Lower back pain is very common and is rarely caused by a serious condition. For most people, staying as active as you comfortably can and returning to normal activities gradually is the best place to start. Get urgent medical help if you develop loss of bladder or bowel control, numbness around the genitals or back passage, or new leg weakness.
How common is lower back pain?
According to the World Health Organization (WHO), lower back pain is the leading cause of disability worldwide. It affected about 619 million people in 2020, or roughly 1 in 13 people. The Chiropractic Association of South Africa also has an article on the burden of back pain.
What causes lower back pain?
Often, no single cause can be identified. Back pain researchers report that around 90% of back pain isn’t linked to identifiable tissue damage or disease. It can flare up for reasons such as:
- A sudden, awkward, heavy or unaccustomed load
- A sudden increase in activity or training
- Long periods in one position
- Poor sleep, stress, low mood or lower activity levels, which can make people more vulnerable to pain
A small minority of cases, estimated at 1% to 5%, involve a specific problem such as a fracture, infection, cancer or nerve compression. Nerve compression can cause leg pain along with weakness or altered sensation.
Posture is often blamed, but the evidence is less clear than many people assume. See does posture really cause pain?
What can you do for lower back pain at home?
- Keep moving within your comfort: short walks and regular changes of position are usually better than prolonged bed rest.
- Return to activity gradually: reduce heavy or painful tasks for a short time if needed, then build back up.
- Try heat if it helps: a heat pack can make moving more comfortable for some people.
- Look after your general health: sleep, stress and overall activity can all affect your pain.
- Ask about medication: speak to a pharmacist or doctor to check what is suitable for you, particularly if you are pregnant or have other health conditions.
Fear of movement can make recovery harder. Researchers note that back pain is more likely to persist when people become very worried about it and avoid activity, work or social life.
What does the WHO recommend for chronic lower back pain?
The WHO defines chronic primary lower back pain as pain lasting more than three months that isn’t due to an underlying disease or condition. Its 2023 guideline includes these options for adults:
- Education and support for self-care
- Exercise programmes
- Some physical therapies, including spinal manipulative therapy and massage
- Psychological therapies, such as cognitive behavioural therapy
- Some medicines, such as non-steroidal anti-inflammatory medicines
The WHO advises tailoring care to the person, and notes that a combination of approaches may be needed. Reports on the guideline note that most of the supporting evidence was low certainty, and that it advises against some common treatments, including traction and lumbar supports.
How can a chiropractor help with lower back pain?
A chiropractor can take your history, examine you, look for signs of a more serious cause and refer you if needed. Depending on your assessment and preferences, care may include advice, soft tissue therapy and rehab exercises and chiropractic adjustments. It’s reasonable to ask how each option fits your goals, and what the benefits and risks are. Our article on what a chiropractor does covers this in more detail.
When should you get help for lower back pain?
Seek emergency care immediately if you have:
- Loss of bladder or bowel control, or difficulty passing urine
- Numbness around your genitals or back passage
- New or worsening weakness in one or both legs
- Severe pain after a major fall or accident
Make an appointment with a health professional soon if:
- Your pain isn’t improving after a few weeks or keeps coming back
- Pain travels down your leg or comes with pins and needles
- You also have a fever, feel unwell or are losing weight without trying
- You have a history of cancer or osteoporosis, or you use long-term steroid medication
Frequently asked questions
Should I rest when I have lower back pain?
A short period of reduced activity may be needed if pain is severe, but long periods of bed rest aren’t usually advised. Gentle, regular movement is generally a better approach.
Do I need a scan for lower back pain?
Most people don’t need one straight away. Scans are usually considered when symptoms suggest a serious cause, or when the results could change your treatment.
Will my back pain come back?
It can. Staying active and building your strength and fitness may help you manage it, and a recurrence doesn’t automatically mean you have damaged your back.
If your pain is affecting your daily life, you can read about chiropractic care or get in touch with any questions.
This article is general information and doesn’t replace an individual assessment by a registered healthcare practitioner.