Condition guide
The leading cause of disability worldwide. It may sound alarming, but most low back pain is not caused by a serious disease, and most new episodes of pain ease considerably within a few weeks. The key to recovery is movement, not rest.
It is pain between the lower edge of the ribs and the crease of the buttocks. In more than 90% of cases of low back pain, no specific structural cause can be found; this is called non-specific or mechanical low back pain. The pain is real, but it does not mean that something in your back has "broken" or "slipped". Muscles, ligaments, joints and the nervous system's sensitivity to pain all play a part together.
If the pain spreads below the knee, into your leg and foot, with numbness or tingling, a nerve root may be affected: Lumbar disc herniation and sciatica →
Work-related factors, smoking and high body weight account for about 39% of disability caused by low back pain, which means a large share of it can be prevented.
The discs in your lower back change with age, much like hair turning grey. A review of the MRI scans of thousands of people with no back pain at all found:
None of these people had low back pain. In other words, these phrases in an MRI report are often normal age-related changes and do not, on their own, explain the cause of pain. That is why guidelines do not recommend routine imaging for low back pain.
When low back pain has just started, pain and limitation usually ease considerably within the first 6 weeks; in studies, pain scores fell by more than half on average. When pain lasts longer than three months, improvement is slower, and regular exercise and a guided treatment programme become even more important.
Exercises at home
Mild tension or discomfort is normal; if the pain settles back to its usual level soon after exercising, you have not done any harm. If the pain starts spreading into your leg or gets noticeably worse, stop that exercise. Start with the easier ones and build up over time.
Lie on your back with your knees bent and your feet flat on the floor. Gently tighten your stomach and press the hollow of your lower back down towards the floor; hold for 5 seconds, then relax. Do not hold your breath.
10 reps, twice a dayLie on your back. Hold one knee with both hands and slowly pull it towards your chest until you feel a gentle stretch in your lower back. If you like, gently lift your head towards your knee as you pull, keeping your shoulders on the floor (as in the Williams exercises); if you have neck pain, keep your head on the floor. Then repeat with the other leg.
Hold for 20–30 seconds, 3 times on each legGet down on your hands and knees. As you breathe out, round your back up like a cat and let your head drop. As you breathe in, slowly let your lower back sink and lift your head. Move slowly, within a pain-free range.
10 repsLie on your back with your knees bent and feet flat on the floor. Squeeze your buttocks and lift your back off the floor so that your shoulders, hips and knees form a straight line. Hold for 3–5 seconds, then lower slowly.
10–15 reps, 1–2 times a dayGet on your hands and knees with your back flat. Reach your right arm forwards and your left leg back, without letting your lower back arch or your hips rotate. Hold for 5 seconds, then repeat with your left arm and right leg.
8–10 reps on each sideLie on your side, facing forwards, with your elbow directly under your shoulder, your forearm on the floor and your knees bent. Lift your hips off the floor so that your body forms a straight line from your head to your knees. You can reach your top arm up towards the ceiling or rest your hand on your waist. Lower slowly, then turn onto your other side.
10–20 seconds, 3 times on each sideYour back is much stronger than most people think, and it gets stronger with regular movement. Rather than being afraid of bending or lifting, it is better to get your body used to them gradually.
Video
From the YouTube channel of US physical therapists Bob Schrupp and Brad Heineck.
A short programme for new or recurring low back pain.
Strengthening and mobility exercises for low back pain that has lasted for months.
No. Guidelines recommend staying active. Resting for the first day or two when the pain is very bad is natural, but lying in bed for long periods weakens your muscles and slows recovery. Walk as much as the pain allows and carry on with your daily activities.
Usually not. The UK guideline (NICE) for low back pain and sciatica does not recommend back braces, insoles or traction. Wearing a brace for a long time can make your muscles do less work.
Usually not. Disc degeneration and disc bulges are very common in people without any pain, too; finding something on an MRI does not mean that it is the cause of your pain. If there are warning signs or surgery is being considered, your doctor will decide.
A very firm mattress is not essential. In a study of people with long-lasting low back pain, a medium-firm mattress gave better results than a firm one. The best mattress is one you sleep comfortably on and wake up from with less pain in the morning.
Yes. Low back pain often comes back: in one study, 69% of people whose pain had gone had low back pain again within a year. Regular exercise and an active lifestyle are the best way to lower the risk of it coming back.
Low back pain is very rarely a sign of a serious disease. However, see a doctor without delay if you have any of the following:
Sources
More from the health library
İhsan Eren