Back pain

Also called Lower back pain, Sciatica

The single biggest cause of disability worldwide. Almost never dangerous, and rest is the wrong instinct.

What it is

Back pain is the leading cause of years lived with disability globally. Around 8 in 10 people in the UK have it at some point.

The most useful thing to know is that in the overwhelming majority of cases nothing is structurally wrong that a scan would usefully find. MRI scans of people with no pain at all routinely show disc bulges and degeneration, so finding them in somebody with pain proves nothing and frightens them badly.

The old advice, rest and avoid movement, has been reversed. Staying active and returning to normal activity as soon as possible produces better outcomes than resting.

Sciatica is nerve pain running down the leg from a compressed nerve root. Most cases settle within weeks without surgery.

Signs you might notice

Pain in the lower back, sometimes with muscle spasm, worse with certain movements.

Sciatica: pain, numbness or weakness travelling below the knee, often with pins and needles.

Improvement over days to weeks in most cases.

The red flags that change everything: numbness in the saddle area, loss of bladder or bowel control, or new weakness in both legs. That is cauda equina syndrome and it is a surgical emergency, measured in hours.

Also concerning: pain with fever, unexplained weight loss, a history of cancer, or pain after significant trauma.

How it can affect day-to-day life

Fear is the strongest predictor of chronic back pain, more than any finding on a scan. People who believe their back is damaged and fragile move less, become deconditioned, and hurt more.

Language matters clinically here. Being told you have the spine of an eighty-year-old, or crumbling discs, causes lasting harm.

Work absence compounds it. The longer somebody is off, the less likely they are to return, so modified duties early beat waiting for full recovery.

Supporting someone well

Keep moving. Walk, stay at work with modifications if possible, and return to normal activity gradually rather than waiting to be pain-free.

Do not rest in bed. It makes recovery slower.

Use heat, gentle exercise and simple pain relief for the first few weeks.

Do not ask for a scan in the absence of red flags. It rarely changes treatment and frequently makes things worse.

Learn the cauda equina red flags and act on them immediately. This is the one thing in this entry that is an emergency.

For persistent pain, ask for physiotherapy or a group exercise programme, and read chronic pain.

Where to get help

A GP or physiotherapist; many areas allow self-referral to physiotherapy.

Go to A and E immediately for saddle numbness, bladder or bowel changes, or new weakness in both legs.

The Chartered Society of Physiotherapy and Arthritis UK both have good self-management material.