Back Pain

Your back goes when you lift a bag of cement, bend to pick up a child, or simply get out of bed. Or it creeps up after years of long shifts and heavy lifting. Back pain is one of the most common reasons people miss work, and while it can be frightening, most back pain is not caused by serious damage and gets better.

What is happening

Most low back pain is called "non-specific", which means strained muscles, ligaments and joints rather than a broken bone or serious disease. It often improves within a few weeks. Scans are usually not needed at the start, because they show wear and tear that many people without pain also have.

Staying gently active helps more than bed rest. Too much rest makes muscles weaker and stiffer and can make pain last longer. Pain can also be turned up by stress, poor sleep, worry and fear of damage. This does not mean the pain is "in your head": it means the nervous system becomes more sensitive when you are anxious, tired or low, and calmer when you feel supported.

Sciatica is pain that travels down the leg, often from an irritated nerve in the lower back. It also usually settles, but needs a check if it lasts or causes weakness.

Signs to notice

• Pain, stiffness or spasm in the lower back
• Pain that eases when you move and worsens after long sitting or standing
• Pain spreading into the buttock or down one leg
• Difficulty sleeping because of pain
• Worry about losing income or your job because of your back

30-second self-check

Answer yes or no:

• Has your back pain lasted more than six weeks?
• Does pain stop you from doing your normal work or household tasks?
• Does pain travel below your knee?
• Do you lift, carry or drive for long hours at work?
• Are you avoiding movement because you fear making it worse?
• Is back pain affecting your sleep or mood?

0-1 yes: This is likely to settle with gentle activity and simple pain relief.
2-3 yes: A physiotherapist can help you recover faster and prevent it coming back.
4 or more yes: See a clinic, doctor or physiotherapist, and talk about how the pain is affecting your life.

What you can do next

• Today: Keep moving gently. Short walks around the house every hour are better than lying down all day. A warm cloth or hot water bottle can ease spasm.
• This week: Ask a clinic nurse or pharmacist about safe pain relief for you. Change position often. Lift with your knees bent, keep loads close and avoid twisting while carrying.
• This month: Start simple exercises such as knee rolls, pelvic tilts and walking, building up slowly. Speak to your supervisor about lighter duties if needed.
• Sleep: Lying on your side with a pillow between your knees, or on your back with a pillow under your knees, can help.
• Mind the fear: Hurting does not always mean harm. Movement is part of healing.

Your tool

Pain Impact Score - a short check of how pain is affecting your sleep, work, mood and daily life, with next steps and a summary you can show a clinician.

When to get professional help

Go to a hospital emergency unit now, or call Ambulance 10177 or 112 from a mobile, if back pain comes with numbness around your genitals, buttocks or inner thighs (the "saddle" area), new difficulty passing urine or controlling your bladder or bowel, or weakness in one or both legs that is getting worse. These are signs of cauda equina syndrome, which needs urgent treatment. See a doctor today if back pain follows a bad fall or accident, comes with fever, unexplained weight loss, a history of cancer, or is severe and constant even at night. See a physiotherapist or doctor if pain lasts more than six weeks.
Who can help: physiotherapist, biokineticist, doctor, occupational therapist, emergency services, psychologist

Getting help in South Africa

Your public clinic can assess you and refer you to physiotherapy at a hospital. In private, many medical aids cover physiotherapy visits. Biokineticists help with longer-term strengthening, and occupational therapists can help adjust your work. If your back was injured at work, report it to your employer so it can be recorded under COIDA, the workplace injury compensation system. If long-term pain is wearing down your mood, the Cleared Mind 24-hour Careline on 0800 212 146 can help.