Most low back pain is caused by a simple strain of the muscles in the back, usually at a time when we are more vulnerable (ie, run down, tired, stressed, tense, sad, inactive or overactive).

While this kind of back pain can be distressing and have a negative impact on our lives for a time, most people who experience low back pain recover within a few weeks.

‘Non-specific pain’

Most people with low back pain have ‘non-specific pain’ – that is, no clear cause can be found, although the pain is NOT caused by a serious condition.

Remember that ‘non-specific’ doesn’t mean the pain you are experiencing is ‘non-important’. Everyone’s experience of pain is different, and your experience is just as important as the next person’s.

Most cases of low back pain resolve within 4–6 weeks.

A scan (an X-ray, CT or CAT scan, or MRI) is unlikely to find the reason for your pain or change how it is treated.

Almost all types of low back pain are treated the same way to begin with. So even if a scan could show the cause of your pain, it’s unlikely to change how you manage it. 

Most cases of acute low back pain are treated the same way whether the cause shows up on a scan or not.  

Scans are not recommended for people with acute low back pain unless a specific cause is suspected. 

Download our fact sheet to find out more. 

Most people with low back pain feel better after a month – and often sooner – whether they have scans done or not.

Unnecessary tests can be costly, and X-rays and CT scans involve exposure to radiation that is best avoided, especially if the results are unlikely to help with your treatment.

Other reasons not to have a scan for low back pain

There are some rare instances where imaging may be needed. You may need a scan if you have low back pain as well as any of the following issues.

• You are older than 65 and have:
  -  used corticosteroid medicines (like prednisone or prednisolone)
  -  experienced recent trauma to your back.

• Weight loss.
  
• Fever over 38 °C.
  
• Loss of control of your bowel or bladder – you need to see your doctor urgently for this.
  
• Loss of feeling in your legs – you need to see your doctor urgently for this.
  
• A history of cancer.
  

If you are worried about your low back pain, arrange an appointment with your doctor.

You can use the Healthdirect question builder to prepare for an appointment with your doctor or specialist.

The best advice for anyone experiencing a new episode of non-specific low back pain is to adopt an active approach to your pain. This means actively managing your own pain with simple strategies. These may include:

• learning about the nature of low back pain
  
• being reassured that many people recover rapidly and most recover within 4–6 weeks
  
• self-managing your symptoms, such as putting a heat pack on your back
  
• staying active, which means avoiding bed rest, and continuing to do your normal daily physical activities as much as possible, including going to work.
  

So, what about treatments provided by a therapist, such as massage, or mobilisation and manipulation of the spine, where you passively receive the treatments? Will these treatments help, in addition to the active self-management techniques described above?

For most people these additional treatments are unnecessary because all you usually need to get better are simple pain management strategies.

Massage, mobilisation and manipulation are only recommended if it’s likely that you will take a longer time than usual to get better. Your GP can assess how likely this is and discuss what treatments you may need in addition to your own simple, active self-management.

Motion is lotion for non-specific low back pain.

In fact, staying active by doing your normal daily activities as much as possible is the most important part of the simple management strategies recommended for everyone with a new episode of non-specific low back pain.

If you’re worried about being active, be reassured that it’s safe. While you might feel some pain during activity, this doesn’t indicate you’re damaging your back – in other words, ‘hurt does not mean harm’.

Relaxed movement will not only help your back pain settle down. Your back gets stronger with movement. And in the end, staying active reduces your pain and time off work, and speeds up your recovery.

Before you start, it’s recommended that you set yourself some activity goals. An activity goal can be anything that makes you feel motivated and that you’re comfortable with. Examples include walking and gardening. Once you have set a goal, make a plan to pace yourself – so you don’t overdo it.

Pacing is the middle path between overdoing and underdoing activity. It involves gradually resuming or increasing your activity, following these steps.

1. Find your daily activity baseline. This is what you can do without significantly increasing your pain. It could be, for example, a distance you can walk. Now reduce that amount by a bit.
   
2. Increase your daily activity baseline, by increasing the distance, speed or number of times you do the activity every day by a small amount.
   

It’s natural to expect that medicines can provide effective relief for non-specific low back pain.

However research studies in recent years show that non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol have limited or no effect. As a result, they aren’t ‘pain killers’, they’re only ‘pain-decrease-a-bit-ers’.

Despite this, medicines can still play a supporting role.

Firstly, this involves ensuring that simple, active management strategies have been put in practice before considering medicines.

Secondly, if you do require medicines, be clear that the aim of taking them is to reduce pain – rather than stop it – so that you can stay active.

There are also potential harms from taking medicines. For example, NSAIDs can cause gastrointestinal, heart and kidney side effects in some people. Although paracetamol is generally considered safer than NSAIDs, there is still a risk of harm, particularly in frail, older people, people who are fasting or have low body weight, or people with liver disease.

Your healthcare professional can discuss which medicines are best for you, taking into account potential benefits and harms. 

While most people with non-specific low back pain will get better within 4–6 weeks, a small number do have a slower-than-usual recovery.

You might think this happens because of damage to the back, but research shows that the connection between your mind and body is more important.

This connection doesn’t mean that your pain is all in your mind. It does mean that your thoughts and feelings can have an impact on whether or not you’ll experience a slower-than-usual recovery.

Because the brain acts as an amplifier, the more you worry and think about your pain, the worse it gets. Low mood can make you feel hopeless about your recovery. You might fear being active because you think it will damage your back, which can lead to further weakness, pain and avoiding activity, in a vicious cycle.

It’s recommended not to wait until your recovery is already slower than usual. Your doctor can assess and discuss your thoughts and feelings about low back pain very soon after your pain has started.

Your doctor may then recommend informal or formal psychologically based treatments, in addition to simple, active self-management. Combined, these treatment and management strategies can help prevent you experiencing a slower-than-usual recovery. 

About a third of people who have recovered from an acute episode of non-specific lower back pain will go on to experience a further episode. However, you can help prevent further episodes of lower back pain with exercise programs that are structured and regular.

Different types of exercise might help. No one type of exercise has been found to be better than another in research studies. So, you can choose whichever one suits you. The key is to stay active and exercise regularly. 

Types of exercise include:

• stretching of joints and muscles
  
• strengthening of muscles
  
• aerobic fitness (walking, swimming, cycling, anything that safely increases your breathing rate).
  

Before you start any type of exercise, speak to your healthcare professional. 

• Choosing Wisely Australia 5 questions to ask if your doctor recommends a scan
  
• NPS MedicineWise Low back pain recovery plan 
  
• NPS MedicineWise fact sheet: Low back pain – do you need a scan? 
  
• Find out about other musculoskeletal conditions at Arthritis Australia
  
• Create an action plan for your low back pain at the MyBackPain website