Low back pain Mamae ā-tuarā o raro
Low back pain is very common. Most people will experience it at some point in their lives. It is usually not caused by serious damage and you can manage it safely with the right information and support.
Understanding your back
Your spine is made up of bones called vertebrae. There are discs between the vertebrae, which act as shock absorbers and allow your spine to be flexible.
Strong bands of tissue called ligaments support your spine, and muscles make it move. Joints between the vertebrae, called facet joints, guide the way it moves.
Your spine protects your spinal cord, which contains nerves to and from your brain. Nerves from your spinal cord come out from between the vertebrae and continue to other parts of your body.
Non-specific (mechanical) low back pain
Most often, low back pain is described as non-specific. This means it is not caused by a major injury or disease, and there may not be one clear structure in your back that is responsible for the pain.
It is often related to having sensitive nerves, muscles, joints or discs in your spine, but not due to lasting harm.
Low back pain is sometimes also described as mechanical back pain. This means that movement, posture or activity might affect how your back feels. It does not mean something is broken or permanently damaged. You might notice that the pain feels worse with:
- bending forwards
- lifting
- sitting for too long.
Low back pain can spread to your buttocks or legs.
The pain often improves with gentle movement, standing or lying down. Even when your pain is severe, your back is strong and resilient, and it is very likely that you will recover.
Self care for low back pain
Most low back pain gets better with self care. You will most likely recover well from low back pain without needing scans, injections or surgery.
Your body is designed to heal, and the best thing you can do is to manage the pain with basic pain medications and know that it is safe to keep moving.
One of the best things you can do to help your back pain get better is to continue normal activities as much as possible. Too much bed rest will not help your recovery from back pain.
Your back is strong and is designed to move. Walking, cycling and swimming can help reduce your back pain.
- Start slowly and increase your activity gradually.
- You may have some minor discomfort as you try to keep active.
- Do what you can without causing significant pain or discomfort.
If the pain is severe at first, carrying out your normal daily activities might be too difficult (like putting on shoes, sitting at work or bending and lifting). If this is the case even gentle movements and walking can help. You may also need to take some pain relief medicines to allow you to move more freely.
Bend backward rather than forward
Your pain may feel worse when you need to bend forward to do things like:
- tying your shoes
- gardening
- doing housework
- sitting
- getting up from a chair.
If so, try to reduce your pain by bending forward less or not at all.
Instead, lie on your belly or do backward-bending exercises. While lying on your belly, do 10 back bends every 1 to 2 hours. If this is too sore just lie on your belly or prop yourself up on your elbows.
Backward bending (modified push-ups)
- Lie face-down on the floor with your arms bent and your hands under your shoulders.
- Push up with your arms and arch your back, leaving your hips on the floor.
- Relax your stomach muscles and let your back sag for a second.
- Slowly return to the floor.
One of the main ways you can help your back pain is to change what you are doing whenever you notice the pain. Give your usual activities a try but if they bring on or worsen your pain, either work out another way of doing it that does not hurt or stop and try again later.
You may need to break up your tasks during the day — this is just one way of conserving energy.
Watch how you are sitting
- There is no perfect posture but if your back is sore while sitting then putting a cushion or folded towel (or lumbar roll) in the small of your back may help.
- If you sit at work, adjust your chair to support the small of your back
- Make sure your feet are flat on the floor or a footstool and your chair points straight at your desk or screen.
- Avoid sitting for long periods. Stand up every 30 minutes and walk around for a few minutes.
Be careful lifting
- Your back is designed to bend, twist and lift but lifting can aggravate the pain, particularly in the early stages.
- As your back pain improves it is safe to return to lifting activities.
- Start by lifting from a raised surface as lifting from floor height can be more challenging.
- Point your feet towards the thing you are lifting, bend at your knees and hips.
- Hold items close to you while you are lifting and carrying.
You may find using a heat pack or wheat bag on your low back helps ease your discomfort.
Sometimes simple pain relief medicines such as paracetamol or anti-inflammatories can be helpful. You may find they do not take the low back pain away completely, but can reduce it and help you move more freely.
Check with your healthcare provider or pharmacist on what pain relief medicines are best for you.
Pain relief medicines for adults
There is no right or wrong position for sleeping.
Sleep in any way that is comfortable on the most comfortable surface, as long as it is flat and not sagging. People were advised to sleep on a firm mattress but there is no evidence that this is better than any other type of mattress.
Other things that may help you feel more comfortable when sleeping, include putting:
- a folded towel under the small of your back (lower back)
- a small, firm pillow between your knees.
Many things can contribute to your experience of pain, including:
- your beliefs about pain
- your general mood
- anger
- depression.
Stresses in your life such as financial problems, job dissatisfaction or family pressures can also contribute to how your back pain feels.
It is important to address emotional distress as well physical causes.
Get back to work as soon as possible — you do not need to wait for the pain to go away. Returning to work (or staying at work if you can) generally helps to reduce your pain by keeping you active.
If you are worried about your work, talk to your employer and treatment provider about what you can and cannot do. Some people need to gradually ease back into their usual work tasks, perhaps doing fewer hours and not doing physical tasks like heavy lifting or twisting.
ACC can also help you get back to work if you are having problems returning to your normal duties.
Recovery at work — ACCexternal link
Diagnosing low back pain
Your healthcare provider will ask you questions and examine you to help assess your low back pain.
Most back pain can be managed well without using tests or imaging, especially if your pain is limited to your back, buttocks or both. Imaging such as x-rays, CT or MRI scans is not usually recommended because:
- it is unlikely to change how your back pain is managed
- it often shows changes that are normal for your age and not related to your pain
- some scans involve exposure to radiation.
If your pain does not get better as expected or your healthcare provider is concerned about a specific cause, you may need an x-ray or other scan. You may also be referred to see a specialist.
Specific causes of low back pain
Sometimes there is a specific cause for low back pain. These problems are not common. They make up less than 5% of all people with low back pain.
Sometimes one of the discs between the bones in your spine can irritate a nearby nerve.
Although it is sometimes called a 'slipped disc' the disc stays safely in place — it does not slip at all.
The irritated nerve can cause pain in your lower back, which may travel down your leg — often it is referred to as sciatica. It is uncomfortable but it usually settles over time, and rarely requires surgery. If you have sciatica, special medications that target the nerve pain can sometimes be helpful.
A bone in the spine can sometimes be fractured, causing low back pain. This can happen after a fall, accident or sporting injury.
The most common type is a compression fracture, seen in people with osteoporosis (low bone density). These are usually stable fractures and they typically need no specific treatment, other than monitoring.
Vertebral compression fracture
This type of pain is caused by inflammation in the joints of the spine. It affects 1% to 2% of people.
It may be linked to medical conditions such as ankylosing spondylitis. This often begins in young adults, and not generally after an accident. Symptoms from ankylosing spondylitis may feel worse in the morning (with stiffness) and improve with movement. You may have joint swelling and a rash.
If this pattern sounds familiar, talk to your healthcare provider about it.
This is a very rare condition caused by pressure on the nerves at the base of the spine. It may cause:
- new or worsening weakness in one or both legs
- difficulty passing wee (urine)
- losing control of your bladder or bowel
- numbness around your genitals or back passage.
If you experience these symptoms, go to the emergency department urgently. While rare, early treatment is important.
If you have cancer or have had cancer (anywhere in your body), it can sometimes spread to your lower back. With cancer as a cause of back pain you may also have unexplained weight loss or constant pain that does not ease.
Rarely, back pain may be related to an underlying infection. You may also feel unwell with a high temperature (fever) or chills.
This is more likely if you have a weakened immune system, for example because of chemotherapy or illness.
Treatment for low back pain
You may want help from a chiropractor, osteopath or physiotherapist to help you recover from your back pain.
All of them can give similar treatment, which can be effective — choose the one that best suits you.
You can expect whichever healthcare provider you choose to thoroughly assess you, advise you on how you can help yourself and give you an individual treatment plan. This plan may include exercises and manual therapy.
Structured exercise programme
Your exercise programme might include:
- flexion (bending forward) and extension (bending backward)
- aerobic exercise like walking, swimming or cycling
- general fitness
- strengthening
- a combination of these.
It might include supervised exercise sessions or exercises you can do at home.
Manual therapy
Manual therapy includes spinal mobilisation and spinal manipulation.
Manual therapy may also include massage. The choice of technique will depend on your wishes as well as what the provider suggests.
If treatment is not working
If you do not get significantly better after 5 to 6 treatments, talk to your healthcare provider about what other options you have.
If your pain lasts for more than 3 months it might be categorised as chronic pain — this means it is persistent. A different treatment approach may be needed.
The Accident Compensation Corporation (ACC) is a government agency that helps pay for treatment if you are injured in an accident.
The ACC provides comprehensive, no-fault personal injury cover for all residents and visitors to Aotearoa New Zealand. This means if you are hurt in an accident, ACC can help no matter who caused the accident.
If you have an accident and need emergency care in a hospital, it will be covered by ACC.
ACC usually pays some of the other medical costs if you have an accident, like surgery, physiotherapy and medicines. ACC may also be able to cover some loss of earnings resulting from an accident.
I'm injured — The Accident Compensation Corporation
Preventing low back pain
Low back pain is very common — there is no way to guarantee you can completely avoid it. But there are some simple things that can help you reduce your risk of any future back pain, and its impact on your life.
Keep active
It does not matter what exercise you do, just do something you enjoy. Studies show that strengthening exercises specifically for your spine and belly (abdomen) do not prevent back pain, but regular general exercise and activity can.
Other measures to prevent back pain
- Manage your stress and anxiety levels.
- Do not smoke — nicotine in tobacco reduces blood flow to your back, and back pain is more common and recovery is slower in smokers.
- Aim to achieve and maintain a healthy weight.
- Try to avoid sitting for long periods of time. It is important to stand up and move regularly.
- Maintain your fitness for the tasks you need to complete in your life.