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Low back pain with leg pain and sciatica

This information is for people with low back pain which may also be felt in the legs.

What causes low back pain?

Low back pain (LBP) can come from a number of sources including muscles, ligaments, discs, joints and nerves. Most LBP and leg pain will resolve within 6 weeks without any specialist treatment but some may continue past this time.

What causes sciatica and leg pain?

Leg pain can be caused by irritation and (or) compression of a nerve causing the pain to travel down your leg. As well as pain, you may experience altered sensation (numbness), pins and needles or weakness in the leg or foot. Simple sciatica can often resolve within 6 weeks without any specialist treatment, however your GP may choose to refer you to physiotherapy or for an MRI scan.

Diagnosis

The exact cause of LBP is often difficult to find. In most cases you will not need an x-ray or an MRI scan as these will not help to determine your diagnosis or decide on how best to treat your pain. If your low back pain is not resolving or is severe, your GP may refer you to a physiotherapist who will ask you questions, examine you and advise on the best course of treatment. If the GP or physiotherapist feels your pain is due to a more serious problem, they may refer you for an MRI scan.

What treatment might you be offered?

You may wish to control your pain by taking simple painkillers (analgesics) or anti-inflammatories but if this does not help, your GP may be able to prescribe you stronger or different medication. Always consult your GP or local pharmacist if you are unsure about what medication to take. Your GP may feel it appropriate to refer you for physiotherapy.
If this is the case, your physiotherapist will assess you and offer you one or more of the following:

individual treatment
an exercise programme
referral to an exercise group

There are other forms of treatment for LBP but those mentioned here are recommended by the National Institute of Clinical Excellence and more information can be on the National Institute of Clinical Excellence website.

Do I need surgery or other intervention?

It is very rare that people with lower back pain only will require surgery and approximately only 5% of people with severe leg pain will go on to require surgery. If you have leg pain and are failing to improve with physiotherapy you may be referred for specialist opinion by your GP or physiotherapist with a view to a spinal injection or neurosurgery.

How can I help myself?

These suggestions may help you recover more quickly. It may also help manage your pain if you have had it for a long time and try to prevent recurrence in the future. Staying active It is very important to stay active. You can do this by taking regular walks and doing gentle exercises (see exercises shown below). Although the pain can make this seem difficult, gradually increasing your daily activity can help your pain. Rest when you need to but avoid bed rest as this will increase stiffness and weakness in your back.

Regular medication

Taking your painkillers or anti-inflammatories at regular intervals will allow you to remain active. Exercising may cause you pain or aching but it will not be harming you. Your body warning signals will still let you know if you are doing too much despite taking the medication. If you have weakness in your leg muscles, reduced feeling in your legs or you generally feel unwell please see your GP immediately. Please note that constipation is common with pain medication and if you have a problem with this please see your GP. If you are unable to pass urine, are incontinent or lose feeling in the genital area please go to A&E immediately.

Change lifestyle factors

Think about everyday activities that may be increasing your pain and see if there are ways you can change those activities. This may be sitting on a sofa, at a desk or in a car for long periods, try to change position regularly and place a cushion in the small of your back to improve your posture.
Repetitive bending movements at home or work, try to bend and lift correctly with your knees bent and break up activities with short periods of rest. Stressful situations can also increase your pain, relaxation can help.

Exercises

To exercise effectively you need to stress the body. Below are a few exercises that may help you maintain your range of movement whilst your low back pain resolves. Muscle aches and pains are normal for a few days after exercises but you can minimise these effects by gradually increasing your activity level. Do not continue with any exercise that makes your pain significantly worse.

Lie on your back and pull both knees up towards chest:
- Hold for 5 seconds
- Repeat 10 times
- Perform exercise 3 times a day
Lie on your back with your knees bent up:
- Lower knees to either side then return to the middle
- Repeat 10 times times to each side
- Perform exercise 3 times a day
Lie on your front with your hands in a ‘press up’ position.
Push your shoulders back off the bed keeping your hips on the bed then lower back down.
- Repeat 10 times.
- Perform exercise 3 times a day.

If the information above does not help, you may benefit from physiotherapy so ask your GP to refer you if they think it is appropriate.

Patient information

10 facts about lower back pain

Long lasting low back pain can be scary but it’s rarely dangerous: Long lasting low back pain can be distressing and disabling but it’s rarely life threatening and you are very unlikely to end up in a wheelchair.
Getting older is not a cause of low back pain: Although it is a widespread belief and concern that getting older causes or worsens back pain, research does not support this, and evidence-based treatments can help at any age.
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 back pain begins with no injury or with simple everyday movements. These occasions may be linked with stress, tension, fatigue, inactivity or unaccustomed activity with makes the back more sensitive to movement and loading.
Scans rarely show the cause of low back pain: Scans are only helpful in a minority of people. Lots of scary sounding things can be reported on scans such as disc bulges, degeneration, protrusions, arthritis etc. Unfortunately, the reports don’t say that these findings are very common in people without back pain, and that 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.
Pain with exercise and movements 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 back pain.
Back pain is not cause by poor posture: How we sit, stand and bend does not cause back pain even though 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.
Back pain is not caused by a ‘weak core’:
Weak ‘core’ muscles do not cause back pain, in fact people with 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.
Backs do not wear out with everyday loading and bending: 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 practice regularly.
Pain flare-ups do not mean you are damaging yourself: Whilst 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 prevent exacerbations and if you have a pain flare-up, instead of treating it like an injury, try to stay calm, relax and keep moving.
Injections, surgery and strong opioids usually aren’t a cure: Spine injections, surgery and strong drugs like opioids aren’t very effective for persistent 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.