Lower back pain affects 80% of adults at some point in their lives and is the leading global cause of disability. The vast majority — over 90% — is non-specific: no identifiable structural cause on imaging, driven instead by muscle tension, postural loading, inactivity and psychological factors. Most episodes resolve within 6–12 weeks without specific treatment.
When you can treat at home
For most acute back pain without red flags (see below), active management at home is recommended and effective. The evidence strongly favours continued movement over bed rest — being immobile for more than 2–3 days prolongs recovery. The goal is to maintain normal activity as much as possible while managing symptoms.
- Continue normal daily activities, modified to reduce pain where necessary
- Apply heat (a warm pack or bath) — reduces muscle spasm and improves blood flow
- Take over-the-counter analgesics — paracetamol and NSAIDs (ibuprofen) are first-line; always follow dosing instructions
- Avoid prolonged bed rest — it weakens supporting muscles and delays recovery
- Gentle movement — walking and light stretching are more effective than rest in RCT evidence
Red flags that require urgent assessment
These symptoms alongside back pain should prompt same-day or emergency evaluation. They suggest serious underlying causes including cauda equina syndrome, infection, fracture or malignancy.
- Bladder or bowel dysfunction — especially new inability to urinate or loss of bowel control
- Saddle anaesthesia — numbness in the inner thighs, groin and buttocks
- Progressive neurological deficit — worsening leg weakness or loss of sensation
- Fever with back pain — suggests spinal infection or discitis
- Unrelenting night pain, or pain that is not positional
- Unexplained weight loss
- History of cancer, osteoporosis, or prolonged corticosteroid use
- New back pain following significant trauma (fall from height, road accident)
- Age under 20 or over 55 with first episode of severe back pain
When to see a GP without urgency
See your GP within 1–2 weeks if: pain persists beyond 6 weeks without improvement; pain radiates below the knee and is accompanied by pins and needles or weakness (suggesting nerve root involvement or sciatica); pain significantly impairs work or daily function; or you are not improving on self-management.
What investigations are (and aren't) useful
Imaging — X-rays and MRI — is not routinely recommended for non-specific back pain within the first 6 weeks. Most structural findings on MRI (disc bulges, degenerative change) are present in people without pain and are poor predictors of clinical outcome. Ordering imaging too early often finds incidental findings that lead to unnecessary procedures.
MRI is appropriate when red flags are present, when symptoms persist beyond 6–12 weeks without improvement despite treatment, or when surgery or injection therapy is being considered.
"Most back pain resolves without imaging, without injections and without surgery. The evidence says: keep moving, manage pain, and be patient."
Sara Nassereddin, Health Technology Writer, Looms