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Back pain 

Introduction 

The structure of the back

The back is a complex structure that consists of:

  • 24 small bones (vertebrae) that support the weight of your upper body and form a protective canal for the spinal cord
  • shock-absorbing discs (intervertebral discs) that cushion the bones and allow the spine to bend
  • ligaments that hold the vertebrae and discs together
  • tendons that connect muscles to vertebrae
  • the spinal cord, which carries nerve signals from the brain to the rest of the body
  • nerves
  • muscles

 

The lumbar region

The lumbar region is the lower part of the back. It is made up of five vertebrae: L1, L2, L3, L4 and L5.

The lumbar region supports the entire weight of your upper body (plus any extra weight that you are carrying). It is under constant pressure, particularly when you are bending, twisting and lifting. This is why most cases of back pain develop in the lower back.

Back pain is a common condition that affects most people at some point during their life. Most cases of back pain are associated with pain and stiffness in the lower back.

Types of back pain

Back pain is classified in two main ways:

  • specific back pain – pain that is associated with an underlying health condition or damage to the spine
  • non-specific back pain – where the pain is not caused by serious damage or disease, but by sprains, muscle strains, minor injuries or a pinched or irritated nerve

Causes of specific back pain include:

  • sciatica – a condition caused by a nerve in the back (the sciatic nerve) being irritated or compressed
  • slipped disc – where one of the discs of the spine (see box, left) splits and the gel inside leaks out
  • ankylosing spondylitis – a condition where the joints at the base of the spine become inflamed

This article focuses on non-specific back pain.

Back pain can also be classified according to how long the symptoms last. For example:

  • acute back pain – the pain does not last longer than six weeks
  • chronic back pain – the pain lasts for more than six weeks

How common is back pain?

Back pain is a very common condition and can affect adults of all ages.

It is estimated that one in five people will visit their GP in any given year because of back pain. And 80% of adults will experience at least one episode of back pain at some point in their life.

Chronic back pain is less common than acute back pain, but it is still very widespread. In England, chronic back pain is the second most common cause of long-term disability (after arthritis). After stress, it is the leading cause of long-term work-related absence. A recent study found that one in every 10 people reported having some degree of chronic back pain.

The rates of reported cases of back pain in England have doubled over the past 40 years – a trend that is seen in almost all Western nations. There are a number of theories to explain the rise in the number of cases.

One theory is that the rates of obesity, depression and stress are now higher than they were in the past. These conditions are all risk factors for chronic back pain. Another theory is that people are now more willing to report symptoms of pain to their GP than they were in the past. See Back pain - causes for more information.

Outlook

The outlook for back pain can vary considerably between individuals. Some people have minor episodes of acute back pain before making a full recovery.

Other people have long periods of mild to moderate back pain that are interrupted by periods of severe pain, which makes them unable to do their normal daily activities.

An Australian study which looked at people who visited their GP because of back pain found that:

  • 40% were completely free of pain within six weeks
  • 58% were pain-free within 12 weeks
  • 73% were pain-free within one year

Psychological and social factors play an important role in the expected outlook for back pain, particularly for chronic back pain.

For example, people who have a positive frame of mind and report enjoying a good quality of life tend to make a faster recovery than those who report symptoms of depression and are unhappy with one or more aspects of their life.

Treatment options for back pain include painkillers, spinal manipulation, acupuncture and exercise classes. Some cases of chronic back pain may also benefit from additional psychological treatment for the reasons discussed above.

Last reviewed: 27/08/2010

Next review due: 27/08/2012

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23 Comments

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merrymaiden said on 10 November 2010

I'd recommend going to a Chiropractor to anyone having trouble getting their problem recognised. Yes, you will have to pay out at first, but you can also pay for an x-ray (something I was never offered on the NHS) and as they are experts in everything to do with the spine, they may be able to tell you what is actually wrong with you. For me it was the first step in getting NHS recognition, although strictly the NHS don't recognise chiropractic as an effective treatment, BUT... I went for months to my Chiropractor, and spent a lot of money, but it was worth it in the end. I also changed my doctor. My original doctor told me (about 5 years ago now - I was 30) I didn't have arthritis and it wasn't hereditary. My new doctor referred me for an MRI scan and physio, as I'd spent about £700 on chiropractic and this is not the action of someone who's not in pain. Turns out I have exactly same problem as my father (who started in his 20s) and genetics ARE supposed to be a factor. I've finally discovered what is wrong about a month ago so it's taken 5 years of pain. I wish I'd seen a chiropractor sooner, as mine knew exactly which discs were bulging etc etc and quoting her expertise in the spine to my new doctor, I feel, helped a lot. I also took my father along to my first appointment so the doctor could see the state he is in and appreciate my concerns. It's early days yet, I'm just being monitored as I've only just had my MRI report, but a huge psychological hurdle for me was actually getting recognition of the problems I was having and being listened to. Good luck to you all, I hope you all get the recognition and sympathetic ear that you deserve.

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kentgirl28 said on 11 October 2010

i first hurt my back in january 2007 and was advised it was muscle strain, 10 months later and numerous doctor visits i was given an MRI which showed a severly prolapsed disc. 3 months later i was seeing a specialist and being referred for surgery. My doctor was astounded that i had been walking around and living with such a severe problem for a year, also its unheard of for young females to suffer this problem.. 2 weeks later i was in hospital undergoing a microdiscectomy. within days i could again feel my toes, it was brilliant. I was advised it was highly unlikely i would ever have the problem again. August 2009 my disc(the same one, well the remainder of it ) prolapsed again and i could not even get out of bed, 2 weeks i had to lie down and the only time i could move was when the pain relief had kicked in. I had a epidural steroid injection in March and again i am now waiting for a referral to see another specialist as my back is still not right. I suffer with daily headaches and spasms in my back that stop me dead in my tracks when walking. I have other symptoms too
I guess its true what they say, once a bad back, always a bad back.
after being told i would be fine and never suffer again, i fear that this will just be something i put up with for the rest of my life

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claymorejohn said on 20 September 2010

hello folks, yes i know what back pain is all about, i have broke mine twice, 1st fell off a roof onto a plough, 2nd time off back of my lorry with 112lbs of seed potatoes on my chest, sidestepped to avoid another worker and landed on a small stone, ive also had a triple by-pass that failed within 3 months, now its left me with M. E, ostio arthritis, fibro mialga, angina (worse than it was) ostioporosis in lower back and am diabetic, some other things i can't pronounce, the constant pain never goes, they say you get used to it but you don't, almost all my joints are getting affected, i have both ankle braces, 1 knee brace, both wrist braces thats just to get about and still get made fun of, i try walks using ski sticks and admit they do help, now my neck, shoulders and most of my spine hurts, i have a back brace too, but it is steel covered with leather straps but gives me no support where its needed, the headaches i get are unbelievable so i'm going to try for a neck shoulder brace with a head rest, my head feels as if its too heavy for my neck to hold up, i know is't brass but its gettin awfy thin and weak, but at least i'll get 40 winks when out for a walk,i'll get more ribbing as i get older, if i reach another birthday, but what the heck, if you don't laugh i reckon we cry.as a matter of fact the cryin bit is never too far away either, like the other ladies in this i miss hill walking like i used to, going out shooting with my pal, i was a workaholic now i'm down to a quivvering bored wreck, i wish there was a cure, a switch to put it away for 10 mins now and then would help, and its amazing how many people do NOT believe you, but i see where they are coming from, there are so many "AT IT" out there it really does screw it up for the genuine thing, hey hoe another moan off the chest, maybe make it lighter, lol.

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Pinkpalomino said on 02 August 2010

I broke my tailbone around 1999. I had no real problems until about 2005. Since then the pain has gotten progressively worse and has expanded to include my hips. I've been seeking relief for a time now and so far have been diagnosed with non-specific chronic lower back pain. They say this may last forever or end tomorrow. I don't see it ending soon but wow, wouldn't that be great? I suspect that since no mri was done, they are just guessing and giving a broad diagnoses. I'm very unhappy with it but it seems this is it.
I'm sick to death of the constant pain. I lie to my husband all the time about my pain. I say it's a good day but it never is. I try to hide how bad it is on bad days but usually get found out. I hate what this has done to me. I led a very physical life for many years. Race horses, training horses, biking etc. I'm only 44 and feel like I'm 80 some days. I take prozac to combat depression and I think if it weren't for that and the loving support of my husband I'd plunge into a serious depression.
Getting a job has been a nightmare. I had a job I dearly loved and was doing very well at for about 4 months this year and was sacked for taking 2 days off for back pain. Now it is harder than ever to get a job.
Argh. I'm so frustrated.

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Antonio Brazen Dale said on 11 June 2010

I must agree, there is nothing worse than Back pain and it can be so disabling. Even this morning just getting out the car my back went and I ended up on the floor having to be helped up by strangers.

If only you could get warnings. I so dream of this.

What is nearly as bad as the pain is the un-supportive nature of friends and colleagues.

The nickname "Glassback" starts off as fun but doesn't ease the pain.

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Antonio Brazen Dale said on 11 June 2010

I must agree, there is nothing worse than Back pain and it can be so disabling. Even this morning just getting out the car my back went and I ended up on the floor having to be helped up by strangers.

If only you could get warnings. I so dream of this.

What is nearly as bad as the pain is the un-supportive nature of friends and colleagues.

The nickname "Glassback" starts off as fun but doesn't ease the pain.

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Antonio Brazen Dale said on 11 June 2010

I must agree, there is nothing worse than Back pain and it can be so disabling. Even this morning just getting out the car my back went and I ended up on the floor having to be helped up by strangers.

If only you could get warnings. I so dream of this.

What is nearly as bad as the pain is the un-supportive nature of friends and colleagues.

The nickname "Glassback" starts off as fun but doesn't ease the pain.

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aussietango said on 12 May 2010

NICE Guidlines of May 2009 recommended the inclusion of Chiropractic Care as a choice for those suffering with Back Pain. So far within BEN this has not happened. Commisioning side-step / avoid / put-off addressing this. Chiropractic services are offered in other PCT's. This is becoming a lottery - we the under priveledged living under BEN are the losers. This situation needs to change.

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mope said on 04 May 2010

There is a gently but incredibly effective therapy for back pain. It originated in Australia, but there are now many practitioners throught the UK.

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amanda 81 said on 19 April 2010

i fractured my T#12 in feb 09 n have never got better, i am now on really strong painkillers indefinatly.i also have 2 use my crutchie every day 4 balance aswell. i have recently been bk in hospital because ov this. they found more damage in my disc's n nerves. i am only 29 n hoping that the doctors find something else 2 help me cause the pain can be inbareable some days

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Lorraine D said on 22 March 2010

I have suffered with back pain on and off for years and have found the best treatment has been through a Osteopath and Acupuncturist. I have nothing against traditional medicine as I suffer with severe osteoarthritis in my knees and am on long term pain killers for this condition but it never hurts to explore other treatments and if you find a great osteopath as I have you will only be treated for as long as necessary to relieve the pain

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jarmila said on 04 February 2010

I suffer lower back pain 1 year almost. As I do a lot of heavy lifting at work I didnt pay much attention. 2 months ago it something blocked in my back and for 2 days I could hardluymove my right leg and right arm. I had very intensive pain along my whole leg and my whole arm. After 2 daysit wasnt so bad, but I feel that pain all the time. It is no so intensive, but it is. 2 weeks ago I started to have shooting pain in my wrists, knees, ankles and fingers and around these areas. I have spasms in my hand and leg sometimes. I have also neck pain and headache which is not very stong but it is constant almost.
I had an appointment with my GP today. I spent in his "office" around 4 minutes. After 4 minutes of typing to PC he said it is muscle pain and he recommend me to take pain killers.
As a child and teenager I practiced a lot of sport so I really know how muscles hurt. This is far away from that.
I am very dissapointed with treatment which I get from my GP. I am in this country almost 2 years, and I registered to GP only 2 weeks ago because the pain is really strong sometimes.
I work here since second day I come to this country and I pay my tax so I supose I should get the same treatment as everyone who was born in this country.
I am not happy with doctors recomendations to take more pain killers. It doesnt help. I dont know what to do next.
If you have any advice I appriciate that. Or any opinion, positive or negative. Thanks

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jarmila said on 04 February 2010

I suffer lower back pain almost 1 year. 2 months ago something blocked in my back, and I couldnt move my right leg and arm for 2 days properly. I could feel in my right leg and arm itching and strange pain. Last 2 weeks I have constant pain in my ankles, wrists, knees and fingers. And i suffer by shootin pain around all these joints. Today I had an appointment with the doctor. I live here in England for 2 years and this was my first appointment. Doctor was very kind, our meeting took aproximately 4 minutes and he said it is only musle pain and I should take more pain killers.
I am exhausted by this pain. I dont know what to do next. Pain killers helped only for a while but now they dont help at all.
I do a lot of lifting at my work and as a child and teenager I did a lot of sport so I know really how muscles hurt.
I am VERY dissapointed with my GP treatment. I work here, I pay my tax, and I deserve treatment as anybody else who was born in this country, and I suppose I didn get that kind of treatment.
I am fed up of eating pain killer. My constat pain has some kind of reason, and I wanted to see my doctor for trying him to find out what it is.

By the way I am from Slovakia.
Thanks for your opinion(positive or negative) and advice.

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jarmila said on 04 February 2010

I suffer lower back pain almost 1 year. 2 months ago something blocked in my back, and I couldnt move my right leg and arm for 2 days properly. I could feel in my right leg and arm itching and strange pain. Last 2 weeks I have constant pain in my ankles, wrists, knees and fingers. And i suffer by shootin pain around all these joints. Today I had an appointment with the doctor. I live here in England for 2 years and this was my first appointment. Doctor was very kind, our meeting took aproximately 4 minutes and he said it is only musle pain and I should take more pain killers.
I am exhausted by this pain. I dont know what to do next. Pain killers helped only for a while but now they dont help at all.
I do a lot of lifting at my work and as a child and teenager I did a lot of sport so I know really how muscles hurt.
I am VERY dissapointed with my GP treatment. I work here, I pay my tax, and I deserve treatment as anybody else who was born in this country, and I suppose I didn get that kind of treatment.
I am fed up of eating pain killer. My constat pain has some kind of reason, and I wanted to see my doctor for trying him to find out what it is.

By the way I am from Slovakia.
Thanks for your opinion(positive or negative) and advice.

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Maria Kh said on 01 February 2010

I had lower back pain on the left side.

The MRI report mentioned sacralization of the L5 as the cause.

Also, the doctor told me that development of a transition vertebrae between L5 and sacrum is the cause.

Would anybody please throw light on how sacralization causes the pain; I mean the mechanism of the pain.

I tried understanding through many websites but couldn't get it cleared.

Thanks.

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Jan46 said on 27 October 2009

I have suffered lower back pain for many years then earlier this year under my new GP I finally received the correct diagnosis - Degenerative Disc Disease. The bottom 2 discs have shrunk hence the reason for it becoming more painful over the past few years, I have been prescribed pain killers eventually surgery which really frightens me, I am a single parent of an eight year old & find it very frustrating that I cannot do the things I should be doing with him due to the constant pain. My GP has stated that I have not to do anything that will cause stress on my lower back which is a multitude of things down to carrying shopping due to this every day life/work is becoming a struggle however I just grit my teeth & get on with it the best I can. I have searched various sites re this condition re what other treatment would help ease the pain as I not a fan of taking medication on a daily basis however I am unsure which applies to me as there are varying degrees of this condition, I would be grateful of any advice someone with this condition can give me.

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geelamch said on 21 October 2009

i would be interested in any comments on the condition affecting the c2 and c3 discs in the neck area .I had sugery due to a compression in this area around two years ago ,however after initial success it has returned with a vengeance.I cannot afford to take another year from work and would be grateful to hear if any one else has this condition.
i was being treated pre surgery with large doses of morphine however this merely renders you (stupified)
and results in no life quality.
My main symptom is the loss of use of my right arm and subsequent pain ,at 44yrs old with a family and due to my employment i do not know how much longer i can continue .I would love any advice.
geelamch

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Charles Tully said on 18 October 2009

I suffered whiplash injuries affecting my neck and lower back and nothing I did in three years helped so I consulted an osteopath who said it was my terrible posture knocked loose by the accident. After clicking things free she started me on Alexander Technique lessons to improve my alignment and to reduce the amount of tension I held which had made things worse. Within a couple of months the pain was history and normal activities resumed.
I don't think people realise the far reaching affects seemingly simple injuries can have and the sooner they are sorted the better.

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MarcusMaher said on 13 October 2009

I found sections of these articles very interesting and relevant, thanks.

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Ireena said on 03 September 2009

Exercises helps to manage osteoarthritis pain. Exercises are helpful for decrease low back pain, recover faster, prevent re injury to back, and reduce the risk of disability from back pain.
Take your doctor's advice before attempting any exercises, if you are already experiencing back pain.
There is no need of any special equipment for doing exercises to reduce low back pain.and it is also not complicated.
Strong abdominal muscles are helpful in maintaining good posture and keep spine in right position .Exercises stretches and strengthen the muscles of abdomen and spine which prevents back problem.
Lie flat on back. bring your chin to chest, at the same time Hug knees to chest and ,do it for two times for 15 seconds.
By lying on stomach, use your arms to push your upper body off the floor, let your back relax and sag. hold for five seconds.do for 5 times.
Do walking, swimming,bicycling for 20 to 30 minutes in a week for alternate days.
Prone hip extension exercise is done by lying on stomach.with your legs straight out behind you. first tighten up your buttock muscles and then lift one leg off the floor about 5-7 inches.for 4-5 seconds keep your knee straight.then lower your leg and relax.do it for 3 times with another leg.
Avoid such types of exercises like twisting hip,any quick and bouncy movement, lying on stomach with legs extended and lifting together.
Do good activities like swimming,biking,walking,aerobics exercise on machines.

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Wilk67 said on 22 August 2009

My 12 year old daughter has been suffering with back pain since January. It's now the end of August - when will she get a diagnosis and treatment? It appears the NHS is not interested in back pain in children - I don't believe prescibing Iboprufen for six weeks is an adequate treatment for a child especially when it doesn't work.

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User309562 said on 14 August 2009

MLH22 mad me laugh:-))). You're really right about it. And you have well described upper back pain. I'm experiencing the same for a while. It's complicated. Would be great to have this info here. Thanking you in advance.

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MLH22 said on 28 May 2009

How about upper back pain? I have hardly ever seen any video or information on pain in the upper back. Has it got a different term? It certainly is not related to spine as such. The one that is due to weakness or muscles or nerves around the area starting from neck through shoulders down to where the rib ends. It would be nice to know how to keep that part healthier and not sprain it every now and then. thanks,

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