Written for Stock My Medicine and clinically reviewed by Hajra Dhanchora, MPharm (GPhC 2216990).
Most lower back pain is frightening, disabling for a few days, and not serious. The spine is strong, a strained back is a muscle and ligament problem in the vast majority of cases, and the evidence on what helps has flipped over the past twenty years: rest makes it worse, movement makes it better, and the painkiller most people reach for first is the wrong one. Here's the current advice, and the short list of signs that mean something more.
What causes lower back pain?
Usually a strain: lifting awkwardly, a long drive, a weekend of gardening after months at a desk, or nothing you can pin down at all. Less often a slipped (herniated) disc, which sends pain, tingling or numbness down one leg (sciatica) because the disc presses on a nerve. Poor sleep, stress, being unfit and being overweight all make an episode more likely and longer. Pain that's worse in the morning and eases with movement in a younger person can be inflammatory and deserves a GP. And yes, constipation and trapped wind can cause backache, as can period pain and a kidney infection, so a back that hurts with tummy or bladder symptoms is worth thinking about differently.
The one rule: keep moving
Bed rest was the advice for decades and it prolongs back pain. Muscles stiffen, the back deconditions, and fear of moving sets in. The NHS advice now is to stay active and carry on with normal activities as far as the pain allows, including work, even if it hurts. Walk, little and often, from day one. Gentle stretches such as knee-to-chest, pelvic tilts and the cat-cow yoga move, a few times a day, keep things loose. Swimming, walking and yoga are the best longer-term activities. What to avoid: lying still for hours, and the heavy lifting that started it, for a couple of weeks.
Which painkiller works for back pain?
Ibuprofen, not paracetamol. Trials show paracetamol on its own is no better than placebo for back pain, which is why NICE no longer recommends it alone. An anti-inflammatory treats the inflamed, spasming tissue as well as the pain. Take it regularly for the first few days rather than waiting for the pain to peak.
| Option | How | Notes |
|---|---|---|
| Ibuprofen tablets | 400mg three times a day with food, up to 10 days | First choice. Not with a stomach ulcer, kidney problems, asthma triggered by NSAIDs, or in late pregnancy. |
| Diclofenac gel or ibuprofen gel | Rubbed into the painful area three or four times a day | Gets the anti-inflammatory to the muscle with far less reaching the stomach. Good if tablets don't suit you, or on top of them. |
| Ibuprofen plus paracetamol | As the pack directs | Paracetamol adds something alongside ibuprofen, just not on its own. |
| Codeine combinations | Pharmacy medicine, three days at most | For pain that stops you sleeping in the first days. Constipating, which is unhelpful for a back. |
Everything above is in our pain relief range.
Exercises for lower back pain: the four to start with
Start on day one or two, gently, and stop short of sharp pain. Knee to chest: lying on your back, pull one knee towards your chest, hold 20 seconds, swap, five times each. Pelvic tilt: lying with knees bent, flatten the small of your back into the floor, hold five seconds, ten times. Cat-cow: on hands and knees, arch the back up then let it sag, slowly, ten times. Walking: five to ten minutes every hour or two, building up over the week. Once the acute pain has eased, the things that stop it returning are regular walking, swimming, pilates or yoga, and strengthening the core and glutes; NHS physiotherapy can give you a programme, and in many areas you can self-refer without seeing a GP first.
Heat or ice?
Either, whichever feels better, wrapped in a towel and never on bare skin. Heat relaxes muscle spasm and is what most people find helps a strained back: a hot water bottle, a heat patch, a warm bath, or a rub such as Deep Heat that creates the same warmth without the kettle. Cold, a cold gel or a wrapped ice pack for 15 minutes, suits the first day or two after a sudden injury when the area is hot and swollen. Alternate them if you're not sure.
How to sleep with lower back pain
On your side with a pillow between the knees, or on your back with a pillow under the knees; both take the strain off the lower spine. Avoid sleeping on your front. A firm-ish mattress helps, but the expensive one advertised for back pain isn't necessary. Take the ibuprofen dose with a snack before bed so it covers the night, and get up and walk for a few minutes if you wake stiff, rather than lying there.
How long does it last, and when to see a GP
Most episodes improve within a few weeks and are largely gone in six. See a GP, or self-refer to NHS physiotherapy where your area offers it, if the pain is no better after three or four weeks, is stopping you working or sleeping, keeps coming back, or runs down the leg below the knee. Physio, not more rest, is the treatment for pain that persists. If back pain is part of a wider picture of anxiety or low mood, say so; it changes what helps.
Red flags: get urgent help
Call 999 or go to A&E if back pain comes with numbness or tingling around the genitals or buttocks, loss of bladder or bowel control, weakness or numbness in both legs, or follows a serious accident or fall. Ask for an urgent GP appointment or call 111 for back pain with a high temperature, unexplained weight loss, a swelling in the back, pain that's worse at night or when lying down, chest pain, or if you're under 20 or over 50 with pain that's new and severe, have had cancer, or take steroids or immune-suppressing medicines. These are uncommon, and they're the reason the word "usually" appears so often above.
Frequently asked questions
How do I get rid of back pain instantly?
You can't, but heat on the area, a full dose of ibuprofen, and ten minutes of slow walking do more in the first hour than lying down. Add a gel for the spot that hurts most.
Can I go to work with back pain?
Usually yes, and it tends to help; people who stay at work recover faster than those who stop. Ask for adjustments such as a different chair, standing breaks or lighter duties for a couple of weeks.
Should I see a chiropractor or osteopath?
Manual therapy can help as part of a package with exercise, but a physiotherapist gives you the exercises that stop it coming back, and NHS physio is free.
Is a slipped disc an emergency?
Not usually; most settle over weeks with the same approach. It becomes urgent with the red-flag symptoms above, especially any change in bladder or bowel control.