Knowledge Centre
Providing rapid medical guidance and expert health insights for informational purposes. Our guides come from a Harley Street clinic, but they do not replace a professional consultation.
Lower back pain: causes, when to worry and treatment
Written by Mr Stephen Lingam · Reviewed by Dr Mohammad Bakhtiar (GMC 4694470) on 25/09/2026
Key takeaways
- Most lower back pain is "non-specific": no serious damage is found, and most episodes settle within weeks.
- Staying active speeds recovery; bed rest slows it.
- Disc bulges and wear show up on scans in plenty of people with no pain, which is why NICE advises against routine imaging.
- A private GP appointment at 117a Harley Street is £150, with a neurological check of your legs and an MRI within a few days if one is needed.
You bent down to pick something up and felt your lower back seize. Or the ache has crept in over weeks of long days at a desk, and now it's there every morning.
The reassuring answer is that most lower back pain is non-specific, meaning there's no serious structural damage behind it, and most episodes settle within weeks with the right approach. It's also extremely common: the Global Burden of Disease study estimated that 619 million people worldwide had low back pain in 2020, making it the leading cause of disability.
If you'd like it examined, a private GP appointment at our Harley Street clinic is £150. It includes a full neurological examination of your legs, and if a scan is needed, an MRI can usually be arranged within a few days rather than weeks.
What causes lower back pain?
Most back pain comes from the muscles, ligaments, discs and small joints of the lower spine. The way it behaves usually points to the cause.
Common causes of lower back pain
| Cause | How it tends to feel | Useful clue |
|---|---|---|
| Muscle and ligament strain | Sharp pain or a dull ache across the lower back, worse with movement | Follows lifting awkwardly, a sudden movement or long spells in one posture; improves over days to weeks |
| Disc problems and sciatica | Pain that shoots down the buttock and leg, sometimes with numbness or tingling | A bulging or herniated disc pressing on a nerve root |
| Degenerative changes | Stiffness and aching that come and go | Facet joint arthritis and disc wear are a normal part of ageing and show on scans from around 30, often without pain |
| Spinal stenosis | Aching or heaviness in the legs when walking that eases when you sit or lean forward | Narrowing of the spinal canal; more common after 50 |
The one thing worth remembering: scans can mislead. Disc bulges and degenerative changes appear on MRI in many people who have no pain at all, so a scan only helps when the examination points to a specific problem.
Why does my lower back hurt on one side?
Pain on just the left or right side is usually muscular, from a strain on that side or a disc pressing on one nerve root. It can also come from outside the spine.
Pain in your side or back with a high temperature, shivering and pain when you pee can mean a kidney infection, which needs antibiotics the same day. Severe pain that comes in waves and spreads towards the groin can be a kidney stone.
Sciatica: pain that travels down the leg
Sciatica happens when the sciatic nerve is irritated, most often by a disc. It causes pain, numbness or tingling that runs from the buttock down the back of the leg, sometimes into the foot, and the leg pain is often worse than the back pain.
The NHS says sciatica usually gets better in 4 to 6 weeks, though it can last longer. If it persists beyond 6 to 8 weeks despite exercise and painkillers, an MRI becomes useful, and referral may be appropriate to consider an epidural steroid injection or a surgical opinion.
When should I worry about back pain?
Book a GP if your pain isn't improving after a few weeks, stops you doing everyday things, or is severe and getting worse. Pain that runs down your leg, or numbness and tingling, is also worth having examined.
A few symptoms need help straight away, because they can mean pressure on the nerves at the base of the spine (cauda equina syndrome) or on the spinal cord:
- numbness around your genitals, buttocks or inner thighs
- loss of bladder or bowel control, or difficulty peeing
- weakness in one or both legs
- back pain after a significant fall or accident
- unexplained weight loss alongside persistent back pain
If you have any of these, go to A&E or call 999.
Which treatments help lower back pain?
NICE is clear that staying active is the single most important thing you can do. Gentle walking, swimming and stretching beat bed rest, which weakens the muscles that support your spine.
For pain relief, NICE no longer recommends paracetamol on its own for back pain. Anti-inflammatory painkillers such as ibuprofen, taken with food, are the preferred first choice for short-term use.
A structured exercise programme, in a group or one to one, is the most effective treatment for non-specific back pain. It should include stretching, strengthening and aerobic fitness. Manual therapies such as spinal manipulation or massage may give short-term relief when used alongside exercise. NICE no longer recommends acupuncture for back pain.
Around 90% of acute episodes improve significantly within 6 to 8 weeks. About 40% of people have another episode within a year, which is why keeping up the exercises after the pain settles pays off.
What happens at a GP appointment
A private GP appointment at 117a Harley Street costs £150, and same-day appointments are often available. Your GP takes a history, examines your back and carries out a neurological examination of your legs to check for nerve involvement.
If you need blood tests or imaging, the GP arranges them directly, with an MRI usually within a few days. If physiotherapy or a specialist opinion would help, your GP can write a referral letter to a physiotherapist, an orthopaedic surgeon or a spinal specialist.
Not sure whether you need to be seen? Our guide on when to see a private GP covers the common situations.
Sources
- Low back pain is the single leading cause of disability globally. Most episodes are non-specific, meaning no serious underlying pathology is identified. Imaging is not routinely recommended for non-specific low back pain. — NICE Guideline NG59 — Low back pain and sciatica in over 16s: assessment and management[Link]
- Exercise therapy, including biomechanical, aerobic, and mind-body approaches, is recommended as a first-line treatment. There is strong evidence that staying active produces better outcomes than bed rest. — NICE Guideline NG59 — Low back pain and sciatica in over 16s[Link]
- Red flags for low back pain include cauda equina symptoms (bilateral leg weakness, saddle anaesthesia, bladder dysfunction), unexplained weight loss, history of cancer, and thoracic pain in younger patients. — NHS — Back pain overview[Link]
- In 2020, low back pain affected 619 million people globally and remained the leading cause of disability; cases are projected to reach 843 million by 2050. — GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020. Lancet Rheumatology 2023;5(6):e316-e329[Link]
- Sciatica usually gets better in 4 to 6 weeks, but it can last longer. — NHS: Sciatica[Link]
Mr Stephen Lingam
Managing Director
Executive leadership
Frequently asked questions
When should I worry about lower back pain?
Most lower back pain improves within 4 to 6 weeks. Get help the same day if you develop numbness around your genitals or buttocks, difficulty peeing or loss of bladder or bowel control, leg weakness that affects walking, or pain after significant trauma, because these can signal cauda equina syndrome, which needs urgent investigation.
Do I need an MRI for my back pain?
Usually not. NICE advises against routine imaging for non-specific back pain because disc bulges and degenerative changes are common on scans even in people without pain. An MRI helps when a specific cause is suspected, such as sciatica that isn't improving after 6 to 8 weeks, or when red flag symptoms are present; at our clinic it can usually be arranged within a few days.
Is bed rest good for lower back pain?
No, and it's one of the most persistent myths in back care. Staying active, even when it's uncomfortable, leads to faster recovery, while long rest weakens the muscles that support your spine. Gentle walking, swimming or stretching are better than lying still.
How long does a typical episode of back pain last?
Around 90% of acute low back pain episodes improve significantly within 6 to 8 weeks, whatever the treatment. About 40% of people have a recurrence within a year, and building core strength, keeping a healthy weight and moving regularly all reduce the chance of it coming back.
Why does my lower back hurt on one side?
One-sided lower back pain is usually muscular or comes from a disc pressing on one nerve root. Pain in your side with a fever and pain when peeing can be a kidney infection, which should be seen the same day.
Should I see a physiotherapist or a GP first?
If your pain is straightforward, with no leg symptoms, no red flags and no history of cancer, a physiotherapist can assess and treat you directly. If you have shooting leg pain, numbness, weakness or other worrying features, see a GP first so they can examine you, request any tests and refer you appropriately.
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