I have pain in my lower back

In brief

In brief

  • Lower back pain can start suddenly or more slowly.
  • The most important thing is to stay active and keep moving as usual.
  • Avoid sitting in the same position for a long time.
  • Keep doing your daily activities (housekeeping, work and hobbies).  
  • Doing exercises can help you feel better.
  • Try to reduce your stress.  
  • The symptoms will usually improve within a month.
  • Dutch healthcare practices in general may differ from what you are used to in your home country. Learn more.
Videos

Videos

Lower back pain (with English subtitle)

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Exercises for your lower back (with English subtitle)

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What is it?

What is lower back pain?

Lower back pain is common. It can start suddenly or more slowly.

  • It is often an aching pain. The pain can also be very severe.
  • Certain positions or movements often cause a lot more pain. Sometimes you can hardly move because of the pain.
  • Your back can feel stiff after sitting still.
  • Sometimes the pain radiates into 1 or both upper legs. This is called sciatica. 

With this kind of lower back pain there are no signs of a slipped (herniated) disc, abnormality or injury as the cause of the pain. We therefore call this ordinary back pain.

Ordinary back pain clears up on its own. 

Causes

Causes of lower back pain

It is not clear precisely what causes lower back pain. The muscles, ligaments and bones of the lower back probably don’t work together well temporarily.

The following factors increase the chance of lower back pain:

  • being overweight
  • a lot of stress
  • heavy physical work
  • long drives in the car
  • lifting a lot
  • twisting or bending the back a lot 
Examinations

Is an X-ray, CT or MRI scan needed for lower back pain?

An X-ray or scan (CT or MRI) is not useful and not recommended for lower back pain. Why not?

  • An X-ray or scan does not provide any useful information. In many people something abnormal can be seen on an X-ray or scan of the back, even in people who never have back pain. Abnormalities on an X-ray or scan are hardly ever related to the lower back pain. 
  • The approach to back pain does not depend on whether or not anything is seen on an X-ray or scan. The approach is always to stay active and keep moving as usual.  
  • An X-ray or scan does not affect how quickly your symptoms will clear up.
  • Sometimes people are given unnecessary treatments because of an X-ray or scan.
  • Another disadvantage of an X-ray or scan is that the radiation can damage the reproductive organs. 
Moving and exercising

Advice for staying active and exercising with lower back pain

Pay attention to your posture and movements

  • Are you unable to find a comfortable position at night because of the pain? Then try lying on your back with some pillows under your knees, or on your side with your legs pulled halfway up.
  • To get out of bed, roll onto your side first. Move your legs over the edge of the bed and push yourself up sideways with both arms. To lie down, make the same movements in reverse order.
  • Sit on a straight chair, preferably with armrests, so that you can stand up more easily. Sit with your back straight and your stomach pulled in. When getting up, place your hands on the armrests and slide forward to the edge of the seat. Place one foot directly under the chair and the other foot slightly in front of you. Try keeping your back straight while you stand up.
  • Use a swivel chair when you sit at a desk, so that you can turn around with the chair when you want to grab something behind you or when you want to stand up.
  • When you have to lift something, bend your knees and lift with your back straight. Keep the object you are lifting close to your body (don’t lift with your arms stretched out in front of you).
  • Don’t lift too much at once. Don’t lift heavy things over long distances, but make stops in between.
  • Avoid twisting and bending your back at the same time.
    • If you want to pick up something next to you or behind you, stand up first, turn around and then bend down with your knees.
    • When you get out of the car, make sure you turn your body and legs a quarter turn at the same time. Place your feet on the ground and support yourself with your hands before you stand up.
  • Preferably wear flat shoes.

Exercising

Exercises will not help lower back pain clear up any faster. But some people find it pleasant to do some stretching exercises. As a reaction to the pain, your muscles tend to tighten. In that case, stretching exercises can help these muscles to relax again.

Stretching exercises

  • Pull up your knees
    Lie on your back with your knees bent and your feet flat on the ground. Use your hands to slowly pull your knee up towards your chest. Hold this position for 30 seconds. Then slowly lower your leg. Repeat the exercise with your other knee.
  • Tilt your pelvis
    Arch your back as much as you can by pushing your buttocks back and your stomach forward. Then gradually straighten your lower back by pulling your lower abdomen in and tightening your buttocks. You can do this exercise lying down, sitting down, standing, or on your hands and knees. You can combine this exercise with your breathing: breathe in while your back is arched, and breathe out while your back is straight.
  • Twist your lower back
    Lie on your back with your knees bent and your feet flat on the ground. From this position, slowly move both knees to the left and then to the right. Keep both shoulders on the ground. Repeat the exercise.

Strengthening your muscles

  • Abdominal muscles
    Lie on your back with your knees bent and your feet flat on the ground. Touch your knees with your fingers and hold this position as long as you can. Relax for a minute and then repeat the exercise.
  • Back muscles
    Lie on your stomach with your arms and legs stretched. Then raise your arms and legs and hold this position for as long as you can. Relax for a minute and then repeat the exercise.

Stay active and get plenty of exercise

  • Make sure you get plenty of exercise. Sports such as swimming, cycling and jogging can help you get stronger, more flexible and fit.
  • Swimming and walking are also recommended in case of severe pain.

Avoid cooling down

Some people with back problems find it pleasant to keep the lower back warm. People with back problems also say that their back becomes stiffer or more painful if their back cools down quickly after exercising or heavy work. This cooling down can be caused by wet sportswear or work clothing sticking to the back. Cooling down can be prevented by quickly changing into dry clothes after sports or heavy work.

Videos

Videos

Advice

Advice for dealing with lower back pain

  • Keep moving as usual. This is important, even if your back is causing you a lot of pain. Moving is not harmful, and is important for your recovery. You can’t break anything in your back by moving, not even if it hurts a lot or is almost impossible. 
  • Avoid sitting in the same position for a long time. For example, after 15 minutes, stand up, go for a walk or do some exercises.
    Physiotherapy is not useful if you have only had back pain for a short time. It won’t make you recover any faster.   
  • Keep doing your daily activities (housekeeping, work and hobbies). This way you have less chance of developing chronic back pain.
  • Lying down in bed during the day does not help the symptoms clear up any faster.
    Is lying down the least painful position for you? Then you can lie down for a few hours a day the first few days. After a few days, start your daily activities again. Bed rest weakens your muscles, which slows down recovery. 
  • Stress can make back problems worse. Try to reduce the stress (in Dutch), for example by using your time differently or solving your problems.
  • Are your symptoms related to your work? Or do your symptoms affect your work? Then discuss this with your employer and the company doctor (occupational physician) (in Dutch). It might be possible to make adjustments, for example by:
    • changing the height of your chair, desk or computer
    • using special aids
    • dividing the tasks differently
Medication

Medication for lower back pain

Painkillers, such as paracetamol, ibuprofen and diclofenac probably do not help much in improving lower back pain.

If you do want to take a painkiller, it is best to take paracetamol (a maximum of 2 x 500 mg tablets 4 times a day). The most important thing is to keep moving, and if paracetamol can help you do that, that's fine.   

You can also try rubbing diclofenac gel or ibuprofen gel on your back. 

Paracetamol is less likely to cause side effects than ibuprofen and other NSAIDs (in Dutch). Are you over 60 years old? Do you have gastrointestinal, cardiovascular or kidney problems? Are you taking medication?? Then ask your doctor or pharmacy first if you can use an NSAID. For risks and side effects, see NSAIDs (in Dutch).

Do not use any muscle relaxants (benzodiazepines, such as temazepam, oxazepam, or diazepam). They do not help for lower back pain, but they can cause side effects. 

What happens next

What happens next if you have lower back pain?

Lower back pain usually clears up on its own. The symptoms usually decrease within 4 weeks if you stay active and keep moving as usual. 

Do you notice no improvement within 4 weeks? Then, see your GP 4 weeks after the symptoms started. Your GP will make a step-by-step plan with you. This plan states when you will resume your activities again, step by step. A physiotherapist or exercise therapist (in Dutch) can support you if necessary. You can discuss possible solutions at work with the company doctor (occupational physician) (in Dutch). 

Chances are high that you will get back pain again. More than half of people with back pain get it again within a year. In that case, the symptoms often clear up again on their own if you stay active and exercise regularly.

When to call

When should I contact my GP for lower back pain?

Urgent: Call your GP or the out-of-hours service immediately if you have 1 or more of the following symptoms:

  • you are dizzy and sweating, and feel like you might faint
  • you can no longer pee (urinate) even though you feel you need to
  • your bottom and groin feel numb 
  • you suddenly lose strength in your leg (you are unable to stand on your toes or heels)

Call your GP or make an appointment (during office hours): 

  • if you have pain in your back after a fall
  • if you have recently had back surgery or an injection in your back
  • if you have (or have had) cancer
  • if the symptoms have not improved after 4 weeks 
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