Most cases of lower back pain are known as ‘non-specific’ because they are not caused by serious damage or disease, but by sprains, muscle strains, minor injuries or a pinched or irritated nerve.

Back pain can also be triggered by everyday activities at home or work, and by poor posture. For example, back pain may be triggered by:

• bending awkwardly,
• lifting, carrying, pushing or pulling incorrectly,
• slouching in chairs,
• standing or bending down for long periods,
• twisting,
• coughing,
• sneezing,
• muscle tension,
• over-stretching,
• driving in hunched positions, or
• driving for long periods without taking a break.

Sometimes, you may wake up with back pain and have no idea what has caused it.

Common causes

Some common causes of back pain include:

• pregnancy,
• gynaecological problems in women, such as pelvic inflammatory disease (PID),
• different types of arthritis, such as osteoarthritis,
• stress-related tension,
• viral infections,
• bone disorders,
• bladder and kidney infections,
• osteoporosis (weak and brittle bones),
• a trip or fall,
• a trauma or injury, such as a fracture,
• lack of exercise,
• obesity, and
• sleep disorders.

Serious back pain

The bulging or rupture of one or more of the intervertebral discs can sometimes cause serious back pain. This results in the inner jelly-like material (nucleus pulposus) pressing on the spinal cord or nerve roots, which run next to the disc. This is commonly known as a ‘slipped disc’, but is more accurately described as a ‘prolapsed’ (bulging) or ‘herniated’ (ruptured) disc.

The pain will usually be in your lower back, but you may also experience pain in you buttocks, thigh, calves, feet and toes, due to irritation of the sciatic nerve, which runs down both legs. Occasionally, the pain is also accompanied by pins and needles, numbness and weakness.

Intervertebral discs tend to dry out and weaken with age, or following an injury. This results in the discs becoming less flexible, which means they do not cushion the vertebrae as well as they did before. This is a common cause of stiffness and pain, particularly in the elderly. It also tends to be worse early in the morning.

Persistent lower back pain can also be caused by a number of rare conditions, such as:

• congenital (inherited) spinal defects,
• bone diseases,
• shingles (an infection that affects the nerves),
• fibromyalgia, or
• cancer that has spread to the spine.

Diagnosing back pain 

Your doctor will be able to diagnose back pain by discussing your symptoms with you and conducting a physical examination.

Usually, there is no need for tests, such as X-rays or scans, when diagnosing back pain. If you have simple back pain, tests are not always helpful because they often do not show anything unusual.

You may be sent for tests if you have had an injury or blow to your back, if your doctor suspects that there may be an underlying cause for your pain, or if the pain has lasted for an unusually long time.

For suspected disc problems, X-rays or a computerised tomography scan (CT scan) may be required. Your doctor may suggest having a magnetic resonance imaging (MRI) scan, that uses a strong magnetic field and radio waves to produce detailed images of the inside of your body, in order to provide more accurate information about the soft tissues in your back.

In some cases, blood tests or a myelogram (a special kind of X-ray using an injected dye) may be needed.

A chiropractor, osteopath or physiotherapist?

 Chiropractic and osteopathy are similar disciplines. Both osteopaths and chiropractors can diagnose by visual inspection and feeling by hand (palpation). 

Chiropractic treatment tends to involve a more ‘direct’ approach, with an emphasis on adjustments of the spinal joints. Chiropractors also rely on X-rays, blood and urine tests and MRI scans for diagnosis. 

The osteopathic approach involves mobilisation (slow, rhythmic stretching), pressure or ‘indirect’ techniques and manipulations on the muscles and joints.

Physiotherapists are trained to diagnose problems in the joints and soft tissues of the body. Physiotherapy for back pain provides a wide range of treatments to relieve pain, promote relaxation and restore movement. They include manipulation, mobilisation and massage. Exercise may also be used to increase general fitness or to strengthen muscles that support the spine.

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