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Updated: 10 Jan 2022

How to treat back pain

What works best for back pain? We asked the experts about the evidence for common back pain remedies
Anna Studman

Most of us will suffer from back pain at some point, but in the path to finding relief, you can end up spending a lot of money on treatments that aren't proven to work.

Back pain is very common, with around 80-90% of us experiencing it at some point, according to the British Medical Journal. 

When faced with the pain and discomfort it brings, it can be tempting to try anything. But treatments are varied and often expensive, and it’s important to know the limits of what they can achieve.

Here we look at what common back pain products, manual treatments and services can and can’t do, with insights from some of the UK's top pain specialists, to help get you moving comfortably again.

What causes back pain?

There's a common misconception that if you're experiencing back pain, there's something 'wrong' or out of place that needs to be found and fixed, says Dr Neil O'Connell of the Cochrane Pain, Palliative and Supportive Care group.

This is understandable, as back pain can feel severe and worrying when it first hits. But Dr O'Connell explains that usually, regardless of medical interventions, back pain should improve substantially over the first few weeks, and that the first couple of days are usually the worst.

How to tackle back pain

There’s a lucrative industry based around selling back pain remedies, but the bottom line is there’s no silver bullet. The best approach for acute back pain is not to panic, and to try and keep moving. 

For short-term symptom relief, try certain painkillers (see more below) and exercises. A massage or treatment such as physiotherapy can also help. 

If the pain bothers you for a couple of days, or is accompanied by new symptoms such as unexplained weight loss, fever or localised tenderness on your back, it’s worth seeing your GP to rule out the small chance of another problem. 

Chronic back pain can be tricky to tackle, but pain specialist Dr Andrew Moore says individualised treatment that allows people to get back to activities they enjoy works best, typically including movement – and possibly psychological support to manage pain.

Back pain: what works and what doesn't

The good news is that some of the best evidence-backed remedies don't actually cost anything. All the experts we spoke to said keeping moving is key. Short-term pain relief and some manual treatment can help to encourage this. We run through what you need to know about the different options below.

Physical movement

The best medicine for a bad back is to get moving again as much as possible. Physical movement is the first line of treatment recommended in the UK, above drugs and other interventions. 

The idea that bed rest is required can be harmful as, according to Dr O’Connell, fear of movement when you’ve got a painful back could prolong or stall your recovery.

You might need to rest for the first couple of days after the onset of pain if it's really severe, but it's important to get gently moving as soon as possible. 

Working on strength and mobility is key, but there's no one way you have to go about it.

There’s evidence that activities such as pilates, yoga and tailored physio exercises can help, but almost any form of movement or exercise is positive. So if there’s something you enjoy doing and can work into your daily life, this should bring some relief.

It’s also important not to stay in any position for too long during the day, so make sure you take regular movement breaks. 

See our tips on how to set up a home gym or yoga studio.

Pain relief

For acute back pain, 200mg fast-acting ibuprofen with 500mg paracetamol works best, according to a Cochrane study on pain. A caffeine hit from a cup of coffee can add to the pain relief effect.

Evidence shows that neither paracetamol on its own nor aspirin are very effective for back pain on their own, whereas ibuprofen is more consistently effective.

Painkillers can help with acute episodes, but aren't usually recommended for chronic pain (pain lasting more than 12 weeks), as over-use of painkillers can have its own issues – ibuprofen can affect your stomach, for example.

Find out more in our painkillers guide

Topical pain relief

Evidence is limited for topical 'rubefacients', such as Deep Heat , which are thought to increase blood flow to the skin, and it might be a placebo effect.

Topical non-steroidal anti-inflammatory drugs (NSAIDs), such as Voltarol, have been shown to have good pain relief for acute painful injuries, but we don’t know as much about the effect on general acute back pain. 

There are some clinical trials that show they might help with chronic back pain.

Heat packs and cool packs

There’s some evidence that heat packs can reduce pain as much as ibuprofen, and heat plus exercise can be helpful for acute back pain. 

Dr O’Connell says that a heat pack isn’t going to make the pain go away more quickly, but it can make you more comfortable until it does.

For cool or ice packs however, there's no evidence that these are helpful for back pain. 

Manual therapies: physio, osteopathy and chiropractors

Whether manual therapies help back pain or not is a matter of debate in healthcare circles.

For manual therapies such as massage, and the hands-on aspects of physiotherapy, chiropractic or osteopathy, the clinical evidence isn’t that strong – but there is some evidence that it’s better than nothing, and can provide short-term symptom relief. 

Manual therapies shouldn’t be the standalone treatment for back pain, but there’s little harm in considering them as a supplement to exercise and movement, Dr O'Connell told us. 

Indeed, physical movement (which does have good evidence) forms a large part of the treatment plans within these disciplines, so if some symptom relief through massage or other manual therapy helps you to exercise, then overall this is positive.

It's also worth acknowledging that something that feels nice can help you to cope with pain and relieve associated anxiety. 

But it’s a matter of personal preference (and affordability), and the bottom line is that you shouldn’t feel like getting a massage is a prerequisite to recovery.

There are some aspects of manual treatments that we know aren’t necessary – such as the ‘click’ where your spine feels like it’s jolted back into place. Dr O’Connell says that we actually don’t know what this is but, while it sounds dramatic, it’s not something being ‘fixed’ or put back into place.

How different manual therapies compare

Physiotherapy

The aim of physiotherapy is to restore a person’s ability to move and function after an injury, illness or disability – or to reduce risk in the future.

Physiotherapists use a combination of manual therapy to encourage better mobility, along with tailored exercise and advice on physical activity.

Typical price: Physiotherapy is available on the NHS; private appointments usually start from around £40.

How to choose a physio: For physiotherapy on the NHS, you will normally need a referral from your GP or consultant, but some areas in the UK over self-referral on the NHS (check with staff at your GP).

If you are looking for a private physiotherapist, make sure they are Chartered (they will have MCSP in their name) and registered with the Health & Care Professionals Council (HCPC). 

You can find a private physiotherapist using the Chartered Society of Physiotherapy's Physio2u directory

Osteopathy

Osteopathy is a way of identifying and treating or preventing health problems by stretching, manipulating and massaging the muscles and joints.

As part of a consultation, an osteopath will generally ask you about your overall health history and lifestyle before carrying out a physical examination.

Typical price: Osteopathy isn't generally available on the NHS. A private consultation ranges from about £35 to £60.

How to choose an osteopath: Osteopaths must be registered with the General Osteopathic Council (GOsC). You can search for a private practitioner on the GOsC website.

Chiropractic

Chiropractors aim to prevent or diagnose and remedy disorders of the musculoskeletal system.

Seeing a chiropractor for back pain would usually involve them performing spinal and neck manipulations, pulling or stretching the muscles, and mobilising joints. They might also offer lifestyle advice.

Chiropractic tends to be associated with alternative ways of treating illness.

Typical price: It isn’t generally available on the NHS; private sessions cost around £30-80.

How to choose a chiropractor: If you're looking for a private chiropractor, make sure they're registered with the General Chiropractic Council (GCC).

Acupuncture

This treatment involves inserting needles into specific points on the body to stimulate sensory nerves, said to produce natural pain-relieving substances. 

A 2020 Cochrane review didn’t find good-quality evidence for this as a treatment for back pain, but NICE guidelines recommend it for things such as chronic tension headaches.

Typical price: NHS access is limited. An initial private consultation can cost anywhere from £35 to more than £100. There are now multibed or community acupuncture clinics, where several people are treated in the same room, bringing the cost down to around £15 - £20. 

How to choose an acupuncturist: If you choose to have acupuncture, you should check that they are registered with the British Acupuncture Council

Foam rollers and self-massage tools

As with manual therapies, products like foam rollers or home massage tools (such as spiky balls, roller balls or tennis balls to roll out tense muscles) are not necessarily going to solve your pain, but they might feel good or help relieve some symptoms. 

Like manual therapies, they may also assist with your mobility when used as part of an exercise programme. You shouldn't rely on them in isolation or feel that you really need them to recover. 

Do you need a scan or x-ray?

There's a misconception is that getting an X-ray or MRI scan can spot precisely what’s wrong, but this isn't really backed up by the evidence, and can cause unnecessary anxiety and over-diagnosis (where medical issues that would never have caused problems are detected and treated unnecessarily).

A series of reports in The Lancet journal on lower back pain noted that most people have some abnormalities that will show up on a spinal MRI but never cause symptoms, and there’s no evidence to suggest routine scanning improves outcomes for back pain.

There are no clinical guidelines internationally that recommend routine imaging for non-specific back pain. 

Does good posture help with back pain?

Posture is another area where misconceptions are rife. As a society, we have an idea of what 'good' posture is, but more recent thinking is that it's more important not to be in any one position for too long than be in a specific 'correct' position.

The NHS says that 'if you have back pain, improving your posture is unlikely to address the root cause of your pain, but it may help alleviate muscle tension.'

The idea that back pain results from 'bad' posture is a myth, says Dr O'Connell – in fact there's no good evidence that posture as we think of it is a risk factor for back pain. 

People can end up spending a fortune on ergonomic products like office chairs but, for a lot of these, evidence is thin on the ground.

Sitting or standing in any one position for too long can cause pain, so again the advice is not to stay still in one position for too long.

How to tackle chronic back pain

For 8-10% of people, back pain can become chronic and debilitating, according to the British Medical Journal.

There’s no simple answer for chronic back pain sufferers, and treatment is complex.

It requires good professional advice tailored to individuals, focused on getting people back to the activities they enjoy. It typically involves a programme of movement and possibly psychological support.

It can help to work with a good rehab clinician, either privately or referred through the NHS (this might be through your GP or a physiotherapist).

Smartphone apps for chronic pain

There are apps that are intended to help people self-manage chronic pain, usually through a combination of guided movements and some form of psychological support – from cognitive behavioural therapy (CBT) to mindfulness.

We don't know much about how well they work yet, as there's little clinical evidence.

But if people are using these apps as a way to build exercise or movement into their routines, this could be helpful. And mindfulness or psychological activities may help some people with pain-associated anxiety.

However, if you're suffering from chronic back pain, it's still important to seek advice and guidance from a qualified medical professional, and work out how different approaches to treatment suit you.