Back pain is common, and most people will experience an episode at some point in their life. Although pain can be a very distressing symptom, for most people, pain does not represent a serious medical condition. Understanding back pain, and the best way of responding, may take away some of the concerns you have when experiencing it.
What causes back pain?
There can be many different causes for back pain and for some, there may be no apparent reason. For most people there is no serious cause and most likely to be a minor strain or sprain.
Very occasionally, back pain is caused by an underlying condition that may need further medical attention. Your doctor or physiotherapist will screen you for these when they assess you. If they find any cause for concern, they will arrange for further investigations. Otherwise, they may just offer you advice on management strategies.
Potential causes:
- Accident, slip, trip, fall or injury
- Sudden increases in activity you are not used to
- Not being active enough and being overweight
- Pregnancy
- Persistent poor sleep
- Depression, low mood or anxiety
- Other medical conditions
Experiencing back pain
The spinal column and its surrounding connective tissue is one of the strongest and robust structures in the body. It is designed for and needs movement to stay healthy. When something temporarily goes wrong, we can experience pain, decreased function, and other symptoms.
Back pain varies from person to person. For some it will be a mild ache, for others it will be moderate but familiar, and some individuals will have severe and frightening symptoms. Likewise, some pain will be short lived and sometimes it will persist. Sometimes the level of symptoms can be disproportionate to the level of the tissue injury. It can also affect various aspects of life and your mental wellbeing, impacting on work, hobbies, and family life differently for each person.
These differences mean that for many, the overall picture may look different and there may be some very specific factors that need to be looked at. How you experience pain will depend on what’s going on in your life and how you are feeling generally. However, on the most part, the body (including your back) can recover and repair itself if you give it the right environment. The same strategies are often advised in most situations.
Identifying your factors
The list of factors that may contribute to back pain is long and not all of these are physical factors – we now know that psychological factors also play an important role. They may not necessarily have been the cause, but they can make your pain feel worse. Becoming more aware of your influential factors can help you to manage your symptoms better.
Some of the factors that can influence pain and other symptoms are:
- Activity levels – too much, too little, or significantly changing levels
- Work and environmental factors
- Mood
- Emotions
- Thoughts
- Reactions to pain (behaviours)
- Poor sleep
- Nutrition and diet
- Smoking and alcohol consumption
- Excessive caffeine consumption
- Other illnesses and medications
Recovery from pain and reduced function
Stay active – The sooner you restart normal activities, the sooner you will feel better. Utilise a gradual and steady increase in activity. Find exercise and activities that suit you, there is no one best exercise when it comes to back pain, and taking part in activity and exercise you enjoy is often best. Our overall fitness is important, and general exercise and movement helps. It may also be possible to continue exercising the non-affected parts of your body.
Avoid bedrest but get good quality sleep – Complete rest in the early stages may help, but continual complete rest does not usually help and may prolong the symptoms. Inactivity can cause stiffness and further discomfort. Avoiding aggravating activities for 48-72 hours may be helpful while remaining as active as possible. Allow time to relax and strive to maintain regular sleep routines if possible. There is no one position or best way to fall sleep, and you will move multiple times throughout the night. Finding a comfy position to fall asleep in that works for you is the best approach.
Pain relief – Pain relief medication is not a cure for back pain. Likewise, ‘soldiering on’ and avoiding medication may also prolong your recovery. Talk to your healthcare professional about what pain relief may help in the short term to help you get moving. Movement and exercise can also be pain relief, and opens up our ‘internal medicine cabinet’. Heat, cold and relaxation techniques can all be utilised for pain relief too.
Stay positive – As our mood, emotions, thoughts, or reactions affect pain, it’s important to try to reduce stress, develop a positive mindset, and maintain enjoyable activities. Any activity that reduces stress is therefore good for our backs. Examples might be yoga, meditation, deep breathing, or tai chi.
Getting back to work and staying in work helps with recovery – Getting back to work is important in the recovery process for back pain. It is not necessary to stay off work until the pain has completely gone. A graded return to work, with amended duties and postural breaks may be implemented to help you build your endurance and fitness to work.
Think Posture – There is no such thing as the ideal posture, movement is key, as the saying “your best posture is the next posture” highlights. Standing, sitting, or maintaining one posture for unusually long periods without movement can irritate symptoms, even when in a supposedly ‘good’ posture. Position changes, even if only for short periods of time, can help reduce stiffness, increase blood flow, reduce postural fatigue and pain.
Flare ups
Flare ups can be common, especially with an increased amount of activity, however they are often not dangerous and are no cause for panic. Remember that the most important steps in managing your back pain are the things you can do to help yourself. You may need to reduce or modify activities and pace yourself back up to your previous levels of being symptom-free again.
If symptoms do not settle within two weeks of a flare up, seek medical advice from a healthcare professional.
Further support
NHS – General advice about back pain, including causes and treatments.
NHS – Strength and flexibility exercises.
Health and Safety Executive – Working safely with DSE equipment.
Sources:
www.backcare.org.uk
www.nhs.uk
www.spine-health.com/blog/best-sleeping-position-your-back-pain
Ref: WPW0246 this information was reviewed April 2025.
