Lower back pain: what to do and when to worry

In short

• Back pain affects about 8 in 10 people at some point, and most episodes improve on their own, though it may take a while.
• About 90 percent of cases are non-specific: no single disease or structural cause can be identified.
• Stay as active as you can. Staying in bed more than a day or two can make it worse.
• Most people do not need an X-ray or an MRI.
• A short list of red flags, including numbness around the genitals or trouble controlling your bladder or bowels, needs urgent care.

What is usually going on

The WHO estimates that low back pain affected 619 million people in 2020, making it the leading cause of disability worldwide. Acute back pain starts suddenly and usually lasts a few days to a few weeks. Pain lasting more than three months is called chronic.

When no specific disease can be identified, the term is non-specific low back pain. Risk factors include low physical activity, smoking, obesity and high physical stress at work. NIAMS also lists weak core muscles, weight gain, chronic poor sleep, depression or anxiety, age over 45 and family history.

Less often, the cause is a herniated disc, sciatica or spinal stenosis. Rarely, it is a broken bone, an infection or cancer, and sometimes pain is referred from another organ such as the kidney.

What it feels like

• A dull, constant ache or a sudden, sharp pain.
• Pain that worsens with lifting, bending, sitting or standing, and that may come and go.
• Morning stiffness that eases with activity.
• Pain that spreads to the buttocks, hip or leg.
• Numbness or weakness in the legs or feet, which needs a clinician's attention.

What to do in the first days

1. Keep moving.Stay active and keep up daily activities as far as the pain allows. Limit painful movements and return gradually. Avoid bed rest, since more than 1 or 2 days in bed can make it worse.
2. Choose a pain reliever carefully.Over-the-counter pain relievers can help you move. The NHS notes that anti-inflammatory painkillers are not suitable for everyone and that paracetamol alone is not recommended for back pain, so ask your pharmacist or clinician what suits you.
3. Use heat or cold.A heat pack relaxes muscles and a cold pack can ease some pain. Wrap either in a towel instead of putting it on bare skin.
4. Sleep smart.Lie on your side with a pillow between your knees, or on your back with a pillow under your knees.
5. Go back to normal.Most people feel relief within 6 weeks, according to NIAMS, and a gradual return to normal activity is part of the treatment.

Exercise and everyday habits

• Back exercises and stretches, plus walking, swimming, yoga or pilates, are suggested by the NHS.
• Add strengthening work once the worst pain settles. Check with your clinician before starting new exercises.
• Change position and move around often if you sit for long periods.
• On long drives, use back support and stop to walk.
• Carry smaller loads and make extra trips. Lift using your legs and abdominal muscles.
• Keep a healthy weight, get good sleep and stop smoking, all of which the WHO links with fewer recurrences.
• Wear low-heel, comfortable shoes, and warm up before exercise. Tai chi and yoga can build strength and balance.
• Eat a diet with enough calcium and vitamin D for your bones.

Progress is best judged by what you can do, such as how far you can walk, how long you can sit and how easily you can bend, and not only by the pain number on a given day.

When to see a doctor, and red flags

See a primary care provider if the pain does not improve after a few weeks, or if it is severe, follows a fall or injury, or comes with numbness or tingling. MedlinePlus advises calling if pain is severe or has not improved after three days.

Be seen soon for unexplained weight loss, fever or feeling hot, cold and shivery, pain that is worse at night or does not ease with rest, pain between the shoulder blades, or a lump or change in the shape of your back.

Call 911 or go to the emergency department for pain, tingling, weakness or numbness in both legs, loss of feeling around the genitals or anus, a change in bladder or bowel control, chest pain, or back pain after a serious accident. Do not drive yourself.

How a clinician finds the cause

A clinician starts with your medical history and a physical exam that may check posture, reflexes, muscle strength and sensation. Most people do not need imaging. When it is used, X-rays show bones and MRI shows soft tissues such as discs, ligaments and nerve roots.

CT scans, nerve tests, bone scans and blood tests can also help when a specific cause is suspected. The WHO recommends a thorough physical and psychosocial assessment when back pain starts.

Treatment options in general terms

• Over-the-counter pain relievers and anti-inflammatories, and for some chronic pain muscle relaxants, as a clinician advises. The WHO says painkillers should not be the first-line treatment.
• Physical therapy, group exercise and manual therapy.
• Cognitive behavioral therapy (CBT) and other support to cope with pain.
• Spinal manipulation or acupuncture may help some people.
• Injections for nerve-related pain.
• Surgery is considered for conditions such as a slipped disc when other treatments have not helped.

Questions and answers

Sources

1. NHS — Back pain
2. MedlinePlus — Back Pain
3. NIAMS — Back Pain
4. NIAMS — Back Pain: Diagnosis, Treatment, and Steps to Take
5. WHO — Low back pain fact sheet

Sources checked on 29 October 2026.