Low Back Pain

Learn about low back pain and how you can approach it in your management plan.

painHEALTH low back pain

Around 80% of people experience back pain in their lifetime, but it is rarely serious. For 10-30% of people back pain can be very distressing, interfering with daily activities, the ability to remain active and negatively affecting their quality of life. This can also impact on those caring for the sufferer – usually family and friends.

Are there different kinds of low back pain?

Yes: ‘specific’ and ‘non-specific’s.

'Specific' back pain

‘Specific’ back pain is rare. Less than 1% of people have back pain related to cancer, infection, fracture or an inflammatory process. Only about 5% of people have nerve compression resulting in a loss of power and sensation in the leg. This means that the majority of people with back pain DO NOT have ‘specific’ pathology.

'Non-specific' back pain

The good news is that for most people (90-95%) back pain is NOT related to ‘specific’ pathology. Most back pain is caused by a simple strain of the back, usually at a time where we are more vulnerable (ie. run down, tired, stressed, tense, sad, inactive or over-active). While this kind of back pain can be really painful and scary, where even small movements hurt and the muscles in the back seize up, the majority of people with this recover in a week or two.

How do you find out your type of low back pain?

Your health professional can screen you for specific pathology. You can also use our pain self-checks to see if you should seek help.

Should I get a scan?

Scans are NOT recommended for the majority of back pain unless ‘specific’ pathology is suspected. The problem with scans is that most people without back pain have age-related changes to discs (80%) including disc bulges (50%) – these are like wrinkles on the inside and do not predict back pain1. Sometimes getting a scan can make things worse as we start to worry about our backs in an unhelpful way and protect them.

How do I manage 'specific' back pain?

Your health care professional will direct your management. If you have nerve compression due to a disc prolapse (which is really painful), the good news is that the majority of these disorders resolve in 3-6 months and the prolapse disappears. Surgery is rarely needed unless you progressively lose muscle power and / or bladder function.

How do I manage 'non-specific' back pain?

The scientific recommendations for the management of ‘non-specific’ back pain are:

  • Take it easy for a day or two only, while gradually increasing your mobility and activity levels.
  • Avoid staying in bed.
  • Remaining at work is safe (even if you have to modify what you do) and can help to keep your mind off the pain.

Common myths about back pain

There are many common and unhelpful myths about back pain like: back pain is caused by wear and tear, damage or the joint being ‘out’; the back wears out from lifting; it is dangerous to exercise, bend or lift with back pain; back pain gets worse as we get older; and back pain can put you in a wheel chair.

In fact, the opposite is true:

  • Backs are really strong structures – they don’t go ‘out’
  • They love to be exercised, moved and trusted.
  • Back pain is rarely associated with damage
  • Back pain doesn’t get worse as we get older
  • People with back pain do not end up in a wheel chair.

Check out our downloadable fact sheets 15 things you didn’t know about back pain and Managing Back Pain.

Why hasn't my low back pain gone?

In a small group of people back pain can persist beyond 8-12 weeks. Surprisingly this is usually NOT because there is something damaged in the back. We know that the things that predict back pain persisting are more related to:

  • Our thoughts (such as freaking out, thinking negatively, becoming fearful and not trusting our backs)
  • Our emotions (such as high levels of stress, anxiety, low mood, sadness, frustration)
  • Things we do (such as not sleeping, tensing up, overdoing it, getting run down, smoking and drinking to excess as well as avoiding movement / exercise and work).

These things can make our nervous system more sensitive and we can get stuck in a vicious cycle of pain and disability.

What help can I get?

While the ‘mix’ of factors linked to back pain is different for everyone, there are some things that are helpful for all people with back pain2. Developing positive thoughts and emotions, learning to relax, learning to move normally and maintaining a healthy lifestyle (such as regular exercise, sleep and diet) really helps. It’s also smart not to rely too much on people doing things ‘to you’. It is much better to find things that you can do yourself to control your pain and get your life back.

This is often really hard to do when you are in pain and may require some health professional support. Some of these important aspects are covered in this website under the pain management modules. Your GP or health professional may be able to guide you in your selection of the modules if you are unsure which ones to do.

Current evidence challenges the use of paracetamol to manage low back pain5. However, there may be occasions when you doctor suggests combining paracetamol and anti-inflammatory medicines to help settle your pain. Combining these may offer better pain relief, with lower doses required and fewer side effects6. You should always discuss this first with your doctor or pharmacist to see if there are any reasons why you cannot use anti-inflammatories. You can read more in the medicine and procedures module.

In some cases, your doctor may suggest that an injection or surgical procedure is indicated as part of your pain management. To see the current evidence for these treatments, refer to our medicine and procedures module.

What can I do now?

The following approach guides you to some of the simple steps you can take to help improve your function and reduce your pain. The approach is informed by current best evidence practice2,3. Some of the most effective options are non-pharmacological (non-medicine based)4.

Stay positive

People’s experience of pain is varied and it can be hard to stay positive. Experiencing low mood, anxiety, fear and many other emotions is very common when you have back pain. Remember that back pain is rarely dangerous, it usually gets better and you are not alone – there is help! If you feel distressed, it is important to discuss your feelings or concerns with your health professional as soon as possible so they can help you. You might also find the approaching pain module useful.

Keep moving in a relaxed manner, stay active and stay at work

Whether you have acute (recent) or persistent (longer term) back pain, moving in a sensibly paced way (that is taking the middle road and doing little and often), can help you recover. Remember, it is normal to experience some back pain as you recover. It is important not to be afraid of the pain or fear re-injury as hurt does not usually equal harm.

Fear of pain and movement usually causes us to tense up, worry and over protect ourselves, which can make back pain worse and slow recovery. Gentle relaxed movement, breathing exercises and physical activity help to “desensitize” the nervous system and prevent the development or worsening of your pain. You will find that as you keep moving, maintain your usual activities and adopt a paced approach to activity, exercise and work, the pain will usually settle.

Avoid prolonged bed rest (longer than 24 hours) as this usually leads to poorer outcomes and slower recovery. Stay at work if possible even if you require short-term changes in your work habits; staying at work leads to better health outcomes for you. Your health professional can guide you regarding any work modifications that are needed.

Daily exercise

Daily exercise helps to engage your own ‘pharmacy’ in the body (your endogenous pain control systems) and this can be a very effective way of improving your function and reducing your pain. The trick here is to use a paced approach – rather than overdoing or underdoing. Remember that hurt does not necessarily mean harm and being overprotective when you exercise is unhelpful and likely to slow your recovery.

Positive health behaviours

Sleep is ‘medicine’ and engaging in healthy sleep habits such as regular sleep times, reducing screen time and avoiding alcohol /caffeine before bed can improve sleep quality. Getting more than 6-7 hours sleep a night is important.

If you are having trouble sleeping, read more in the sleep and pain module. Relaxation techniques and regular exercise may be helpful for improving your sleep: check out the mindfulness and pain module. if this fails to help, then specific medicines that help stabilise your mood may help you get restorative sleep. Read more in the medicines and procedures pain management module.

A healthy diet is also important as there is growing evidence that abdominal obesity (fat around your belly) is associated with back pain and can cause inflammation. Sometimes losing weight is really difficult and this requires assistance from a health professional.

Smoking is another predictor for persistent back pain, so getting assistance to quit is a great idea.

Helpful Low Back Pain tips

  • Don’t be afraid of back pain as hurt does not usually equal harm. See making sense of pain
  • Try and stay positive, most back pain gets better
  • Remember that it is normal to have some pain as you improve
  • Relaxed movement and daily exercise helps to engage your own body (endogenous) pain control systems helping to improve function and reduce your pain. See movement with pain
  • Healthy lifestyle habits help reduce the risk of pain persistence
  • Stay at work if possible even if short-term changes are required as this helps you recover
  • Low mood, anxiety and fear are common when you have back pain. Remember that you are not alone - there is help! Check out our approaching pain module

Want more information?

For more information visit Cochrane Summaries and download the consumer’s guide to managing back pain.

You can use the Orebro Musculoskeletal Pain Questionnaire Screening Tool to help rate the risk of your low back pain persisting. We acknowledge AOWA for allowing us to re-produce the attached additional resources from Arthritis Australia to assist in managing your low back pain.

Lastly, if you would like to talk a health professional about your lower back pain, please seek further assistance.

Approaching Pain

Pacing and goal settings

Movement with pain

Managing Low Back Pain

Managing Low Back Pain in Primary Care

My Back On Track - Indigenous Specific

  1. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol 2015; 36(4): 811-6. [PubMed]
  2. Low Back Pain: Early Management of Persistent Non-specific Low Back Pain. National Institute for Health and Care Excellence, London; 2009. [PDF]
  3. Angel Garcia D, Martinez Nicolas I, Saturno Hernandez PJ, Lopez Soriano F. [Clinical approach to chronic lumbar pain: a systematic review of recommendations included in existing practice guidelines]. An Sist Sanit Navar 2015; 38(1): 117-30. [PubMed]
  4. Chang KL, Fillingim R, Hurley RW, Schmidt S. Chronic pain management: nonpharmacological therapies for chronic pain. FP Essent 2015; 432: 21-6. [PubMed]
  5. Machado GC, Maher CG, Ferreira PH, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. Bmj 2015; 350: h1225. [PubMed]
  6. Schug SA, Goddard C. Recent advances in the pharmacological management of acute and chronic pain. Ann Palliat Med 2014; 3(4): 263-75. [PubMed]

This module has been developed by Peter O’Sullivan and Helen Slater. Professor Peter O’Sullivan Dip Physio; Grad Dip Man Ther; PhD, FACP, Curtin: Professor, School of Physiotherapy and Exercise Science; Clinical Director, Specialist Musculoskeletal Physiotherapist, Bodylogic Physiotherapy. Associate Professor Helen Slater, PhD, FACP, School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia. The information in this module is based on current best evidence research and clinical practice