What is low back pain?

Low back pain is a very common symptom that can affect around 8 out of 10 of us at any one time in our lives.  In fact, it is more uncommon if you have not had back pain at some point! In the vast majority of people who experience an episode of back pain, the symptoms get better naturally, with a little time, keeping active and being positive.  However, in some it can be a regular or even a constant experience that affects mobility, function and quality of life both physically and mentally.

In the majority of cases, 98%, low back pain is not related to a serious disease or pathology, but to the interaction between:

• our physical system (anatomical structures (muscles, soft tissues, joints and nerves and physical fitness),
• our brain and nervous system (controls our bodies and provide us with thoughts and feelings) and
• the environment (situations in which we live, work and play)

As health care professionals supporting people experiencing low back pain, we are better aware that we must help people understand how all aspects of health and well-being can influence back pain, and how best to treat it.  Getting the right information and advice early, creating a plan and sticking to it are important steps to improving your management.

You may have heard terms such as ‘simple back pain’, ‘mechanical back pain’ and ‘musculoskeletal back pain’.  These are all terms used to describe common back pain that is felt in the lower back and/or buttocks regions.  Some people can get pain on one side, central or both sides.  The pain is commonly affected by movements such as bending or walking but can also be aggravated by sitting or standing as well as many other daily activities.   This type of back pain rarely has a cause that can be seen or identified on x-rays or scans, and therefore it is also referred to as non-specific low back pain.

Advice & Education

We know that having up to date reliable information on the medical problem you are dealing with is important and can improve your outcome.  That is why  these web pages have been developed and why it is important that you read and consider the information and advice provided.  Throughout these pages we have provided other trustworthy resources for you to view and use.

For low back pain and related leg symptoms, prolonged bed rest is not advised, providing no benefit in the long-term and in some can cause a slower recovery.  However, it is recognised that some initial rest after an injury may be unavoidable and appropriate but aim for no greater than 48 hours and gradually increase your movements and activities.

Pain is often the main reason why people seek help for their back and related leg symptoms.   Getting your pain better controlled in the early phase of low back pain or leg symptoms can be a significant step in the right direction to having a natural recovery and return to your normal.  Pain can often be effectively managed with simple over the counter medications although a discussion with your GP or local pharmacist can be important before starting any new medication to ensure it is not harmful for you.

Ibuprofen is a non-steroidal anti-inflammatory and is recommended for low back pain.  However, some people should avoid using ibuprofen and others should use it with caution.  Those with severe heart failure, a history of stomach ulcer, liver disease, asthma, taking aspirin or have had a previous reaction to non-steroidal anti-inflammatory drugs should speak with their GP or pharmacist before starting. Use pain medications as directed on the label or leaflet. Discuss with your GP or pharmacist if you are getting any side-effects or this is not helping after two weeks.

Hot/Cold – use hot or cold compression packs for short-term relief – you can buy these from a pharmacy, or a hot water bottle or a bag of frozen vegetables wrapped in a cloth or towel will work just as well. More information can be found on heat and ice treatment.

If you are experiencing persistent nerve related leg symptoms due to your low back pain, there can be some medications that can be occasionally helpful for nerve related symptoms. These are Amitriptyline / Gabapentin and it may be worthwhile discussing this further with your GP.

The simplest and safest medicines that are effective are encouraged first.  If your pain continues to be distressing, affecting sleep and simple daily tasks, it is advisable to consult with your GP to discuss your pain medication options further.

Manual Therapy

Manual therapy is the common term used to describe ‘hands on’ treatment delivered by a therapist such as a physiotherapist, chiropractor, osteopath, sports therapist and masseur to name a few.  The main treatment approaches are spinal manipulation, mobilisations and massage aimed to reduce pain, improve movement and support function.

The current UK guidelines suggest that these treatments should not occur on their own but form part of a package of care alongside activity and exercise.

All NHS physiotherapists are trained to deliver manual therapy appropriate for your needs and goals. If you wish to consider private treatment, make sure the therapist you see is registered with a valid UK governing body.  You can also check whether you are receiving recommended up to date care by asking your therapist whether they are aware and considerate of the National Guidelines on the management of low back pain and sciatica (NICE NG59), and how the treatment plan they have agreed with you reflects this.

The National Institute for Health and Care Excellence (NICE) have produced Information for the public on this topic.

Activity & Exercise

We know that exercise is one of the most powerful tools for helping people to manage many musculoskeletal problems and persistent pain. However, for many people with ongoing problems this does not always make sense.

You will have read that most cases of low back pain and related leg symptoms are a combination of the interaction between our physical system, our brain and nervous system and our environment.  We know that by being active and exercising, this can condition our anatomical structures (muscles, tendons, bones), improve our physical fitness, manage our thoughts and feelings and allow us to manage the challenges of our environment.

So, what do we mean by exercise. Well pretty much anything really. As long as it works your limbs and back or your heart and lungs, or preferably both, it will help your pain and function. It is important to get a balance and little and often is usually the best place to start.

Most people who exercise regularly do so because they enjoy it and often because it comes with a social situation or friends that they enjoy spending time with. Therefore, it’s worth considering these things in your plan.

We have put a lot of information on the website about leisure facilities and groups that might help you find something you enjoy.

One option to help you become more confident to exercise is the National Exercise Referral Scheme, or NERS for short. This is available throughout Aneurin Bevan University Health Board region. It is a community run scheme supported by most council run leisure centres. It provides a variety of activities and exercise types, there really is something for everyone. To access the scheme, you will need a referral from your GP, physiotherapist or another healthcare professional. There is also a small cost associated with the programme. A commitment to attend twice a week for 16 weeks would be necessary. More information can be found on this NERS leaflet.

Physiotherapy is another option for helping with your back pain symptoms. Consider physiotherapists as experts in human movement and how pain or disease can affect this. A physio can assess your situation and physical ability, and discuss recommendations for how to reduce some of your symptoms and improve your function. Exactly what options are used will vary depending on the person, and what the physio finds. These options will be discussed with you at the time of your assessment.

Physiotherapists will nearly always recommend the use of exercise to build physical fitness. They can help you find the right option for you. In some of our physiotherapy departments we have group exercise classes dedicated to improving physical fitness for those with back pain and related leg symptoms.  These are usually 30-60 minutes exercise sessions once per week for up to 6 weeks.  If you are interested in this option discuss with your physiotherapist.

Some people feel confident to exercise without professional support, and we would absolutely support this. The decision of how to exercise, on your own, with friends, at NERS or with Physiotherapy is up to you and your preferences.

Further information on exercise can be found on NHS Exercise website.

Psychologically Informed Management

As you have already read, our thoughts and feelings can significantly influence our behaviour and therefore can impact on our potential to recover and rehabilitate successfully.  For some individuals who are experiencing persistent pain and reduced function this can be an important area for them and requires just as much consideration as their physical health and fitness.  Having the opportunity to actually talk through some of these issues and introduce some strategies can be really useful for some.  All NHS physiotherapists are trained to support individuals with common musculoskeletal concerns and pain anxieties, but in some cases a discussion with your GP and the options of further counselling with a professional in this area may be necessary.