Back pain

Back pain is one of the most common reasons for seeking medical care. It is also the most common cause of absence from work and loss of productivity.

Back pain can affect your lower back, your mid-back, or your upper back. Lower back pain is the most common form of back pain.

On this page, we review the causes, symptoms, and treatments for back pain. We also provide an overview of the treatments and services available for back pain at Circle Health Group’s The Alexandra Hospital in Manchester. 

Back pain can occur suddenly, such as in the case of an injury or after lifting something heavy, or it can have a gradual start, like in the case of degenerative conditions.

Back pain isn’t usually serious, and most of the time it will go away with time.

However, if you experience other additional symptoms and the pain doesn’t go away with regular painkillers, you may need to seek medical attention and find out the underlying cause.

Dr Ankur Saxena, MBBS MRCSEd FRCS, is a consultant neurosurgeon who specialises in spinal disorders at The Alexandra Hospital. He explains:

“The most common pain in the spine is in the lower back, and the most common cause is due to muscular problems. [This] could be something simple, like a sprain, which can come on either by excessive muscular activity, light injury or sometimes just abnormal posture sustained over a long period of time, like prolonged sitting.” 

In the vast majority of lower back pain cases, the cause is not known.

However, in rare cases, Dr Saxena explains, the cause may be something more serious like an infection or rarely, a tumour.

For this reason, he notes, “if there is pain in a person’s spine, particularly lower back, which is getting worse with time and which is not helped with simple conventional treatment, like painkillers, light exercise [...], or if the patient has other symptoms, like localised tenderness, temperature, weight loss [...], then the patient needs to seek medical attention to look into other causes [and] relevant clinicians should organise an investigation.”

To understand the causes of lower back pain, we must first understand the structure of the back.

Lower back pain is also called lumbago, and it affects the lumbar area of your spine. The lumbar region is between your hips and the beginning of your ribcage. Usually, this pain comes with tension in your muscles and the inability to move as much as you’d like or as you used to.

The lumbar region supports a lot of the weight of the upper back and is made of five vertebrae. In-between these vertebrae there are spinal discs — soft pads that are meant to act as shock absorbers when you move your body.

Vertebrae are held in place by ligaments and muscles, and they attach to the spine with the help of tendons.

Your spinal cord also holds the roots of 62 nerves, which control body movements and send signals to the brain. 

Specific and non-specific lower back pain causes

When a clear, specific cause cannot be found for your back pain, this is called ‘non-specific’ back pain.

Common causes of non-specific lower back pain include:

• Being inactive and having weak core muscles
• Having tense muscles due to strain
• Sitting in one position for a long time
• Strain due to excessive physical activity
• A sprain, or injury to the ligaments or muscles that support the spine
• Tense muscles due to psychological stress

Causes for specific lower back pain include:

• A narrowing of the spinal canal (called spinal stenosis)
• A slipped spinal disc or vertebra
• A broken bone in the spine (for example caused by osteoporosis)
• Ankylosing spondylitis (a form of arthritis that is usually genetically inherited)
• Age-related disc degeneration, where the spinal discs between the vertebrae lose their rubbery texture and shock-absorbing quality
• A slipped spinal disc or vertebra
• Arthritis
• Infection
• Congenital problems such as scoliosis or lordosis (abnormal curvatures of the spine)
• Tumours

Your consultant will help you get to the bottom of your back pain and establish the underlying cause.

Although mid- and upper back pain — also known as thoracic spine pain — is still quite common, it is not as common as lower back pain. It has therefore not received as much attention in the research community as lower back pain.

Sometimes, mid and upper back pain have clear, specific causes, such as:

• Osteoporosis
• Fractures in the vertebrae
• Hyperkyphosis, or having an excessively curved spine as a result of bone loss in the vertebrae
• Ankylosing spondylitis
• Osteoarthritis
• Scheuermann’s disease, a hereditary condition in which the curvature of the spine is excessive

Other times, the cause is not as specific. In these cases, mid- to upper back pain may be caused by:

• oor posture
• Having lifted something heavy in an improper way
• Overuse or excessive use of the upper back muscles
• Accident or injury

Less common causes include arthritis, a herniated disc, fibromyalgia, or compression fractures as a result of osteoporosis.

Sometimes, lower back pain can radiate or spread down the back of the leg. Sometimes the pain goes as far as below the knee or into the foot. This form of lower back pain may be what is called sciatica, or radiculopathy.

Sciatica is a specific cause of lower back pain and is usually due to a slipped disc. A slipped disc puts pressure on the sciatic nerve.

In sciatica, the leg pain may be worse than the back pain. It might travel through the buttocks and along a certain nerve, or it may come with other symptoms like tingling or numbness.

The vast majority of lower back pain is caused by musculoskeletal problems — that is, problems with the muscles and the skeleton (in this case, the spine).

Sometimes, however, back pain is not caused by the spine. This is called “referred” pain, explains Dr Saxena. “Technically, any organ in the abdomen can cause referred pain to the lower back,” he says.

Some of the abdominal causes for referred pain include:

• Kidney stones or kidney infection
• Abdominal aneurysm
• Pancreatitis
• Colon cancer

However, Dr Saxena stresses that the vast “majority of back pain is caused by either the muscles or the skeletal structure of the spine.”

Dr Saxena explains that there are no particular spine-related conditions that affect one sex more than another.

“But you can have other pathologies, especially pelvis-related, where females are affected more than males,” he explains.

Some possible causes of back pain in women are:

• Pelvic inflammatory disease (PID) – caused by inflammation of the fallopian tubes or the ovaries
• Recurrent urinary tract infections
• Endometriosis – a condition in which tissue that lines the uterus grows outside of the uterus

Dr Saxena also adds that postmenopausal women who are not taking hormone replacement therapy (HRT) are at an increased risk of osteoporosis, which may cause back pain.

However, he stresses that “by and large in our practice, from a spine point of view, we see almost an equal incidence of spinal pain [in both sexes].”

Back pain can affect everyone, but some of the factors that raise the risk of back pain include:

• Age – back pain is more common in older people, particularly after the age of 45. Age-related conditions such as osteoporosis and spinal stenosis may cause back pain in an ageing population. Also, bones lose their strength with age, muscles lose their elasticity, and the spinal discs become less flexible and less able to absorb the shock from the vertebrae.
• Inactivity or low fitness levels – being suddenly very active after a long period of inactivity may cause back pain. Weak back and core muscles may cause lower back pain.
• Being overweight or obese or suddenly gaining a lot of weight may put stress on the back and cause lower back pain, as the lumbar region has more weight to support.
• Mental health – anxiety, depression, and psychological stress are also risk factors for lower back pain; negative mood and mental health problems may reflect in muscle tension and back pain. This is called somatisation. Anxiety and depression may also affect how you experience pain.
• Genetic predisposition – some conditions that cause back pain, such as ankylosing spondylitis, are inherited genetically.
• Occupation – jobs that require a lot of heavy lifting, bending, or twisting may lead to back pain.

Sometimes your back pain may be due to a combination of a few of these different factors.

Some of the things you can do to treat your back pain at home include:

• Taking painkillers
• Applying pain relievers such as gels, creams, patches, or sprays locally on the affected area
• Applying heat and/or ice to relieve the pain, reduce inflammation, and improve mobility
• Gentle stretches or gentle mobilisation of the painful area

“The old theory used to be that if patients have severe back pain, they were advised bed rest,” Dr Saxena explains. “But now, the recent understanding is that bed rest is actually more harmful to patients. So, [now we] encourage the patients to mobilise as much as they safely can.”

How to take painkillers for back pain

You can treat acute back pain at home with over-the-counter painkillers. These include medicines that are also anti-inflammatory, like the non-steroidal anti-inflammatory drug (NSAID) ibuprofen, or painkillers that only relieve the pain, such as paracetamol and aspirin.

Dr Saxena recommends that people take painkillers as quickly as they can. “If you take even a painkiller or two initially when the pain starts, then your recovery is likely to be faster than if you try to be brave and hope that you could ride it out without any intervention.”

Anti-inflammatory painkillers are very good for muscular pain, explains Dr Saxena, but you need to be mindful of their side effects. These include:

• Gastritis
• Heartburn
• Long-term risks of gastric ulcers
• Kidney problems
• Slower blood clotting

Special caution is also necessary if you have asthma, and you have never taken ibuprofen before.

There are two main ways that people can access the services of The Alexandra Hospital for back pain, explains Dr Saxena.

GP-led urgent care centre

“One of them is a GP-led urgent care centre, for patients in acute pain who are struggling to get relief and must seek urgent medical attention,” say Dr Saxena.

Here, highly experienced GPs will “take a full history and perform a detailed examination of the patient and arrange for necessary investigations,” he says.

Depending on the outcome of these examinations and tests, the GP may refer the patient to a spine specialist or a physiotherapist. These specialists are usually widely available in the hospital and can quickly provide assistance if there is an urgent condition that needs addressing.

Self-referral

The second way is by self-referral. Patients can directly book to see a spinal specialist — some specialists may require a GP referral, Dr Saxena says, while others like himself happily see patients without a GP referral.

To make sure the underlying cause of your back pain is not something more serious, your consultant will ask you a series of questions about your medical history. This is to accurately diagnose the cause of your back pain and establish the course of your treatment.

They may perform an imaging test, such as:

• a CT scan
• an X-ray
• an MRI scan of the spine or relevant parts of the spine

They may also ask you to take some standard blood tests and sometimes a urine test.

Spinal specialists

“The good thing about The Alexandra Hospital is that we are one of the biggest spinal centres in the private healthcare sector in the country. So [there is] a spinal specialist available on most days to see a patient if the need arises,” Dr Saxena says. He adds that same-day appointments are also available, depending on how busy the clinic is that day.

The spinal specialist, much like the GP, will ask a series of questions about the patient’s medical history and occupation. They will also perform a thorough examination, including imaging tests and any other specific investigation they feel is necessary.

“The advantage of seeing the spinal specialist is that more spine specialists are able to read and interpret the scans by themselves [...] if there is something urgent.”

Eventually, the specialists will catch up with the radiologists to make sure they haven’t missed anything, Dr Saxena adds.

Alexandra Hospital’s specialists have received prestigious medical awards or are serving as members of editorial boards for renowned academic medical journals.

In addition, Dr Saxena explains, the hospital’s specialists are used to performing “slightly higher risk surgeries” compared to other private healthcare institutions. This is due to the fact that the hospital has a 24/7 critical care unit and is one of the largest private hospitals and spinal centres in the country, with a “large spinal and neurological presence.”

“Because of the sheer number of surgeons and the volume of patients we see here, you've got almost a dedicated spinal list [of specialists] every day of the week.”

“So that helps, along with the fact that our nurses, our physiotherapists, our theatre staff, everybody is so used to dealing with spinal pathology that we've developed quite a good expertise with a range of problems, from simple spinal problems to quite complex ones.”

Types of treatment and surgery

After the consultant makes a diagnosis, they can devise a management and treatment plan.

This, explains Dr Saxena, may consist of conservative treatment such as:

• Painkillers and specific exercises
• Physiotherapy
• Steroid injections in the spine

Surgery is sometimes also recommended as a treatment. However, Dr Saxena emphasises, surgery just for back pain is quite rare.

“The majority of [spinal surgeries] are to relieve compression of the nerve or to add to the stability of the spine.”

The Alexandra Hospital specialists “have expertise in a lot of minimally invasive surgical procedures, [such as] endoscopic surgical procedures, and in open spinal surgical procedures” for a range of conditions such as sciatica or stabilisation surgery.

The Alexandra Hospital is a national centre of excellence for endoscopic surgery, Dr Saxena adds, and there are very few centres in the country that offer this kind of surgery for sciatica. 

The outlook for back pain is usually good, with most cases being resolved in a couple of weeks. In fact, some studies estimate that in 90% of back pain cases, the patients stop seeing their consultant within three months.

However, it is also common for the pain to come back. A bit over 70% of people who have had back pain will experience it again within a year.

It is less likely that these recurrences are as severe as the first episode of pain, and most people do not need to see their healthcare provider for these.

Chronic and acute lower back pain

Back pain usually goes away in a few days or weeks, sometimes on its own, even without treatment. However, in some cases, the pain becomes chronic.

Doctors classify back pain into three main categories:

• Acute back pain, or short-term pain that lasts for a few days or up to 6 weeks
• Subacute back pain, when it lasts between 6 weeks and 3 months
• Chronic back pain, which is pain that continues for 3 months or more, even after treatment.

About 20% of people with acute back pain go on to develop chronic back pain.

The Alexandra Hospital offers fixed price packages which comprise of an initial consultation, treatment, and aftercare.

We also offer flexible payment options, should you pay for the treatment yourself.

If you have private health insurance, you can also use it to pay for care at The Alexandra Hospital.