OAK Low Back Pain

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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 theenvironment(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.  In most cases x-rays are no longer advised for low back pain, and MRI scans are only useful in a small number of people with back pain and other signs and symptoms.

What are low back pain related leg symptoms (sciatica)?

Leg symptoms related with low back pain is also a common feature.  Most of us are aware of the term sciatica.  The sciatic nerve is the large nerve that runs down the back of your leg and is formed by a number of nerve roots that come from your lower spinal cord.  It is nerves that transmit messages to and from your spinal cord and brain to the rest of your body.  These nerves also have the potential to generate painful messages themselves.  However, technically not all leg symptoms related with back pain are caused by the sciatic nerve and that is why appropriately trained health care professionals choose not to just label all leg symptoms sciatica.  The nerve roots can sometimes be a cause of leg symptoms if they are irritated or compressed as they exit the spine.  Common experiences of nerve root leg symptoms are pain, pins and needles and or numbness down one leg, with the leg symptoms often being more bothersome than any related back pain.

The most common causes for a nerve root problem are the intervertebral disc and degenerative (aging) features of the spine. Unlike the common expression of a ‘slipped disc’, discs do not slip or come out.  Medically terms such as bulging, prolapsed or herniated discs are used.  All of us will have disc bulging as we age, and all of us will have aging features of our spine.  These are normal. Due to variety of reasons, some disc bulges may be larger or different than others, and some peoples aging can appear more significant.  At times these changes can contribute to sensitivity and compression of the nerve roots (resulting in leg symptoms) whilst at other times and in other people it does not. Reassuringly, most disc bulges get smaller over time and those that have symptoms as a consequence usually improve.  Degenerative features do not go away, but the symptoms they influence can settle, be improved and managed so that the spine and body continues to work efficiently with the demands it faces. Consider this, not all 70 and 80 year olds are debilitated with significant back and leg pain even though they will definitely have disc bulges and age changes in their spines.

Like non-specific back pain, most people who experience back pain related leg symptoms improve naturally, but this can take longer if you have leg symptoms than if you just have back pain.  In some cases, where back pain and related leg symptoms are not getting better, it is advisable to be assessed by an appropriately trained health care professional so that you can be guided on the recommended management options.  In cases that continue to not improve regardless of introducing the professional advice and treatments, an MRI scan can be helpful to understand whether other treatments such as injections and in very few cases surgery, could help.

Don’t overlook the fact that although your back and leg symptoms can be pretty bad, the facts suggest most people improve with time and the right approach to recovery – this is very positive.


Physiotherapy is all about restoring and maximising function and independence when someone is affected by injury, illness or disability.  NHS Physiotherapists are all registered with the Health and Care Professions Council and trained to a high level to consider the ‘whole person’ for their health and well-being.  Physiotherapists within Aneurin Bevan University Health Board receive additional training on back pain and related leg symptoms and are able to use all of the treatments (advice, education, exercise and manual therapy) and support you have read so far, ensuring that the care you receive is consistent and up to date with the national UK guidelines.  The physiotherapy service is structured in a way that also ensures that further support on investigations and non-physiotherapy options for patients is available when appropriate and needed.

If you attend one of our OAK Backs session and believe Physiotherapy is the right option for you, you will be able to self-refer from this session.  Alternatively you can access Physiotherapy self referral process LINK

The following video is a patient’s experience of physiotherapy:

OAK Backs Education Patient Video


Injections for low back pain on its own are not recommended.  Injections for low back pain related leg symptoms can occasionally be helpful if the presentation and subsequent MRI scans are consistent and there has not been benefit from conservative management.

In Aneurin Bevan University Health Board, if your symptoms are not improving you would need to be referred to an Orthopaedic Spinal team either privately or through the NHS to have a further assessment and discussion on these options.

If you feel injections could help your condition, please discuss this with an appropriate health care professional, being clear on why this option is right for you.


Surgery for low back pain on its own is not recommended.  Surgery for low back pain related leg symptoms may be considered if the individual’s presentation and subsequent MRI scan supports a need, or the individual has persistent symptoms that have not been sufficiently helped with conservative management and injection therapy to date.  In this case, you would need to be referred or continue your care with an

Orthopaedic Spinal team either privately or through the NHS to have further assessments and discussion on these options.

If you feel surgery could help your condition, please discuss this with an appropriate health care professional, being clear on why this option is right for you.

The following video is Mr Manoj-Thomas, one of our Orthopaedic Spinal Surgeons working in Aneurin Bevan University Health Board:

OAK Backs Consultant Video

Further Information

Back Pain Guidelines & Advice

NICE guidelines for the public

Chartered Society of Physiotherapy

Versus Arthritis

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