Lower Back Pain: Causes, Treatment and When to See a Doctor

How common is lower back pain?

Very. Lower back pain is the leading cause of disability worldwide, and most adults will have at least one episode in their lifetime. It affects people of every age, from teenagers to older adults, and is one of the most common reasons Australians see a GP.

Because it’s so common, it helps to know that in most cases it isn’t a sign of serious damage, even when it hurts a lot.

What causes lower back pain?

In around nine out of ten people, doctors can’t point to one structure that’s causing the pain. This is called non-specific low back pain. It’s real pain, but it comes from a mix of things: muscles, joints, discs and ligaments, along with how sensitive the nervous system is at the time.

A smaller group of people have pain with a more specific cause:

• Sciatica (nerve root pain). Pain that travels down the leg, often past the knee, sometimes with pins and needles or numbness. See our sciatica guide.
• Inflammatory back pain. Pain and stiffness that are worse in the morning, ease with movement and often start before the age of 45.
• Serious causes. Fractures, infection, cancer and compression of the nerves at the base of the spine (cauda equina syndrome) are rare, but they need to be picked up quickly.

Things that make back pain more likely or slower to settle include heavy physical work, long periods of sitting, poor sleep, stress, low mood, smoking and carrying extra weight. Worry that the pain means damage can also keep it going.

Do I need an X-ray or MRI?

Usually not. Australian and international guidelines advise against routine imaging for back pain when there are no warning signs. Scans often show changes such as disc bulges and wear that are just as common in people without pain, and finding them rarely changes treatment. It can also make people more worried and less active.

A scan makes sense when your GP suspects a serious cause, or when you have nerve symptoms that aren’t improving and a procedure is being considered.

What helps lower back pain?

For most people, the best approach is a combination of reassurance, staying active and a gradual return to normal life.

• Keep moving. Bed rest slows recovery. Keep doing as much of your usual activity as you can, even if you need to do it more slowly.
• Heat. A heat pack can ease pain in the first few weeks.
• Exercise. For back pain that has lasted more than a few weeks, exercise is one of the best-supported treatments. The type matters less than doing something you can keep up. See exercises for lower back pain.
• Physiotherapy. A physio can guide exercise and help with confidence in moving again.
• Psychological approaches. For pain that’s lasting, programmes that combine movement with help for stress, worry and coping, such as cognitive functional therapy, have good evidence.
• Medicines. These play a smaller role than many people expect. Some common ones give little benefit for back pain and some carry real risks, which is why guidelines put non-drug treatments first. Talk to your GP or pharmacist before starting or combining anything.

How long does lower back pain last?

Most new episodes improve a lot within the first six weeks. Some people have pain that lingers for longer, and back pain often comes back. If your pain has lasted more than three months, it’s considered chronic, and a broader plan usually helps more than waiting for it to pass. See chronic back pain.

When should I see a doctor?

See a GP if your pain:

• is severe, or isn’t improving after two to four weeks
• travels down your leg below the knee, or comes with pins and needles or numbness
• is affecting your sleep, work or mood
• keeps coming back

Get urgent help (call 000 or go to an emergency department) if you have numbness around your groin or buttocks, new trouble controlling your bladder or bowel, or weakness in your legs that’s getting worse. Back pain with a fever, after a significant fall or accident, or with a history of cancer also needs prompt assessment. Our guide to back pain red flags explains why.

What happens at a GP consult for back pain?

Your GP will ask how the pain started, where it is, what changes it, and about warning signs. They’ll ask about work, sleep, mood and what you’ve tried. Much of this can be done by telehealth, including watching how you move on video. If you need a hands-on examination or a scan, your GP will arrange it.

Together you’ll agree a plan, which may include activity advice, a physiotherapy referral, help with sleep and stress, and treatment where appropriate.

References

1. Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356-2367.
2. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736-747.
3. Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368-2383.
4. Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530.
5. Hayden JA, Ellis J, Ogilvie R, et al. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;9(9):CD009790.
6. Kent P, Haines T, O'Sullivan P, et al. Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial. Lancet. 2023;401(10391):1866-1877.
7. Australian Commission on Safety and Quality in Health Care. Low Back Pain Clinical Care Standard.
8. healthdirect. Back pain.