Your back is a complex structure that provides support for your pelvis, legs, ribcage, arms and skull. The spine is made up of bones called vertebrae that are stacked together to form a loose ‘S’-shaped column.

Each vertebra is cushioned by spongy tissue called intervertebral discs. These discs act as shock absorbers and give your spine its flexibility. Vertebrae are joined by pairs of small joints known as ‘facet’ joints. A mesh of connective tissue called ligaments holds the spine together.

Complex layers of muscle provide structural support and allow you to move. Your spinal cord runs through the centre of the vertebral column and connects your brain to the rest of your body.

The causes of back pain are not fully understood.

Most people with back pain don’t have any significant damage to their spine. The pain comes from the muscles, ligaments and joints.

Common causes of back pain include:

• arthritis – osteoarthritis and ankylosing spondylitis are two types of arthritis linked to back pain

• muscle and ligament strains – if your back is out of condition or if you have pre-existing problems, you’re more vulnerable to soft tissue injuries such as sprains (stretching or tearing ligaments) and strains (injuring muscles or tendons). Stretching a ligament or muscle too far or too fast can result in a tear of the tissue. Excessive force and repetitive use may also damage muscles

• sciatica – develops when the nerve that runs from the lower back into the leg is squeezed by a bulging intervertebral disc, causing pain

• osteoporosis – is a condition where your bones lose density and strength. The vertebrae can become so porous and brittle that they break easily. Pain is due to a fracture of the vertebrae

• stress – one of the side effects of stress is increased muscle tension. This can lead to fatigue, stiffness and pain.

• structural problems – lifelong bad posture, osteoporosis and genetic conditions (e.g. kyphosis, a curving of the upper back - sometimes called a hunchback), and scoliosis (which produces a sideways curve) can cause pain by putting added stress on the structure of the spinal column.
  
  

More persistent back pain may be associated with arthritis of the ‘facet’ joints and degeneration of the discs. However, people with this condition may not experience any pain.

Very rarely back pain can be a sign of a spinal fracture, an infection of the spine or cancer. Your GP will look for symptoms and signs associated with these conditions.

Lifestyle factors contribute to back pain.

Most cases of back pain are exacerbated by lifestyle factors including:

• lack of exercise

• being overweight or obese

• sitting for long periods

• poor posture

• stress.

Your doctor will discuss your back pain with you and will:

• ask about your back pain, including:

• • potential causes or triggers,

  • if you’ve 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 (e.g. x-rays, CT or MRI scans) isn’t useful and isn’t recommended. Unnecessary tests can be expensive, and some scans involve exposure to radiation that should be avoided if the results won’t help with your treatment.

A thorough examination by your doctor will decide whether more investigations are appropriate or helpful in developing a treatment plan that’s right for you.

It‘s also 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.

The key to preventing back pain is keeping your back flexible and strong. In most cases back pain can be prevented by making a few lifestyle changes:

• exercise regularly – exercise will improve your posture and increase muscle support of the spine. Aim for 30 minutes of moderate physical activity most days. This can be broken into shorter blocks of exercise if you prefer. You can try swimming, Nordic walking, yoga, tai chi or group exercise classes. Exercising with a friend or as part of a team is also a great idea and helps keep you motivated. If you need help getting started, or you haven’t exercised in a while, talk with your doctor, a physiotherapist or an exercise physiologist for advice.

• manage your weight – try to maintain a healthy weight to lessen the strain on your back.

• quit smoking – smoking increases your chances of developing back pain.

• develop good posture – be aware of your posture particularly when sitting at home, at work or in the car. Don’t slouch, and use supports such as a lumbar support or footstool where needed.

• take regular stretch breaks – when you’re driving, standing or sitting for long periods of time, take a moment to stretch or move about. Try to do this every hour. This will help change the position of your joints and loosen your muscles.

• lift and carry 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 (e.g. a trolley) if the load is too heavy to manage comfortably on your own.

• relax – 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.

• try mindfulness – this is a form of meditation that has been scientifically proven to reduce levels of pain.  

• sleep on a good mattress – a medium to firm mattress is best for preventing back pain. It should be firm enough to support your shoulders and hips and buttocks without sagging and should keep your spine straight. Avoid sleeping on your stomach.

In many cases of back pain, the first and most important treatment is to keep active and resume normal activities – work, sport and recreation – as soon as possible. The majority of back injuries will improve by themselves.

However there are times when it’s important to see your doctor to check there are no medical problems that may be contributing to your pain.

See your doctor if you have back pain and any warning signs such as:

• severe pain that gets worse instead of better over time

• you’re unwell with back pain or have a fever

• difficulty passing or controlling urine

• numbness around your anus or genitals

• numbness, pain, pins-and-needles or weakness in your legs

• unsteadiness on your feet.

Most cases of back pain will get better on its own and you won’t need to see a doctor. If your back pain is recent, the following may help relieve your symptoms and speed up your recovery.

• learn more about your back pain – what makes it better, what makes it worse? Knowing as much as possible about your condition means that you can make informed decisions about your healthcare and play an active role in the management of your condition.

• rest your back (temporarily) – reduce strenuous activity for a short period of time. This may be necessary at the beginning, however bed rest for more than a couple of days isn’t helpful and will actually make your back pain worse.

• get back to your normal activities – try to be as active as possible and get on with your day-to-day life, including work and exercise. If you’re returning to heavy manual jobs this may take longer.

• use medication as prescribed – pain-relieving and muscle relaxant medication may be prescribed temporarily by your doctor.

• apply heat and cold therapy – hot and cold packs applied to the area of pain may be helpful in relieving pain temporarily. Make sure you take measures to protect your skin from heat and cold (e.g. wrap your ice pack in a tea towel).

• try an anti-inflammatory or analgesic cream or gel – There are many different kinds that may provide some temporary pain relief. Talk with your doctor or pharmacist for more information.

Back pain can be an ongoing problem for many people. About half of the people who get back pain will experience it again. It’s important to strengthen and condition your back, and be aware of your posture, even after the pain has subsided. 

Talk to your physiotherapist or exercise physiologist about exercises you can do on an ongoing basis to maintain the health of your back and for your general wellbeing.

• Your GP

• Physiotherapist

• Exercise physiologist

• Occupational therapist

• MOVE muscle, bone & joint health
  National Help Line: 1800 263 265

• Back pain is a common problem

• It’s usually not the result of a serious injury or disease

• There are many things that you can do to live well with back pain

• Learning about your back pain and the best ways to manage it is the first step

1. Australian Institute of Health and Welfare. Back pain and problems, 2017.

Need medical information regarding your condition and commonly prescribed treatments? Or assistance navigating the health, disability and social services systems? Contact our nurses on the Help Line on 1800 263 265 or email helpline@move.org.au.

Interested in finding out about our upcoming webinars and seminars and other events? Click here to learn more.

• Australian Physiotherapy Association

• Exercise and Sports Science Australia

• Better Health Channel

• Pain Australia