Back pain

If you have back pain, you’re not alone. It’s a common problem experienced by many Australians. In fact one in 6 Australians reported back problems in 2017 to 2018. That’s close to 4 million people.

For most people back pain comes on quickly, but then improves or goes away within 3 to 6 weeks. This is acute back pain. It is also common for back pain to come back, with some people going on to develop more persistent pain (pain that lasts for more than 3 months).

Back pain can have a significant impact on all aspects of life including daily activities, family life, work, recreation and social activities. But there’s a lot you and your healthcare team can do to deal with back pain so you can get on with life.

How does my back work?

To understand your back pain, it’s helpful to know a little about how your back works.

Your backbone (spine or spinal column) is made up of bones called vertebrae stacked on top of each other to form an 'S'-shaped column.

The spinal cord, which transports messages to and from the brain and the rest of the body, runs down a bony tunnel behind the vertebral bodies where it's protected from damage. It runs through the length of the spinal column.

Each vertebra is cushioned by spongy tissue called intervertebral discs. These discs act as shock absorbers. Vertebrae are joined together by small joints (facet joints), which allow the vertebrae to slide against each other. This allows you to twist and turn.

Tough, flexible bands of soft tissue (ligaments) also hold the spine in position.

Layers of muscle provide structural support and help you to move. They're joined to bone by strong tissues (tendons).

The structures and soft tissues in your back are tough, flexible, and designed to move, carry weight and support you.

Signs and symptoms of back pain

Back pain may be experienced anywhere along the spine – from the neck to the buttocks. In some cases, pain may also be felt in one or both legs.

It’s common to be a bit restricted in daily activities such as bending, lifting, sitting and walking while you’re experiencing back pain.

Movement of your torso may be limited by back pain. There may also be tenderness when pressure is applied to the joints of the spine. Reduction of reflexes, strength and sensation in the legs can be a sign of nerve compression.

It's common for people with back pain to feel distressed about their recovery. People with persistent back pain can develop fear of movement and activity (including work), worrying that it will make things worse or increase their pain. Living with persistent back pain may also lead to mood issues, such as anxiety, irritability, frustration and depression.

Causes of back pain

In most cases (90% to 95%), the cause of back pain is unknown. This is non-specific back pain – it isn’t caused by a specific condition, illness or serious damage to the back.

Non-specific back pain may be caused by:

• soft tissue sprains and strains
• anxiety or depression
• not getting enough exercise
• being overweight or obese
• bad sleep
• smoking
• stress
• sudden or unusual increase in spinal loading – for example, if you have a sick child and have to lift and carry them more than usual.

Back pain with a specific cause is less common. It includes things such as:

• inflammatory arthritis, including ankylosing spondylitis
• osteoarthritis
• bone fracture
• osteoporosis
• herniated disc – when the intervertebral disc becomes weakened causing it to bulge, sometimes pressing on nerves, however it doesn't 'slip' or move out of place.

In a very small number of people (less than 1%), back problems are caused by a serious condition. Signs you should be aware of include:

• severe pain that gets worse over time instead of better
• you're generally unwell with your back pain or have a fever
• problems controlling your bladder or bowel
• numbness, pins-and-needles in your legs, between your legs, or feet
• weakness in your legs or unsteadiness on your feet
• unexplained weight loss
• redness or swelling on your back.

If you experience these symptoms, contact your doctor, or call the Healthdirect Helpline on 1800 022 222. Registered nurses are available 24 hours a day, 7 days a week to provide advice.

There is no evidence that back pain is caused by:

• getting older
• poor posture
• a weak core
• everyday lifting and bending.

Diagnosing back pain

If you have back pain that is impacting your life, you see your doctor for help. Your doctor or healthcare clinician will:

• ask about your back pain, including the potential causes or triggers, if you have had back pain before, and how it affects you
• ask about any other symptoms or health issues you have
• do a thorough physical exam.

Your doctor may refer you for some tests if they think there may be a more serious cause for your back pain.

However, in most cases of back pain, imaging such as x-rays, CT or MRI scans is not useful and is not recommended because they aren’t good at identifying the cause of pain.

An examination by your doctor will decide whether more investigations are appropriate or will be helpful in developing a treatment plan that is right for you. It is important to know that many investigations show 'changes' to your spine that are likely to be normal signs of ageing, not 'damage' to your spine.

For more information about questions to ask your doctor before you get any test, treatment or procedure, visit the Choosing Wisely Australia website.

Treating back pain

Most people recover quickly from acute back pain, whether they seek treatment or manage by themselves.

Over-the-counter pain relievers, like non-steroidal anti-inflammatory drugs (NSAIDs) and topicals, and staying active will help lessen pain and help you get on with your life.

For more persistent pain, effective treatments include:

• supervised exercise therapy with a qualified health professional (such as a physiotherapist or exercise physiologist)
• cognitive behaviour therapy (CBT) – this involves working with a mental health professional in order to change unhelpful or unhealthy habits of thinking, feeling and behaving
• multidisciplinary pain management involving a team that often includes specialist pain physicians, physiotherapists, occupational therapists and psychologists
• some medications.

Surgery is rarely needed for back pain unless a more serious issue or condition is causing your back pain, or if nerve compression is present.

Paracetamol has been proven to have no effect on back pain. Opiods have commonly been prescribed to treat back pain, but there's no evidence that they provide any greater benefit than NSAIDs for acute back pain. They also have a high risk of serious side effects and the potential to cause harm.

Self-management of back pain

Almost everyone suffers back pain at some stage in their lives. Most people recover quickly with little or no treatment. The best medicine involves staying active and at work whenever possible, as well as remaining positive about recovery.

Even in people with recurrent or persistent back pain, the most effective treatments involve things you can do yourself, such as:

• Learning more about your back pain – what makes it better, what makes it worse?
• Exercising and staying active as much as possible – talk with a physiotherapist or an exercise physiologist if you need specific advice.
• Managing your stress and looking after your mental health.
• Managing your weight – try to maintain a healthy weight to lessen the strain on your back.
• Getting up and moving if you have been sitting or standing in one position for a period of time. Take regular breaks to get up, stretch and move around every hour.
• Staying involved in your usual home, leisure and social activities – social connections are extremely important to recovery.
• Quitting smoking – smoking increases your chances of developing back pain.
• Aiming to stay at work and developing a plan with your employer to return to your full work. Your doctor, physiotherapist and occupational therapist can help you with information about how to stay at work.
• Lifting and carrying safely – if you're picking up a heavy load, squat down, hold the object as close to your body as practical and lift by using your legs. Make sure you keep your back straight. Get some help from another person or use equipment (such as a trolley) if the load is too heavy to manage comfortably on your own.
• Relaxing – learn some relaxation techniques to reduce stress levels and related muscle tension. Try massage, heat or cold packs and gentle exercise. Seek advice from a physiotherapist.

See treating persistent pain for more ways to manage pain.

Moving on from back pain

In most cases, acute back pain will get better within 3 to 6 weeks.

Some people can develop recurrent or persistent back pain, however working with your healthcare team and using self-management techniques will lead to the best outcomes. It is important to understand that, even with persistent back pain, most people are able to remain at work and lead a full life.

Where to get help

• Your GP (doctor)
• Physiotherapist
• Exercise physiologist
• Psychologist
• Occupational therapist
• Musculoskeletal Health Australia B.A.M Helpline Tel. 1800 263 265
• Beyond Blue – Support Service Tel. 1300 224 636
• painHEALTH
• Pain Australia
• Chronic Pain Australia
• Work Assist
• Transport Accident Commission (TAC)
• Worksafe.