Lower Back Pain Guide

Lower back pain affects roughly one in three UK adults at any given time. It is the single leading cause of disability worldwide, according to the Global Burden of Disease study. The good news: the vast majority of cases are "non-specific," meaning there's no serious structural damage. Most episodes settle within weeks with the right approach.

The challenge is knowing when back pain is routine and when it signals something that needs investigation. Understanding the difference saves unnecessary worry and, in rare cases, can prevent permanent harm.

Common causes

Muscle and ligament strain

The most frequent cause. Lifting awkwardly, sudden movements, or prolonged poor posture overloads the muscles and ligaments supporting the lumbar spine. Pain is usually felt across the lower back, may be sharp or a dull ache, and worsens with movement. It typically improves over days to weeks.

Disc problems

Intervertebral discs act as shock absorbers between the vertebrae. A bulging or herniated disc can press on a nerve root, causing sciatica — pain that radiates down the buttock and leg, sometimes with numbness or tingling. Disc bulges are common on MRI scans even in people without symptoms, which is why imaging alone can be misleading.

Degenerative changes

Osteoarthritis of the facet joints and disc degeneration are normal parts of ageing. They show up on X-rays and MRI scans from the age of 30 onwards but correlate poorly with pain. Many people with significant degenerative changes on imaging have no symptoms at all.

Spinal stenosis

Narrowing of the spinal canal, usually from a combination of disc bulging and bony overgrowth, can compress nerves. This tends to cause aching in the legs during walking that eases when sitting or leaning forward. It's more common after age 50.

Treatment and recovery

NICE guidelines are clear: staying active is the single most important thing you can do. Gentle walking, swimming, and stretching are better than bed rest. Paracetamol alone is no longer recommended for back pain; NSAIDs like ibuprofen (with food) are the preferred first-line painkiller for short-term use.

Physiotherapy with a structured exercise programme is the most effective treatment for non-specific back pain. NICE recommends group or individual exercise programmes that include stretching, strengthening, and aerobic fitness.

Manual therapies (spinal manipulation, massage) may provide short-term relief but should be used alongside exercise, not as a standalone treatment. Acupuncture is no longer recommended by NICE for back pain.

For sciatica that persists beyond 6-8 weeks despite conservative management, referral for consideration of epidural steroid injection or surgical assessment may be appropriate.

How we can help

We provide same-day GP assessments for back pain, including a full neurological examination of the lower limbs to check for nerve involvement. If blood tests, imaging, or specialist referral are needed, we can arrange these directly — MRI scans typically within a few days rather than weeks.

For patients who need physiotherapy, we work with trusted musculoskeletal physiotherapists and can refer to orthopaedic or spinal specialists when the clinical picture warrants it.