If you have back pain, you’re not alone. Back pain is common. In 2011, one in seven Australians (14 per cent) reported having back problems. That's three million people.
For most people back pain comes on quickly (acute back pain), but then improves or goes away within three to six weeks. However, it is common for it to come back, with some people going on to develop more persistent pain (that lasts for more than three 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.
The first thing you can do is learn more. Read on to better understand how your spine works.
The spine allows for a great range of movement and flexibility. It is made up of 33 bones (or vertebrae) that sit one on top of the other. In between the bones are intervertebral discs.
The spine is divided into several regions (see image):
Our vertebrae are connected by pairs of small facet joints that guide our movements.
- cervical – 7 vertebrae
- thoracic – 12 vertebrae
- lumbar – 5 vertebrae
- sacrum – 5 fused vertebrae
- coccyx – 4 tiny fused vertebrae.
Ligaments hold the spine together. Ligaments are strong, flexible connective tissue.
Layers of muscle provide structural support and allow movement. The spinal cord runs through the centre of the spine and connects the brain to the rest of the body.
What causes back pain?
The causes of back pain are not fully understood. In most cases back pain is caused by a simple strain to the soft tissues (the muscles, ligaments or tendons), and is not the result of serious damage to the spine.
There is a range of possible lifestyle factors that may lead you to develop back pain, including:
- poor posture
- repetitive or heavy lifting (manual handling)
- not getting enough regular physical activity (being sedentary).
Some health conditions are also linked to back pain, such as:
There are also a number of things that can make it more likely that the back pain will become persistent, such as:
- already living with, or developing, negative beliefs about your chances of recovery
- already living with, or developing, depression or anxiety
- work-related issues.
In a very small number of people, back problems are caused by a serious condition such as cancer, inflammatory problems, infection, fracture or compression of the nerves in the spine. However this is rare, and your doctor will check for these causes.
Signs and symptoms of back pain
Back pain may be experienced anywhere along the spine – from the ribs to the buttocks. In some cases, pain may also be felt in one or both legs. It is common to be a bit restricted in daily activities such as bending, lifting, sitting and walking while you are feeling 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.
Diagnosing back pain
Your doctor or healthcare clinician will:
- ask about your back pain, including:
- potential causes or triggers
- if you have had back pain before
- things that make your pain worse
- things that make it better
- conduct a thorough physical exam.
Your doctor may also refer you for some tests, especially 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. Unnecessary tests can be expensive, and some scans involve exposure to radiation that should be avoided if the results will not help with your treatment.
A thorough 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 represent the normal passage of time, 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 and staying active will help lessen pain and help you get on with your life.
There is also evidence to suggest that, as part of staying active, people with back pain should make efforts to remain at work, or return to work as soon as possible. By working together with your employer and healthcare team, you are more likely to recover and avoid the problems associated with long periods of time off work.
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.
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 for your situation
- managing your stress
- getting up and moving if you have been sitting or standing in one position for a period of time (for example when at work, or while travelling)
- staying involved in your usual home, leisure and social activities – social connections are extremely important to recovery
- aiming to stay at work, on restricted duties if required, 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
- being aware of your posture.
Back pain – moving on
In most cases, acute back pain will get better within three to six 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
Thanks to the following organisations whose pain experts helped create and review our pain content.
This page has been produced in consultation with and approved by:
MOVE muscle, bone & joint health
Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your doctor or other registered health professional. Content has been prepared for Victorian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions.