MSK Physiotherapy

Low back pain can feel different from person to person, but common symptoms include:

• Pain in the lower back area which may travel into the buttocks, thighs or hips.
• Stiffness after a period of rest or reduced movement, e.g. first thing in the morning
• Difficulty moving, such as getting up from a chair or out of bed, or bending, lifting or twisting

Your back pain symptoms may be constant or they may come and go, and they may be made worse by certain activities, movements or body positions and eased by others.

Important

If pain travels from your back to below your knee(s) and/or you have pins and needles, numbness or tingling, please contact us by emailing 
patientcontactcentre@nhft.nhs.uk or calling 0330 555 6789 (Option 2) and say you need further physiotherapy assessment.

There are a few different things which can make it more likely you will develop low back pain.

The back has lots of muscles, joints and discs which can be injured or swell up if you lift something too heavy or awkward, for example, or from a sudden twisting movement that you were not ready for. These structures can heal and repair. It's not essential to know exactly which structures are involved in your back pain as this won't usually change the advice or treatment you are given.

Other common causes of low back pain include:

• A sudden increase or decrease in your normal activity or exercise levels 
• Previous back pain - if you have experienced back pain before, it might become painful from time to time (this is called a flare-up) 
• When you've been feeling stressed, worried or in a low mood
• When you've been struggling with poor sleep or feeling tired or run down
• Some lifestyle factors, like being overweight and smoking
• Having other health conditions like osteoarthritis, rheumatoid arthritis or fibromyalgia

Is back pain caused by bad posture?

People with low back pain often report that it's painful to sit, stand or bend. It's often thought that we need to sit and stand with a straight, but in fact research shows that there is no 'perfect' posture to prevent or reduce back pain. Our backs come in all shapes and sizes and having different spine postures through the day is actually healthy for your back. 

It is safe and often more comfortable to relax while sitting, standing, and bending, rather than tensing and overprotecting the back.

Facts about posture and back pain

• There is no 'correct' posture - there is no strong evidence that the ideal posture exists or that avoiding 'incorrect' posture prevents back pain
• It is safe to adopt more comfortable poses - exploring different postures, including those which are frequently avoided, and changing from the postures you're used to may help to relieve back pain
• Differences in postures are a fact of life - people's spinal curves are different and there is no single spinal curve that's strongly linked to pain
• The spine is strong and can be trusted - the spine can safely move and carry loads in lots of different postures. Warnings about certain postures being bad for your spine are not actually based on evidence!
• Posture reflects beliefs and mood - our emotions and concerns about our body image can show in our posture, and understanding the reasons behind preferred postures can be helpful
• Sitting is not dangerous - sitting for longer than 30 minutes in one position is not dangerous, but it can still be helpful to move and change position regularly
• One size does not fit all - advice about adopt a certain posture or to 'brace the core' when lifting is not based on evidence, and postural movement screening (analysis of your posture and movement) doesn't prevent injuries

• Most episodes of acute low back pain get better within 6 weeks
• Around 1 in 5 people will still have low back pain at 12 weeks. This is why it is important to take what's known as an 'active approach' to managing your back pain, which means staying as active as possible rather than avoiding movement

Click on the headings below to reveal more information and useful advice.

Rest is not always best

At first, it may be helpful to change or reduce your usual activities. But remember that resting and avoiding normal activities for more than a day or two can:

• Reduce your physical fitness
• Make your spine more stiff
• Cause your muscles to start to waste

This means it may actually take longer for you to get better. Instead, evidence shows that keeping active and gradually returning to all your usual activities and exercise will help you to recover sooner.

Pain does not always mean harm

It is normal to experience some pain during your recovery, but it does not mean you are causing harm or damage to your back. Pain does not always equal harm, but is often just a sign that your nervous system has become more sensitive. You can find more information about this in these videos.

Keep moving

Movement is a really important part of your recovery from lower back pain. Staying active supports the healing process and if you are feeling any stiffness, gentle movement helps to reduce this. We often think of bed rest as a good thing for back pain but in fact it actually slows your recovery down.

Benefits of exercise

Regular exercise helps with your health and wellbeing in lots of different ways:

• Keeps your blood pressure stable
• Keeps your heart healthy
• Keeps your bones strong
• Helps with your mental wellbeing
• Reduces stress
• Helps you keep a healthy weight
• Improves your balance and flexibility
• Improves sleep
• Reduces your risk of illnesses like diabetes, heart diseases, joint and back pain and some cancers
• In older adults, reduces your risk of frailty and falls
• Helps you do more of the things you enjoy

Remember, rest and recovery are as important as exercise itself. It's important not to put too much stress on your body so always allow yourself enough rest between exercise sessions.

Exercise - what to aim for

The World Health Organisation (WHO) recommends:

• At least 150 minutes of moderate intensity exercise per week - this is exercise that increases your breathing rate but not so much that you're not able to talk. Examples include swimming, a brisk walk or cycling

OR

• At least 75 minutes of vigorous intensity exercise per week - this is exercise that gets you breathing fast so that you have trouble talking. Examples include running, stair-climbing and sports

WHO recommendations also include:

• Doing strength-building exercise on at least 2 days per week - this is things like going to the gym, doing yoga or carrying heavy bags, which help to keep your muscles, bones and joints strong
• For older adults, do exercise that improves your balance on at least 2 days per week - this is things like bowls, Tai Chi and dancing, which help to reduce your risk of frailty and falls
• Spend as little time as you can sitting or lying down during the day, and break up periods where you are inactive with movement and standing

Fitting exercise into your daily life

Trying to fit 150 minutes of moderate intensity exercise into your daily life might feel like a big ask. But look at this example of how this could look:

• 10 minutes of vacuuming
• 20 minutes of dancing
• 60 minutes of gardening
• 60 minutes of walking

Broken down in this way across a week, 150 minutes starts to look more manageable.

Suggestions to help you

• Break up your sitting time by changing your position regularly, getting up and moving about - this can ease muscle tension and stiffness
• Make activity part of your daily life - take the stairs instead of the lift, use a toilet further away, get up to make a drink during TV adverts, or walk to nearby shops instead of driving
• Choose activities you enjoy - most activities are good for your health and if it's fun, get it done!
• Something is better than nothing - start small and gradually build up your activity levels over time
• Exercise involving bending, lifting and twisting are good for your lower back - but remember to build your activity slowly and steadily
• Set goals for the short and medium term to help keep you on track - involve friends, family members or work colleagues if you can to help with motivation
• Exercise at home with NHS Fitness Studio exercise videos
• If you prefer to exercise in a gym, your health professional can make a referral to give you gym membership at reduced cost. If you are aged over 55, this can also give you access to local group exercise activities like walking football, Nordic walking and activities matched to your age

Medication

Over-the-counter medicines can help to ease pain and help you to move more comfortably. They are not a cure but should help to keep you active and working.

If you need to take them, it is important to take tablets regularly and as directed on the packet. Do not wait until your pain is out of control, or the tablets will not work as well.

If you have indigestion, an ulcer problem or asthma, ask your GP practice or pharmacist about the use of anti-inflammatories and aspirin. If you need more advice about pain relief medication, talk to a pharmacist or your GP practice.

Heat and cold

Using heat can help to reduce pain and relax your muscles. Use a warm water bottle, or microwaveable wheat bag, following the instructions that come with the product. To protect your skin from heat burns, wrap the item in a few layers of towel.

Using ice can help to reduce pain and inflammation (swelling). Use crushed ice cubes or a bag of frozen peas. Protect your skin from ice burns by putting your ice pack in a wet towel and apply oil, such as baby oil, to your skin.

Leave your heat or ice pack in place for 15 to 20 minutes. You can use it again after 2 to 3 hours if you need to.

Returning to work

Try to stay at work or return to work as soon as you are able. Talk to your employer, GP or health practitioner for advice about how you can return to your work duties. Research clearly shows that the longer you are away from the work, the higher your risk of your symptoms continuing. Aim to get back to work as soon as possible, even if this means making some changes to your usual role.

Movement breaks

Take regular movement breaks to change your position or exercise every 30 to 40 minutes. This helps to prevent stiffness and muscle spasms. If sitting down is painful and your job involves long periods of sitting, it may be helpful to use different postures, spending periods sitting, standing and walking throughout the day.

Pace yourself

Don't try to do to much when it comes to exercise and activity. Adapt activities by pacing yourself and breaking activities down into smaller, more manageable chunks. 

Sleep well

Good sleep habits may help you cope better with your pain and reduce the risk of long-term pain. Find more information about getting good sleep:

• Fall asleep faster and sleep better - Every Mind Matters - NHS
• Sleepstation - sleep improvement and insomnia course

Stress and mental wellbeing

Things like stress and feeling sad or depressed can make it more likely for you to have continuing and long-term back pain. Taking care of your mental and physical health can help to keep your back healthy. Find more information about managing stress and mental wellbeing:

• 5 steps to mental wellbeing - NHS
• How to seek help for a mental health problem

Healthy lifestyle

Unhealthy lifestyles, including being overweight, drinking too much and smoking, can slow your recovery from back pain. You can reduce your risk of back pain by living a healthy lifestyle. Find more information about healthy lifestyles:

• Eatwell Guide: How to eat a healthy balanced diet | NHS Inform
• Nutrition and chronic pain - International Association for the Study of Pain (IASP)
• Anti-inflammatory diet: what you need to know - British Heart Foundation
• Quit smoking - Better Health - NHS
• Alcohol support - NHS

Start exercising as early as possible and include stretching exercises, resistance training and a range of different movements. Keep your exercise at a level where you can cope with the pain or discomfort, and aim to improve your flexibility and strength gradually over time. A strong and flexible back is less likely to experience future flare-ups of pain.

The following exercises can help your lower back feel better. They work best when you also keep moving, go for walks, and do your normal daily activities.

Exercises for low back pain

You will need to enter 2025 where asked to 'Enter your year of birth'

There are two main types of exercises:

• Moving and stretching exercises to help reduce pain and keep your back flexible
• Resistance exercises to help make your back stronger so it's less likely to hurt again

You can try different movements and stretches to see which ones help you the most. A little discomfort is okay, but the pain should not get worse each time you do an exercise or feel much worse after you stop.

Use the exercises that make you feel better like 'pain helpers', and do them for short times, regularly throughout the day.

Strength exercises can be done once a day at first. When they get harder or heavier, doing them 2 to 3 times a week is enough to help build muscle.

Any movement or exercise can help! You may feel more confident starting with gentler exercise types like walking, swimming and stretching. Aim to get confident with using and moving your back again.

There are no movements that will be dangerous or cause damage to your back. It is okay to return to sports or the gym if you feel up to it. But you may need to change the exercise you would normally do or do a bit less than usual. Avoiding all pain isn't necessary, but you do not need to 'push through' pain either, especially if it is spoiling your enjoyment of exercise!

Over time you might want to look at more challenging workouts like those in from the NHS Fitness Studio.

NHS Fitness Studio

Scans are important for people who show signs of serious conditions like cancer, infections, broken bones or compressed nerves. But this accounts for only a very small number (1% to 5%) of people with back pain.

For around 95% of people with back pain, scans cannot tell us about how much pain you are feeling or how pain is impacting on your life, now or in the future. They also do not tell us what treatment you need.

What do disc degeneration, disc bulges or arthritis mean on a scan?

Findings like disc degeneration, disc bulges and arthritis on a scan sound scary and important. However, they are commonly found in people without back pain, including in top athletes who use and load their backs all the time.

For example, at the age of 20 years, 37% of people without low back pain have disc degeneration, 30% have disc bulges and 29% have disc protrusions. These findings increase with age and do not predict a person's future likelihood of developing disabling low back pain.

So, in many cases these findings are normal and not the cause of the pain.

If there is nothing on my scan, is the pain in my head?

Back pain is 100% real and felt in the back. When the cause of back pain doesn't show on the scan, it doesn't mean you're imagining the pain. It's like having a severe headache without damaging your head. 

There are lots of structures in the low back (e.g. muscles, ligaments, joints, nerves and discs) that can become very pain sensitive to movement and loading without being damaged. The sensitivity of these structures is influenced by many factors. These include both physical factors (such as muscle tension and over-protection of the back, inactivity or overactivity) and non-physical factors (such as poor sleep, stress low mood and pain-related fear). 

Together these things can result in sensitivity of the spine's structures. Importantly, these factors can get better with the right treatment.

More information

• Spinal MRI - patient advice

Low back pain can feel different from person to person, but here are some common symptoms:

• Aching or soreness in your lower back
• Sharp or stabbing pain when you move in a certain way
• Stiffness that makes it hard to bend or twist
• Muscle tightness or spasms (like a cramp in your back)
• It might feel worse when sitting for too long or after lifting something heavy.
• Sometimes, the pain travels down into your buttocks, side of hip or down the back of your legs to your knees (but not below)

Important

If pain travels from your back to below your knee(s) and/or you have pins and needles, numbness or tingling, please contact us by emailing
patientcontactcentre@nhft.nhs.uk or calling 0330 555 6789 (Option 2) and say you need further physiotherapy assessment.

Low back pain can happen for many reasons and sometimes there's no clear cause! Here are some common ones:

• Lifting something heavy or awkwardly - if you lift something your body is not prepared for, your back must work extra hard and can get sore
• Sitting too long - if you sit all day without moving regularly your back muscles can get tight and achy
• Sudden movements - a sudden, unexpected twisting movement your back was not ready for can sometimes cause your back to ache
• Weak muscles - if you have weaker back muscles, they may struggle with activities and cause pain
• An old injury - if you've hurt your back before, it might get sore again sometimes (this is called a flare-up)
• Stress - being stressed can make your muscles tense up, which can cause pain

Other common causes of low back pain include:

• When you have been feeling worried or in a low mood
• When you have been struggling with poor sleep, or feeling tired or run-down
• Some lifestyle factors, like being overweight and smoking
• Having other health conditions like osteoarthritis, rheumatoid arthritis or fibromyalgia

Is back pain caused by bad posture?

People with low back pain often report that it's painful to sit, stand or bend. It's often thought that we need to sit and stand with a straight, but in fact research shows that there is no 'perfect' posture to prevent or reduce back pain. Our backs come in all shapes and sizes and having different spine postures through the day is actually healthy for your back. 

It is safe and often more comfortable to relax while sitting, standing, and bending, rather than tensing and overprotecting the back.

Facts about posture and back pain

• There is no 'correct' posture - there is no strong evidence that the ideal posture exists or that avoiding 'incorrect' posture prevents back pain
• It is safe to adopt more comfortable poses - exploring different postures, including those which are frequently avoided, and changing from the postures you're used to may help to relieve back pain
• Differences in postures are a fact of life - people's spinal curves are different and there is no single spinal curve that's strongly linked to pain
• The spine is strong and can be trusted - the spine can safely move and carry loads in lots of different postures. Warnings about certain postures being bad for your spine are not actually based on evidence!
• Posture reflects beliefs and mood - our emotions and concerns about our body image can show in our posture, and understanding the reasons behind preferred postures can be helpful
• Sitting is not dangerous - sitting for longer than 30 minutes in one position is not dangerous, but it can still be helpful to move and change position regularly
• One size does not fit all - advice about adopt a certain posture or to 'brace the core' when lifting is not based on evidence, and postural movement screening (analysis of your posture and movement) doesn't prevent injuries

Sometimes, back pain lasts longer and doesn't go away as quickly as expected. This can happen for different reasons, like:

• Not moving enough - if you stop being active because of pain, your muscles can get weaker, making it harder to recover
• Stress or worry - feeling anxious or upset about your pain can make your body more tense, which can keep the pain going
• Poor sleep - not getting enough rest can make it harder for your body to heal
• Other health issues - things like being overweight, smoking, drinking too much alcohol or not eating well can slow down recovery

If back pain lasts longer than a few weeks, it's important to understand why and find ways to help it improve.

Click on the headings below to reveal more information and useful advice.

Rest is not always best

At first, it may be helpful to change or reduce your usual activities. But remember that resting and avoiding normal activities for more than a day or two can:

• Reduce your physical fitness
• Make your spine more stiff
• Cause your muscles to start to waste

This means it may actually take longer for you to get better. Instead, evidence shows that keeping active and gradually returning to all your usual activities and exercise will help you to recover sooner.

Pain does not always mean harm

It is normal to experience some pain during your recovery, but it does not mean you are causing harm or damage to your back. Pain does not always equal harm, but is often just a sign that your nervous system has become more sensitive. You can find more information about this in these videos.

Keep moving

Movement is a really important part of your recovery from lower back pain. Staying active supports the healing process and if you are feeling any stiffness, gentle movement helps to reduce this. We often think of bed rest as a good thing for back pain but in fact it actually slows your recovery down.

Benefits of exercise

Regular exercise helps with your health and wellbeing in lots of different ways:

• Keeps your blood pressure stable
• Keeps your heart healthy
• Keeps your bones strong
• Helps with your mental wellbeing
• Reduces stress
• Helps you keep a healthy weight
• Improves your balance and flexibility
• Improves sleep
• Reduces your risk of illnesses like diabetes, heart diseases, joint and back pain and some cancers
• In older adults, reduces your risk of frailty and falls
• Helps you do more of the things you enjoy

Remember, rest and recovery are as important as exercise itself. It's important not to put too much stress on your body so always allow yourself enough rest between exercise sessions.

Exercise - what to aim for

The World Health Organisation (WHO) recommends:

• At least 150 minutes of moderate intensity exercise per week - this is exercise that increases your breathing rate but not so much that you're not able to talk. Examples include swimming, a brisk walk or cycling

OR

• At least 75 minutes of vigorous intensity exercise per week - this is exercise that gets you breathing fast so that you have trouble talking. Examples include running, stair-climbing and sports

WHO recommendations also include:

• Doing strength-building exercise on at least 2 days per week - this is things like going to the gym, doing yoga or carrying heavy bags, which help to keep your muscles, bones and joints strong
• For older adults, do exercise that improves your balance on at least 2 days per week - this is things like bowls, Tai Chi and dancing, which help to reduce your risk of frailty and falls
• Spend as little time as you can sitting or lying down during the day, and break up periods where you are inactive with movement and standing

Fitting exercise into your daily life

Trying to fit 150 minutes of moderate intensity exercise into your daily life might feel like a big ask. But look at this example of how this could look:

• 10 minutes of vacuuming
• 20 minutes of dancing
• 60 minutes of gardening
• 60 minutes of walking

Broken down in this way across a week, 150 minutes starts to look more manageable.

Suggestions to help you

• Break up your sitting time by changing your position regularly, getting up and moving about - this can ease muscle tension and stiffness
• Make activity part of your daily life - take the stairs instead of the lift, use a toilet further away, get up to make a drink during TV adverts, or walk to nearby shops instead of driving
• Choose activities you enjoy - most activities are good for your health and if it's fun, get it done!
• Something is better than nothing - start small and gradually build up your activity levels over time
• Exercise involving bending, lifting and twisting are good for your lower back - but remember to build your activity slowly and steadily
• Set goals for the short and medium term to help keep you on track - involve friends, family members or work colleagues if you can to help with motivation
• Exercise at home with NHS Fitness Studio exercise videos
• If you prefer to exercise in a gym, your health professional can make a referral to give you gym membership at reduced cost. If you are aged over 55, this can also give you access to local group exercise activities like walking football, Nordic walking and activities matched to your age

Medication

Over-the-counter medicines can help to ease pain and help you to move more comfortably. They are not a cure but should help to keep you active and working.

If you need to take them, it is important to take tablets regularly and as directed on the packet. Do not wait until your pain is out of control, or the tablets will not work as well.

If you have indigestion, an ulcer problem or asthma, ask your GP practice or pharmacist about the use of anti-inflammatories and aspirin. If you need more advice about pain relief medication, talk to a pharmacist or your GP practice.

Heat and cold

Using heat can help to reduce pain and relax your muscles. Use a warm water bottle, or microwaveable wheat bag, following the instructions that come with the product. To protect your skin from heat burns, wrap the item in a few layers of towel.

Using ice can help to reduce pain and inflammation (swelling). Use crushed ice cubes or a bag of frozen peas. Protect your skin from ice burns by putting your ice pack in a wet towel and apply oil, such as baby oil, to your skin.

Leave your heat or ice pack in place for 15 to 20 minutes. You can use it again after 2 to 3 hours if you need to.

Returning to work

Try to stay at work or return to work as soon as you are able. Talk to your employer, GP or health practitioner for advice about how you can return to your work duties. Research clearly shows that the longer you are away from the work, the higher your risk of your symptoms continuing. Aim to get back to work as soon as possible, even if this means making some changes to your usual role.

Movement breaks

Take regular movement breaks to change your position or exercise every 30 to 40 minutes. This helps to prevent stiffness and muscle spasms. If sitting down is painful and your job involves long periods of sitting, it may be helpful to use different postures, spending periods sitting, standing and walking throughout the day.

Pace yourself

Don't try to do to much when it comes to exercise and activity. Adapt activities by pacing yourself and breaking activities down into smaller, more manageable chunks. 

Sleep well

Good sleep habits may help you cope better with your pain and reduce the risk of long-term pain. Find more information about getting good sleep:

• Fall asleep faster and sleep better - Every Mind Matters - NHS
• Sleepstation - sleep improvement and insomnia course

Stress and mental wellbeing

Things like stress and feeling sad or depressed can make it more likely for you to have continuing and long-term back pain. Taking care of your mental and physical health can help to keep your back healthy. Find more information about managing stress and mental wellbeing:

• 5 steps to mental wellbeing - NHS
• How to seek help for a mental health problem

Healthy lifestyle

Unhealthy lifestyles, including being overweight, drinking too much and smoking, can slow your recovery from back pain. You can reduce your risk of back pain by living a healthy lifestyle. Find more information about healthy lifestyles:

• Eatwell Guide: How to eat a healthy balanced diet | NHS Inform
• Nutrition and chronic pain - International Association for the Study of Pain (IASP)
• Anti-inflammatory diet: what you need to know - British Heart Foundation
• Quit smoking - Better Health - NHS
• Alcohol support - NHS

Exercise as regularly and consistently as you can and include stretching exercises, resistance training and a range of different movements. Keep your exercise at a level where you can cope with the pain or discomfort, and aim to improve your flexibility and strength gradually over time. A strong and flexible back is less likely to experience future flare-ups of pain.

The following exercises can help your lower back feel better. They work best when you also keep moving, go for walks, and do your normal daily activities.

Exercises for low back pain

You will need to enter 2025 where asked to 'Enter your year of birth'

There are two main types of exercises:

• Moving and stretching exercises to help reduce pain and keep your back flexible
• Resistance exercises to help make your back stronger so it's less likely to hurt again

You can try different movements and stretches to see which ones help you the most. A little discomfort is okay, but the pain should not get worse each time you do an exercise or feel much worse after you stop.

Use the exercises that make you feel better like 'pain helpers', and do them for short times, regularly throughout the day. The exercises are split into easy, medium, and hard levels.

Strength exercises can be done once a day at first. When they get harder or heavier, doing them 2 to 3 times a week is enough to help build muscle.

Any movement or exercise can help! You may feel more confident starting with gentler exercise types like walking, swimming and stretching. Aim to get confident with using and moving your back again.

There are no movements that will be dangerous or cause damage to your back. It is okay to return to sports or the gym if you feel up to it. But you may need to change the exercise you would normally do or do a bit less than usual. Avoiding all pain isn't necessary, but you do not need to 'push through' pain either, especially if it is spoiling your enjoyment of exercise!

Over time you might want to look at more challenging workouts like those in from the NHS Fitness Studio.

NHS Fitness Studio

Scans are important for people who show signs of serious conditions like cancer, infections, broken bones or compressed nerves. But this accounts for only a very small number (1% to 5%) of people with back pain.

For around 95% of people with back pain, scans cannot tell us about how much pain you are feeling or how pain is impacting on your life, now or in the future. They also do not tell us what treatment you need.

What do disc degeneration, disc bulges or arthritis mean on a scan?

Findings like disc degeneration, disc bulges and arthritis on a scan sound scary and important. However, they are commonly found in people without back pain, including in top athletes who use and load their backs all the time.

For example, at the age of 20 years, 37% of people without low back pain have disc degeneration, 30% have disc bulges and 29% have disc protrusions. These findings increase with age and do not predict a person's future likelihood of developing disabling low back pain.

So, in many cases these findings are normal and not the cause of the pain.

If there is nothing on my scan, is the pain in my head?

Back pain is 100% real and felt in the back. When the cause of back pain doesn't show on the scan, it doesn't mean you're imagining the pain. It's like having a severe headache without damaging your head. 

There are lots of structures in the low back (e.g. muscles, ligaments, joints, nerves and discs) that can become very pain sensitive to movement and loading without being damaged. The sensitivity of these structures is influenced by many factors. These include both physical factors (such as muscle tension and over-protection of the back, inactivity or overactivity) and non-physical factors (such as poor sleep, stress low mood and pain-related fear). 

Together these things can result in sensitivity of the spine's structures. Importantly, these factors can get better with the right treatment.

More information

• Spinal MRI - patient advice

Work is generally good for physical and mental health and it plays an important role in recovery and rehabilitation. It's also known that long periods away from work are harmful to physical and mental health.

Around two-thirds of sickness absence and long-term incapacity are due to common, mild-to-moderate conditions, such as back pain, many of which are preventable.

It's not essential to be 100% fit for you to be able to return to work safely. In fact, being at work may be helpful to help with recovery from health problems and can also support wellbeing for people with longer-term health conditions. Many common health problems can be managed at work with the right adjustments and support.

Why is work good for your health?

Work is a central part of life. It supports identity, social connection, financial security and psychological wellbeing.

Evidence shows that work:

• Supports recovery and rehabilitation from ill-health or injury
• Leads to better long-term health
• Reduces the physical, mental, and social harms of long-term absence
• Improves quality of life and wellbeing
• Reduces social exclusion and poverty

Why does being out of work harm health?

Long periods out of work are linked to:

• More GP visits, medication use, and hospital admissions
• 2x to 3x higher risk of poor general health
• 2x to 3x higher risk of mental health problems
• A 20% higher risk of death

The longer someone is off work, the less likely they are to return. Overall, the health benefits of work outweigh the risks and are greater than the harm of being out of work.

Things to think about

• What is stopping you from returning to work?
• What could help overcome these barriers?
• Could your work duties or working hours be changed to meet your needs?
• Focus on what you can do rather than what you can't

Planning for a return to work

Managing common health problems like back pain often focuses on keeping symptoms under control so that you can maintain a level of health and wellbeing and return to normal activity.

Recovery and returning to work are active processes, which means they need motivation and effort to be successful.

Line managers have an important role providing continuing support for the person returning to work, and they are the people to talk to first. They can work with you to create a return-to-work plan that can help to:

• Set realistic goals, expectations and timescales
• Gradually increase your activity levels
• Agree clear goals and timescales
• Focus on what you can do, rather than what you can't
• Identify and address any barriers, including any issues with your workplace
• Understand the support that's available to you 

Small changes at work can often make a big difference to a successful return to work after a period of sickness absence.

Most people really do want to get back to work and are often best placed to work out a solution themselves as long their fears, concerns and ideas are listened to.

Healthcare professionals can also support with this process.

Communication with your employer

Effective and safe return-to-work planning depends on clear communication between the employee and their employer. Shared decision-making is an important part of this, and the process can be supported by healthcare professionals.

Where available, occupational health services can help to coordinate a return to work.

Communication with employers should focus on what the person can do and any temporary, medically necessary restrictions that may be needed to enable the person to carry out their role.

A 'Fit note' (sometimes called a 'Med3') can help with communication with your work. The 'Remarks' section of this document can be used to share further detail, advice and guidance for employers and may be used instead of a separate letter. Please contact your GP practice to discuss this further if you need to.

Everyone should remember that supporting a person to return to work is usually in that person's best long-term interests.

More resources

More information and advice that should help you to remain well in work and/or support your return to work is available here:

MSK at work: Mersey Care NHS Foundation Trust

(Please note: information about locally provided services on the above website does not apply to Northamptonshire residents)

For further information about returning to work after absence, phased returns and reasonable adjustments please see this guidance from Acas, the independent advisory, conciliation and arbitration service working with employers and employees to improve workplace relationships.

Returning to work after absence - Acas

Most people with persistent back pain (back pain lasting for longer than 12 weeks) have pain in the middle or on one or both sides of their backs. They may also feel it around their hips and buttocks and sometimes in one or both thighs.

Back pain may make it difficult for you to do certain activities or tasks or make certain movements. For some people this may affect their work, sleep, and social life as well. Because of this, people with persistent back pain often also experience feelings of low mood, anxiety and depression.

There are lots of reasons why back pain doesn't get better, including things like: 

• Over-protecting the body by tensing muscles
• Avoiding movement or activity because of fear of the pain it may cause
• Not being active
• Doing too much and not resting enough
• Poor sleep
• High levels of stress
• Worry, fear and depressed mood
• Smoking
• Drinking too much alcohol
• Not eating well
• Being overweight

These things cause changes to the way the nervous system works, which makes the structures of our back more sensitive, makes muscles more tense and affects the way we control our bodies and move.

If your back has become sensitive over time because of these factors, feeling worried about the pain, avoiding movement and having negative thoughts about your recovery can make the pain last longer.

The good news is that many of these things can be helped with an effective treatment plan.

For more information about supporting better general health and wellbeing, including advice about mental health, stopping smoking and weight management, see our healthy lifestyles section.

Also please see the 'What can I do to manage my back pain' section for advice on how you may be able to help yourself.

Is back pain caused by bad posture?

People with low back pain often report that it's painful to sit, stand or bend. It's often thought that we need to sit and stand with a straight, but in fact research shows that there is no 'perfect' posture to prevent or reduce back pain. Our backs come in all shapes and sizes and having different spine postures through the day is actually healthy for your back. 

It is safe and often more comfortable to relax while sitting, standing, and bending, rather than tensing and overprotecting the back.

Facts about posture and back pain

• There is no 'correct' posture - there is no strong evidence that the ideal posture exists or that avoiding 'incorrect' posture prevents back pain
• It is safe to adopt more comfortable poses - exploring different postures, including those which are frequently avoided, and changing from the postures you're used to may help to relieve back pain
• Differences in postures are a fact of life - people's spinal curves are different and there is no single spinal curve that's strongly linked to pain
• The spine is strong and can be trusted - the spine can safely move and carry loads in lots of different postures. Warnings about certain postures being bad for your spine are not actually based on evidence!
• Posture reflects beliefs and mood - our emotions and concerns about our body image can show in our posture, and understanding the reasons behind preferred postures can be helpful
• Sitting is not dangerous - sitting for longer than 30 minutes in one position is not dangerous, but it can still be helpful to move and change position regularly
• One size does not fit all - advice about adopt a certain posture or to 'brace the core' when lifting is not based on evidence, and postural movement screening (analysis of your posture and movement) doesn't prevent injuries

When a person's back pain becomes persistent (lasting more than 12 weeks) and they have had lots of treatment, it is common to lose hope that they will ever get better.

But even if back pain is severe and has persisted for many years, the right treatment can significantly reduce pain and improve movement and quality of life. The journey to recovery is different for each person and even with the right care may take some months.

For some people pain can continue for much longer because people adapt and cope in different ways. It important to know that for some people, life-long self-management of back pain is needed.

Please watch this short video to help you understand more about pain, why it happens and why it can become persistent. It also explains how the ways you think about pain and react to pain can help you reduce it.

Everybody's experience of back pain is different and can be shaped by lots of different things, including:

• Poor sleep
• Not being active
• Doing too much activity
• Muscle tension
• Tiredness
• Being overweight
• Being stressed, worried or in a low mood
• Their thoughts and feelings about the pain 

These things act a bit like a 'volume dial' on our nervous systems, making our backs more sensitive to touch, movement and carrying loads.

Many treatments for persistent low back pain provide only short-term pain relief (e.g. medication, massage, manipulation, injections). This means you need to go back for more and more treatment.

Your personal recovery plan

The best long-term treatments involve guiding you to care for your own back. This involves developing a personal recovery plan which is tailored to your own situation, your needs and your goals. This personal recovery plan includes:

• Learning about the different things which may be behind your pain and disability, and thinking more positively about your recovery
• Becoming more aware of your body, including ways to relaxation and control the way you move in a way that reduces pain, builds your confidence and strength and helps you get back to doing the things in life that are important to you
• Becoming more physically active, getting good sleep, managing your stress and having a healthy lifestyle

The journey to recovery is different for everyone. For some people it can happen quite quickly and for others it can take longer and need more support if self-management isn't working well.

Advice for your recovery

For people with persistent low back pain, it's common for the structures in the back to become very stiff and sensitive to simple movements (like bending and twisting) and daily activities (like sleeping, sitting, standing, dressing, physical activity and work). 

Movement and exercise are two of the best ways to help treat back pain. It is important to know that feeling some pain when you start to move and exercise is safe and normal. This pain is usually a reflection of how sensitive the structures in your back have become, rather than a sign of damage. 

Learning ways to relax and control the way you move can help reduce pain and build your confidence to gradually get back to doing the things you love.

• Evoolve Academy patient resources - back facts, recovery stories and useful infographics and other trusted information
• What is Persistent Pain? - Pain Toolkit - advice and guidance from Pete Moore, who lives with persistent back pain but has learned how to self-manage it
• Pain Toolkit podcasts - short podcasts on managing back pain with Pete Moore and guests

Start by gradually increasing what you can manage in terms of movement, activity, and exercises.

The following exercises will help you get started. Start with the easiest and gradually work through them over time. Don't forget to practise the breathing exercises and relaxation too, as this is often really helpful for people with persistent pain.

Exercises for low back pain

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You may prefer to increase your activity levels in other ways, such as by walking, swimming, or joining an exercise class like Pilates, Tai chi, aquafit, or yoga.

The important thing is you find something you enjoy doing and can do regularly to stay active.

Scans are important for people who show signs of serious conditions like cancer, infections, broken bones or compressed nerves. But this accounts for only a very small number (1% to 5%) of people with back pain.

For around 95% of people with back pain, scans cannot tell us about how much pain you are feeling or how pain is impacting on your life, now or in the future. They also do not tell us what treatment you need.

What do disc degeneration, disc bulges or arthritis mean on a scan?

Findings like disc degeneration, disc bulges and arthritis on a scan sound scary and important. However, they are commonly found in people without back pain, including in top athletes who use and load their backs all the time.

For example, at the age of 20 years, 37% of people without low back pain have disc degeneration, 30% have disc bulges and 29% have disc protrusions. These findings increase with age and do not predict a person's future likelihood of developing disabling low back pain.

So, in many cases these findings are normal and not the cause of the pain.

If there is nothing on my scan, is the pain in my head?

Back pain is 100% real and felt in the back. When the cause of back pain doesn't show on the scan, it doesn't mean you're imagining the pain. It's like having a severe headache without damaging your head. 

There are lots of structures in the low back (e.g. muscles, ligaments, joints, nerves and discs) that can become very pain sensitive to movement and loading without being damaged. The sensitivity of these structures is influenced by many factors. These include both physical factors (such as muscle tension and over-protection of the back, inactivity or overactivity) and non-physical factors (such as poor sleep, stress low mood and pain-related fear). 

Together these things can result in sensitivity of the spine's structures. Importantly, these factors can get better with the right treatment.

More information

• Spinal MRI - patient advice

Work is generally good for physical and mental health and it plays an important role in recovery and rehabilitation. It's also known that long periods away from work are harmful to physical and mental health.

Around two-thirds of sickness absence and long-term incapacity are due to common, mild-to-moderate conditions, such as back pain, many of which are preventable.

It's not essential to be 100% fit for you to be able to return to work safely. In fact, being at work may be helpful to help with recovery from health problems and can also support wellbeing for people with longer-term health conditions. Many common health problems can be managed at work with the right adjustments and support.

Why is work good for your health?

Work is a central part of life. It supports identity, social connection, financial security and psychological wellbeing.

Evidence shows that work:

• Supports recovery and rehabilitation from ill-health or injury
• Leads to better long-term health
• Reduces the physical, mental, and social harms of long-term absence
• Improves quality of life and wellbeing
• Reduces social exclusion and poverty

Why does being out of work harm health?

Long periods out of work are linked to:

• More GP visits, medication use, and hospital admissions
• 2x to 3x higher risk of poor general health
• 2x to 3x higher risk of mental health problems
• A 20% higher risk of death

The longer someone is off work, the less likely they are to return. Overall, the health benefits of work outweigh the risks and are greater than the harm of being out of work.

Things to think about

• What is stopping you from returning to work?
• What could help overcome these barriers?
• Could your work duties or working hours be changed to meet your needs?
• Focus on what you can do rather than what you can't

Planning for a return to work

Managing common health problems like back pain often focuses on keeping symptoms under control so that you can maintain a level of health and wellbeing and return to normal activity.

Recovery and returning to work are active processes, which means they need motivation and effort to be successful.

Line managers have an important role providing continuing support for the person returning to work, and they are the people to talk to first. They can work with you to create a return-to-work plan that can help to:

• Set realistic goals, expectations and timescales
• Gradually increase your activity levels
• Agree clear goals and timescales
• Focus on what you can do, rather than what you can't
• Identify and address any barriers, including any issues with your workplace
• Understand the support that's available to you 

Small changes at work can often make a big difference to a successful return to work after a period of sickness absence.

Most people really do want to get back to work and are often best placed to work out a solution themselves as long their fears, concerns and ideas are listened to.

Healthcare professionals can also support with this process.

Communication with your employer

Effective and safe return-to-work planning depends on clear communication between the employee and their employer. Shared decision-making is an important part of this, and the process can be supported by healthcare professionals.

Where available, occupational health services can help to coordinate a return to work.

Communication with employers should focus on what the person can do and any temporary, medically necessary restrictions that may be needed to enable the person to carry out their role.

A 'Fit note' (sometimes called a 'Med3') can help with communication with your work. The 'Remarks' section of this document can be used to share further detail, advice and guidance for employers and may be used instead of a separate letter. Please contact your GP practice to discuss this further if you need to.

Everyone should remember that supporting a person to return to work is usually in that person's best long-term interests.

More resources

More information and advice that should help you to remain well in work and/or support your return to work is available here:

MSK at work: Mersey Care NHS Foundation Trust

(Please note: information about locally provided services on the above website does not apply to Northamptonshire residents)

For further information about returning to work after absence, phased returns and reasonable adjustments please see this guidance from Acas, the independent advisory, conciliation and arbitration service working with employers and employees to improve workplace relationships.

Returning to work after absence - Acas

Click or tap on the heading to reveal more information.

1. Low back pain can be scary but it's rarely dangerous 

Low back pain can be distressing and disabling but its rarely life threatening and you are very unlikely to end up in a wheelchair.

2. Getting older is not a cause of low back pain

Although it is a common belief and concern that getting older causes or worsens low back pain, research does not support this. Evidence-based treatments can help at any age.

3. Long-lasting back pain is rarely associated with serious tissue damage

Backs are strong. If you have had an injury, tissue healing occurs within 3 months. So, if pain persists beyond this time it usually means there are other contributing factors. A lot of low back pain begins with no injury or with simple everyday movements. These occasions may be linked with stress, tension, tiredness, inactivity or activity you are not used to, which makes the back more sensitive to movement and loading.

4. Scans rarely show the cause of low back pain

Scans are only helpful for a small number of people. Lots of scary sounding things can be reported on scans such as disc bulges, degeneration, protrusions and arthritis. Unfortunately, the reports don't say that these findings are very common in people without low back pain and they don't predict how much pain you feel or how disabled you are. Scans can also change, and most disc prolapses shrink over time.

5. Pain with exercise and movement doesn't mean you are doing harm

When pain persists, it is common that the spine and surrounding muscles become really sensitive to touch and movement. The pain you feel during movement and activities reflects how sensitive your structures are - not how damaged you are. So, it's safe and normal to feel some pain when you start to move and exercise. This usually settles down with time as you get more active. In fact, exercise and movement are one of the most effective ways to help treat low back pain. See the NHS Fitness Studio for some practical approaches.

6. Low back pain is not caused by poor posture

How we sit, stand and bend does not cause low back pain, even if these activities may be painful. A variety of postures are healthy for the back. It is safe to relax during everyday tasks such as sitting, bending and lifting with a round back - in fact it's more efficient.

7. Low back pain is not caused by a 'weak core'

Weak 'core' muscles do not cause low back pain, and in fact people with low back pain often tense their 'core' muscles as a protective response. This is like clenching your fist after you've sprained your wrist. Being strong is important when you need the muscles to switch on, but being tense all the time isn't helpful. Learning to relax the 'core' muscles during everyday tasks can be helpful.

8. Backs do not wear out with everyday loading

The same way lifting weights makes muscles stronger, moving and loading make the back stronger and healthier. So, activities, like running, twisting, bending and lifting are safe if you start gradually and practise regularly.

9. Pain flare-ups do not mean you are damaging yourself

While pain flare-ups can be very painful and scary, they are not usually related to tissue damage. The common triggers are things like sleep, stress, tension, worries, low mood, inactivity or unaccustomed activity. Controlling these factors can help stop things getting worse and if you have a pain flare-up, instead of treating it like an injury, try to stay calm, relax and keep moving.

10. Injections, surgery and strong opioids usually aren't a cure

Spine injections, surgery and strong drugs like opioids aren't very effective for long-lasting low back pain in the long term. They come with risks and can have unhelpful side effects. Finding low-risk ways to put you in control of your pain is the key.