Mechanical low back pain

Back pain is very common and most is not due to serious illness. Aches and pains can last for quite a long time, but acute pain usually improves within a few days or weeks.

Very few back problems ever need surgery or injections. MRI is not usually required and is usually misleading in simple mechanical back pain. Back pain usually gets better on its own with time and self-management.

A proportion of people who get backache will get it again within a couple of years but most people return to normal activity between episodes.

X-rays are rarely useful in diagnosing neck pain and don’t help to guide treatment, either from your GP or physiotherapist. Most x-rays will show normal, age related changes, which are not a cause for pain.

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Causes and symptoms

Causes of mechanical low back pain

Your spine is strong. It is made up of a series of solid bony blocks joined by discs and held together by strong ligaments and muscles.
Most simple back sprains do not cause lasting damage. The problem is usually that the working parts of your back (muscles, ligaments and small joints) are not working well and moving properly.
Doctors and therapists sometimes mention degeneration; this is not damage but the normal age-related changes.

Diagnosis of mechanical low back pain

X-rays are rarely useful in diagnosing back pain and don’t help to guide treatment, either from your GP or physiotherapist. Most x-rays will show normal, age related changes, which are not a cause for pain.

When to seek urgent help

These symptoms are very rare but if you do have back pain and develop any of these you should see your doctor straight away.

Difficulty passing or controlling urine.
Numbness around your back passage or genitals.
Numbness, pins and needles or weakness in both legs.
Unsteady on your feet.
Severe pain which is getting worse over several weeks instead of better or if you are unwell with back pain.
Recent unexplained weight loss.

Self management of mechanical low back pain

Keep moving

Your back is designed for movement; the sooner you get moving and back to ordinary activities, the sooner you will feel better. Those people who cope best with back pain are those who stay active and get on with life despite the pain.

If you have to rest, find a position of comfort. Lie on your back with a pillow behind your knees or on your side with a pillow between your knees.

Pace yourself – limit or modify your activity for a time if needed. Anything that causes a lot of pain should be avoided but some discomfort may have to be accepted when trying to do normal activities.

Try not to sit for more than 20–30 minutes without getting up and moving around.

Avoid slouching (try some support in your lower back).

Weight loss

If you are overweight you should try and lose weight to reduce stress on your back and help prevent recurrence.

The NHS website has some useful resources:

BMI calculator Weight loss plan Exercise advice

Painkillers

Use painkillers if you need them. Over the counter painkillers are often effective and should be taken regularly at the recommended dose. If in doubt talk to your pharmacist or GP.

Heat and cold

Heat and cold can be used for short term pain relief and to relax muscle spasm e.g., a bag of frozen peas wrapped in a damp towel, a hot water bottle applied for 20 minutes or bath or shower.

Professional treatments

Treatments from a qualified professional (physiotherapist, osteopath) may help. However, you shouldn’t need treatment for months on end and you should be given advice on self-management and shown ways to keep your joints moving and muscles strong.

Keep working

Stay at work if you can. Temporary modification of your job or work hours may help.

Exercises for mechanical low back pain

Exercise 1: pelvic tilts

Lie on your back with your knees bent and your feet flat on the floor.
Put your hands on your hips. Slowly roll your pelvis – tilt your tailbone – upward and close the space between your low back and the floor.
You’ll feel a gentle stretch of your low back.
Return to the original position.

Exercise 2: knee rolls

Lie on your back. Keep your knees bent and together.
Keep your upper body relaxed. Roll your knees to one side, keeping both shoulders on the floor.
Hold the stretch in your back/hip and return to the starting position.

Exercise 3: hip flexion

Stand sideways
Make sure you are supported
Keep your knee straight
Take your leg forwards and back. Repeat

Exercise 4: standing side bend stretch

Start in a standing position.
Next, bend your trunk to the side as you slide your hand down the side of your legs.
Do not bend forward or back.
Repeat to the other side.
Keep your muscles relaxed during the movement.

Exercise 5: four point kneeling forwards weight transference

In four point kneeling.
Move your body forwards and backwards over your hands.
You should try to increase the weight through your arms.

What next?

If you are still experiencing symptoms despite following the above advice, it is important you seek advice from your GP. Your GP may decide to refer you to the musculoskeletal clinic or to a physiotherapist.

Page updated 01/12/2020. Review date 01/01/2024

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