Low back pain

Condition · 14 min read · 10 Jun 2021

Learn about low back pain and how you can manage your low back pain.

Getting credible and helpful information is vital to help you recover and manage your back pain.

  • Peter O’Sullivan
  • Lucie O’Sullivan
  • Brooke Fehily
By Prof Peter O’Sullivan, Ms Lucie O’Sullivan and Ms Brooke Fehily

Australian data shows that around 80% of young people will develop back pain at some point in their life. For 20% of young people experiencing back pain, it negatively impacts their life. Back pain can negatively impact a young person’s capacity to study, sleep, complete tasks at work or school, and engage in physical activity. Young people also struggle with the invisibility of their pain and the lack of understanding, empathy or even acknowledgement from their friends, peers and family, all of which can negatively impact their mental health.

While living with back pain is really challenging, you can live well with back pain if you have the right understanding, the right plan and the right team of health professionals supporting you.

Busting the Myths of Back Pain

There are lots of myths about back pain that people commonly believe. Myths can be very unhelpful. Understanding what is true and what is false about back pain is the first step to positively and effectively managing your back pain.

Common myths and facts about back pain

Myth: Back pain is caused by lose joints, or the spine being ‘out’ of place. Back pain means my back is damaged damage
Fact: Backs are really strong, mobile structures and they don’t go ‘out’ of place

Myth: Disc degeneration and disc bulges on a scan are serious signs of pathology. Back pain is just a physical, structural problem


Fact: Back pain is rarely associated with serious tissue damage or pathology. When back pain is associated with tissue damage, healing typically occurs within 6-8 weeks. Findings on a scan such as disc degeneration and disc bulges are common in young people without back pain


Myth: Back pain needs to be rested and protected. It is dangerous to exercise, bend or lift with back pain


Fact: Back pain is closely related to levels of muscle tension, poor sleep, mood, stress or worry. Good sleep, healthy diet, relaxed movement and exercise helps back pain. Backs get healthier and stronger with graduated movement and exercise


Myth: You need to watch your posture with back pain


Fact: A range of postures are safe for the back. Being too sedentary isn’t good for back pain


Myth: Its not safe to carry a back-pack


Fact: There is no evidence to suggest that wearing a backpack is unsafe for young people


Myth: Ongoing back pain means the spine is becoming more damaged


Fact: Ongoing back pain is related to hyper-sensitivity of the spine’s structures to load and movement. This is related to many factors but is rarely linked to tissue damage


Myth: There is nothing you can do for back pain


Fact: Back pain can be effectively managed with the right support


Myth: Back pain will get worse with time


Fact: With the right care, back pain does not get worse over time


Myth: A back pain flare-up means I have injured my back


Fact: Pain flare-ups are common and are usually cause by factors such as inactivity, stress and low mood


Myth: Scoliosis is a cause of back pain


Fact: While people with scoliosis may experience back pain, they are at no greater risk of back pain than those without scoliosis


"Back pain is rarely associated with any serious damage or pathology and can be effectively managed with the right support."

Are there different kinds of back pain?

Yes: ‘specific’ and ‘non-specific’. Want to know more about kinds of back pain – read on.

You can also use our medical self-check to see if you should seek help.

‘Specific’ back pain

‘Specific’ back pain, or back pain relating to a clear structural or pathobiological cause is very rare. Less than 1% of people have back pain related to cancer, infection, fracture or an inflammatory process, such as Juvenile Inflammatory Arthritis. Internal organs can also sometimes refer pain to the lower back.

In a small group of young people engaged in repetitive sports such as gymnastics and cricket, back pain can develop from stress to the bony structures of the spine (a stress fracture).

Less than 1% of young people have nerve compression from a disc bulge or prolapse resulting in a loss of power and pain or tingling/numbness sensations running down the leg. In very rare cases, this may also result in a numbness over the saddle area (groin, buttocks, genitals and inner thigh) and an inability to pass a bowel motion or urinate due to a loss of nerve function to this region.

NOTE: It is important to understand that findings such as disc bulges and disc degeneration are also common in people without back pain. This means these changes aren’t always associated with a specific diagnosis.

The majority of people with back pain DO NOT have ‘specific’ pathology. This means that there are other known factors that may be contributing to your back pain.

What should I do if I have ‘specific’ back pain?

If you are given a specific diagnosis, your health care professional will work with you to develop a management plan that works for you and that takes into account any specific clinical guidance for your back pain. Depending on what your diagnosis is, the type of management plan will vary. With any health care encounter, we recommend you ask these 5 important questions to ensure you are getting the right amount of care; not too much and not too little.

Some examples of specific diagnoses are listed below:

  • Spine infections and cancer are very rare in young people, but require urgent medical care.
  • If you have a back fracture (break) from a traumatic injury or a stress fracture from repeated loading, this can be extremely painful and distressing. It’s important to know that bones heal within 6-8 weeks and your back pain should gradually resolve. Once the fracture has healed a graduated rehabilitation process is usually needed to restore normal relaxed movement, strength and confidence in the spine. If pain persists after healing time other factors may need to be addressed.
  • Leg pain from nerve compression due to a disc prolapse can be very painful and distressing. For most people, their pain gradually resolves in 6-12 weeks and the disc prolapse is re-absorbed naturally over a 3-6 month period. It’s a good idea to work out a pain management plan with your health professional, including how gradually increasing your activity can assist the process of recovery. This means surgery is rarely needed unless you progressively or suddenly lose muscle power and/or bladder/bowel function. See our pain management modules for what you can do to help your recovery and cope with your pain.

Other spine conditions that are not necessarily related to back pain:

  • Scoliosis occurs in up to 5% of adolescents and it is more common in females than males, however, back pain is not commonly associated with scoliosis.
  • Scheuermann’s disease is a condition that affects the growth plate of the vertebral body of the spine during adolescence, affecting about 3% of young people. This may result in the vertebra becoming wedge-shaped affecting the curvature of the spine. However, this is often not associated with back pain.
  • Spondylolisthesis is a condition that can occur in up to 5% of young people. Here, one spinal vertebra can shift forward on another, due to a weakness or defect in a part of the spines structure, but the spine is still intact. In many cases, such a condition is pain-free and can be effectively managed with an exercise program tailored to specific needs.

‘Non-specific’ back pain

For 95% of people back pain is ‘non-specific’. Here, spinal structures can become very painful and sensitive without specific structural damage or pathology. This means that there are likely to be other factors that are causing your back pain. While back pain is always REAL, searching for a tissue cause with this type of back pain can be unhelpful and distressing.

In some cases, back pain can be localised, while in others it can co-exist with other pain problems such as pelvic pain, gut pain, neck pain, headaches, and chronic widespread pain. Exploring and understanding the other factors that are known to cause back pain, that are within your control and that with help and support you can change, is the key. Other factors known to cause ‘non-specific’ back pain include:

  • Physical factors such as muscle tension, holding awkward stiff postures, over-protecting the spine during movement or activity, and poor physical conditioning.
  • Lifestyle factors such as being sedentary, inactivity, over-activity and poor sleep patterns.
  • Psychological factors such as stress, worries and low mood.
  • Other health factors such as generalised fatigue, unhealthy body weight (over and under-weight) and mental health conditions.

All these factors differ between individuals and can result in tension in the back and ‘core’ muscles. This can result in heightened sensitivity (also known as hypersensitivity) to touch, pressure or temperature and to normal movement, postures, or activities.

For example, ‘non-specific’ back pain in some people can occur with repeated activity (i.e. sport), or with sudden or awkward loading on the back. This most often happens when you’re doing too much, you’re run down, or not active enough. It’s like a ‘sprain’ that can be very painful but usually recovers quickly with gentle progressive movement and activity.

At other times, ‘non-specific’ back pain can occur without any clear mechanical trigger. This kind of back pain can occur when you are stressed, sad, not sleeping well, and are run down or unwell. It can also occur when you are more sedentary i.e. sitting or studying for long periods. This kind of back pain is a bit like an intense headache that can develop with little prior warning.

‘Non-specific’ back pain can be really intense and scary, and even small movements can hurt. Muscles in the back might feel like they “seize up” to guard the back as a protective response to the pain. Most young people with this kind of back pain naturally recover in a week or two.

Working with a health care practitioner to coach you through this process can help you regain full confidence, mobility, and functional capacity, especially if you feel tense, fearful and unsure about what to do.


"Exploring and understanding the factors known to cause back pain, and within your control, is the key to effective back pain care"

Should I get a scan?

Scans (x-rays or other imaging) are not recommended for most young people with back pain. The exception is when ‘specific’ pathology is suspected, for example when there is:

  1. A traumatic injury, such as when a fracture is suspected
  2. A fever
  3. Progressive loss of sensation, power and/or bowel/bladder function
  4. Progressive weight loss and feeling unwell

What you need to know about scans

Research shows that up to 30% of 16-year-olds and 45% of 21-year-olds with NO back pain show signs of disc degeneration and disc bulges. These findings occur normally and are not indicative of serious pathology.

These findings can sound scary and can lead a person to start to worry about their backs in an unhelpful way and over-protect movements and activities. Checking out our pain management modules, helps you to find ways to safely progress towards recovery from back pain.


“Up to 30% of 16-year-olds and 45% of 21-year-olds with NO back pain, show signs of disc degeneration and disc bulges”

How do I manage my back pain?

You and your health professional can work together to develop a management plan. Knowing what to ask your health professional is important.

Ask your healthcare professional what the best evidence is for managing your back pain (benefits and risks, costs and what happens if you do nothing). View our recommended care fact sheet (PDF) including 5 important questions you need to ask your health professional about your care.

Some of the most effective options for managing back pain are simple, low risk and non-medicine based. The approach is informed by current best evidence practice – that means is shown to be safe and effective.

Understanding the factors that are linked to your back pain

Understanding the factors (i.e. physical, lifestyle or psychological) linked to your back pain, is important as it helps you and your heath team to target the best way to manage the pain, as well as recover and prevent it from recurring. To easily understand the factors influencing your back pain, download our low back infographic.

Keep moving in a relaxed manner, stay active and stay at work/school

Over-protecting the back is a problem and can delay recovery. Whether your back pain is recent, or you have had back pain for a long time, moving in a paced way (that is taking the middle road and doing little bits often), and building up gradually over time, helps you recover. See our getting back to what you want to do module.

Moving doesn’t damage your spine although you may feel pain initially as your body gets used to moving again. So, it’s really normal to experience some back pain as you begin to move and exercise. Try not to be afraid of the pain or worry about re-injury. Fear of pain and movement usually causes us to tense up, worry and overprotect ourselves, and we have good evidence that this can make back pain worse and slow recovery.

Gentle relaxed movement, deep breathing exercises and graduated physical activity all help to calm your system and prevent the persistence or worsening of your pain. As you keep moving, maintaining your usual activities and adopting a paced approach to activity, exercise and work, pain will usually settle.

Daily exercise

Daily exercise helps to boost your own inbuilt pain control systems. This can be a very effective way of improving your function and reducing your pain. You don’t have to get hot and sweaty: walking and yoga are also good forms of activity.

Avoid prolonged bed rest (longer than 24 hours)!

Bed rest usually leads to poorer outcomes and slower recovery. Stay at school, study and work if possible, even if you require short-term changes in your study or work habits. Keep engaged in day to day activities and maintain your social connectivity as this leads to better outcomes e.g. encourages normalcy, gets you moving, distracted and experiencing happy things.

Staying positive and protect your mental health

Young adults experience pain in various ways. We know that it can be really hard to stay positive. Experiencing low mood, anxiety, fear and many other emotions is very common and is a normal response to an abnormal situation when you have back pain. Remember that back pain is rarely life threatening, it usually gets better and you are not alone – there is help. Getting help early is important. You might also find the approaching pain module useful. If you feel distressed and can’t cope with the pain, please seek medical advice early.

Good quality sleep

Sleep is powerful natural pain ‘medicine’. Getting more than 6-7 hours of sleep a night is important and helps reduce the risk of many health conditions. Check out the sleep and pain module.

Sleeping well helps to boost immune function, lift mood and reduce tissue sensitivity. Regular sleep times, reducing screen time and avoiding alcohol /caffeine before bed can improve sleep quality. Relaxation techniques and regular exercise may be helpful for improving your sleep.

Healthy diet

Growing evidence shows that abdominal obesity (fat around your belly) is associated with back pain and sciatica (nerve pain). Losing weight is really difficult, but certainly possible with the right support. Consider seeking help from a dietician or nutritionist with expertise in this area.


Smoking is another predictor for persistent back pain, so getting assistance to quit is a great idea.

Drinking too much alcohol

Drinking too much alcohol can increase back pain in the long run. Alcohol disrupts sleep, lowers mood and can be dangerous (even fatal) in combination with some medicines. Reducing your alcohol intake is helpful. Get help here.

What if my back pain hasn’t gone?

In a minority of people (20-30%), back pain can persist beyond 8-12 weeks. Importantly, this is usually NOT because there is something damaged in the back. Factors that predict ongoing back pain include:

  • Our bodily responses (such as over-protecting/ tensing and or avoiding normal postures, movement and activities).
  • Habits such as not sleeping, overdoing exercise or avoiding exercise and movement, as well as work and social engagement.
  • Our thoughts (such as developing a negative mindset around the back, over-focussing on pain and losing trust in our backs as being strong and resilient).
  • Our emotions (such as high levels of stress, fear of pain, movement and activity, worries, low mood, sadness, frustration, and anger).
  • Other factors such as taking illicit drugs, smoking and drinking alcohol to excess are also associated with persistent back pain.

These things can combine to make us more sensitive and over-protective of our backs so that we can get stuck in a vicious cycle of pain and disability.

However, there is a way out of pain. View our management modules for helpful tips and skills to manage your pain and recovery.


"The best person to be in control of your back is you."

So what is safe and best to do when back pain persists?

The key to effectively managing persistent back pain is finding a good health team who can work with you to support your management. This process takes time and is often really hard to do when you are in pain. Getting support is a good idea. Good care includes:

  1. Understanding the factors that are relevant to your back pain.
  2. Learning to relax your back particularly when you experience pain.
  3. Building confidence to move and function normally without over-protecting the back.
  4. Gradually get back to doing the things in life you value.
  5. Making a plan to engage in regular physical activity that you enjoy.
  6. Making a plan to get back to school/work and social engagements.
  7. Developing healthy sleep and lifestyle habits.
  8. Learning to manage your stress, worries and mood.
  9. Developing a pain flare up plan.

Health professionals can work with you to help you better understand your back pain and assist you with ways to manage your pain, relax your body and regain confidence, mobility and function and do the things in life that matter to you.

You can also check out our pain management modules to get more help. Your GP or health professional may be able to guide you in your selection of the modules if you are unsure which ones to do.

What about using medicines?

Check out our recommended low back care fact sheet (PDF). Medicines do not work well for back pain. Clinical trials show they are not very effective. They also have significant side effects.

Here is a summary of current recommendations for use of medicines in low back pain care. You can read more about this in the medicines management module. While medicines may be helpful, they are not for everyone:


Low back pain recommended medicines

  • Paracetamol, one of the most common medicines available (and very safe in usual doses of below 4 gms a day [i.e. 2 x 500 mg tabs every 6 hours]), has been shown to be ineffective for the management of acute low back pain.
  • Anti-inflammatory medicines (NSAIDs) may give a small reduction in pain for some people but have many serious side effects.
  • If medications such as ibuprofen are used, taking the lowest effective dose for the shortest duration is recommended.

What about if back pain is severe?

If you have severe pain, you should discuss with your doctor the risk of harm versus benefits when using stronger medicines.

What about strong medicines?

While strong pain medicines have been used for people with low back pain, current evidence shows:


They do not work


They cause significant harm


Are not recommended at all for the management of non-specific low back pain.

Summary of Helpful Low Back Pain tips


Pain can mean we become over-protective, stopping valued life activities: see our making sense of pain management module


Looking back at your progress can help, as you can see how gradually you are regaining activities that you value. Sustaining your efforts brings rewards

Be reassured that it is normal to have some pain as you move and improve
Try and stay positive, most back pain gets better and there is help

Relaxed movement and daily exercise help to engage your own body (endogenous) pain control systems helping to improve your quality of life


Healthy lifestyle habits (like exercise and quality sleep) help reduce the risk of back pain persisting

Keeping socially engaged as well as staying at school or work if possible, helps you recover better and sooner
Low mood, anxiety and fear are common when you have back pain and can be helped with the right support and care

Check out our approaching pain module for help

If your pain is severe and distressing, please seek health professional help.

Want more information?

For more information visit Cochrane Plain Language Summaries and download the consumer’s guide to managing back pain.


  1. Low back pain and sciatica in over 16s: assessment and management, National Institute for Health and Care Excellence, Nov 2016, [PubMed]
  2. Maher C, Underwood M, Buchbinder R, Non-specific low back pain, Lancet 2017 Feb 18;389(10070):736-747. doi: 10.1016/S0140-6736(16)30970-9. [PubMed]
  3. O’Sullivan P, Smith A, Beales D, Straker L. Understanding Adolescent Low Back Pain From a Multidimensional Perspective: Implications for Management, The Journal of Orthopaedic and Sports Physical Therapy. 2017 01 Oct;47(10):741-51. [PubMed]
  4. Managing low back pain in active adolescents. Best Pract Res Clin Rheumatol Journal. 2019 February;33(1):102-21. [PubMed]
  5. Lin I, Waller R, Wiles L, et al., What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high quality clinical practice guidelines: systematic review, BJSM, 2019, Mar 2: doi: 10.1136/bjsports-2018-099878. [PubMed]
  6. Saragiotto BT, Machado GC, Ferreira ML, Pinheiro MB, Abdel Shaheed C, Maher CG. Paracetamol for low back pain. Cochrane Database Syst Rev. 2016 Jun 7(6):CD012230. PMID: 27271789. doi: 10.1002/14651858.CD012230. [PubMed]
  7. Qaseem A, Wilt TJ, McLean RM, Forciea MA, Clinical Guidelines Committee of the American College of P. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-30. PMID: 28192789. doi: 10.7326/M16-2367. [PubMed]