases, can reduce the movement of the neck and head. Neck pain can also cause tension headaches.
Most muscles in the body will relax completely when they are not being used, but the muscles in the neck are permanently tensed in order to support the head. Although most common in people over 50, neck pain can develop at any age as the result of excess strain on the neck. This could include slouching, sleeping in an awkward position or working at a computer for long periods of time without a break.
Neck pain can also develop as the result of an accident. Perhaps the best known is whiplash; an injury sustained as a result of the head being thrown forward and back in a car accident.
Neck pain is rarely the result of a serious injury and will often lessen after a few days. If you are suffering from neck pain, try to keep moving and maintain your normal routine as best you can. Over-the-counter painkillers may also help.
Visit the Health A-Z section of NHS Choices for more detailed information about all aspects of neck pain and stiff neck.
Upper and middle back pain
The upper and middle back refers to the section of vertebrae, known as the thoracic vertebrae, which runs from the base of the neck to the bottom of your ribcage. This type of back pain is less common than neck or lower back pain as the bones in this area are not required to move and flex as much.
Like many other types of back pain, upper and middle back pain can range from aching and stiffness to a sharp or burning sensation. Pain in this area is often the result of pinched nerves in the spine by the ribs.
One cause of back pain in this area is poor posture. Try to keep your back as straight as possible and balance your weight evenly on both feet. When sitting, keep your shoulders rolled back and be sure to adopt suitable positions when driving, sitting or using computers.
For more advice on ways you can protect your back, see the 'preventing back pain' section of this guide.
Lower back pain
This is the commonest type of back pain with around 8 out of 10 people affected at some time in their lives. The lower back is defined as the area between the bottom of the ribcage and the top of the legs. Symptoms range from tension and stiffness to pain and soreness.
Most people's back pain is described as non-specific, meaning it is caused by structures in the back as opposed to rare conditions such as cancer or a fracture.
The back is a delicate area of muscles, nerves, bones and joints and is continuously working hard to support the weight of the upper body. Lower back pain is often triggered by everyday activities such as bending awkwardly, lifting incorrectly, standing for long periods of time, slouching when sitting and driving for long periods without taking breaks.
The 'preventing back pain' section of this guide has advice on guarding against these common causes of back pain and includes tips on lifting correctly, sitting properly, using computers and avoiding back pain caused by driving.
Buttocks and legs (sciatica)
Sciatica is pain caused by irritation or compression of the sciatic nerve. The sciatic nerve is the longest nerve in your body and runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet.
When something compresses or irritates the sciatic nerve, it can cause a pain that radiates out from your lower back and travels down your leg to your calf. This can be mild to very painful.
The most common cause of sciatica is a slipped disc. This occurs when one of the discs that sit between and cushion the vertebrae is ruptured. Most cases of sciatica will pass without the need for treatment. A combination of the self-help measures described in this guide such as over-the-counter painkillers, exercise and hot or cold packs can usually relieve the symptoms.
For persistent sciatica, you may be advised to try a structured exercise programme under the supervision of a physiotherapist. In rare cases, surgery may be needed to control the symptoms.
Visit the Health A-Z section of NHS Choices for further details about causes, symptoms and treatments for sciatica.
Urgent (red flag symptoms)
Most cases of back pain will usually get better without medical help. However, there are a number of warning signs, known as 'red flags', which may indicate that your back pain is serious.
These red flag signs include:
If you have any of the signs or symptoms listed above, contact your GP immediately. If this is not possible, you can telephone NHS 111 on 111.
You should also seek medical advice if you are having back pain and:
Also contact your GP if your symptoms fail to improve within three days or you have persistent pain that lasts longer than six weeks.
Treating back pain
In the past, it was thought the best cure for back pain was to rest. We now know that rest can be harmful as it allows your muscles to weaken, therefore delaying recovery. Staying mobile and keeping active is important for your recovery. Try not to let back pain interfere with your daily routine too much and return to work as soon as possible.
Could some part of your daily routine be causing or at least aggravating your back pain? Explore the 'preventing back pain' area of this guide for ideas and advice on the best ways of sitting, lifting and driving so that your back is protected. There is also advice on using computers.
If back pain is so severe that it begins interfering with your daily activities, medication could be the next step. It is recommended that you first try over-the-counter medication such as paracetamol. If that doesn't provide sufficient relief, try ibuprofen. In either case, make sure you are taking the painkillers as regularly as the dosage information recommends.
Don't wait until your back pain is very bad. If you want any further advice on this, speak to your GP or pharmacist.
Visit the Health A-Z section of NHS Choices for more information on treatment for back pain.
Manual therapy is designed to provide physical relief for your symptoms and can be performed by a number of different types of practitioners. Perhaps the best-known example is a physiotherapist.
There are many people offering back pain treatment and if you choose to arrange manual therapy yourself, there are a number of questions you should ask. Here is what the charity BackCare recommends you consider:
Your GP may refer you for some manual therapy, which will begin with an examination to see if there are joints that can be freed up. This can be done with a gentle massage, mobilisation or manipulation. Your GP, or the practitioner they might refer you to, will be able to advise on stretching routines or exercises you should be doing to keep your back muscles strong.
Hot or cold packs
Some back pain sufferers find relief by applying hot or cold packs to the affected area. If you think your back pain is the result of a sprain or a tear, try a hot pack first. If you think the pain is the result of an inflammation, a cold pack may be better.
Hot and cold packs can be bought from pharmacies and can be left in the freezer until required. Many can also be heated in the microwave; depending on the type of relief you require. (Always follow manufacturer's instructions). Failing that, a bag of frozen peas or a hot water bottle will do the same job. It is not advisable to apply a hot or cold pack directly to the area, instead, make sure it is wrapped in a thin piece of towel.
If you are in the middle of experiencing an episode of back pain, some gentle stretches can help ease any discomfort and will help strengthen the muscles in your back.
Strengthening the muscles in your back will help protect it from further problems. It is for this reason that stretching should become part of your daily routine if you suffer or have suffered from back pain in the past.
BackCare, the charity for healthier backs, has produced a leaflet on stretches for spinal mobility that should be performed daily. You can find this leaflet on the BackCare website.
As well as stretching, research shows that exercise can be effective in reducing back pain. If back pain has become a recurring problem, exercising regularly will improve the strength of your back muscles and will become an important part of your coping strategy.
Preventing back pain
Keeping your back strong
Strengthening your back through exercise is one of the best ways to keep back pain at bay. It can also be very helpful in treating back pain.
Choose a low-impact, gentle exercise that will help strengthen the muscles in your back, without the risk of strain or sudden jolts. Swimming, yoga and pilates are very good for improving flexibility and strength and once you feel your back is strong enough, you can graduate to something more energetic such as jogging, cycling or dancing.
Pick something you enjoy so that it is more likely to become a habit. You should aim to exercise three to five times a week for 30 minutes each time.
Stretching is another key way of strengthening your back. It can help to warm up the muscles in your back before starting to exercise and can even be helpful in preparing your back muscles prior to household chores or gardening. But the best way of maximising the benefits of stretching is to make them a part of your everyday routine. See the ‘stretching’ section of this guide for more information and a link to a printable back stretches handout.
Lifting can strain your back and lifting badly can lead to injury. Follow these simple tips to avoid damaging your back:
Read this article about more safe lifting tips.
Sitting in the wrong position can cause or aggravate back pain. Try to follow these simple tips to combat poor sitting habits:
Driving can prove a real challenge for backs, especially if you drive for extended periods of time. Here are some tips to help support and protect your back:
Computers are probably the biggest problem when it comes to back or neck strain. Ensuring your workspace is set up correctly will help in reducing the potential for harm:
Further reading on using computers:
If you use a laptop, this can cause a number of different issues. This article has specific advice for laptop users.
Read this article for further information about repetitive strain injury (RSI).
The structure of the back
The back is a complex structure that consists of:
The lumbar region is the lower part of the back and is made up of five vertebrae. This region supports the entire weight of your upper body which is why most cases of back pain develop in the lower back.
NHS Choices 2011