Low back pain is pain between the bottom of the ribs and the buttocks, sometimes spreading into a leg. It is extremely common, it is the leading cause of disability in the world, and in most cases it is not caused by anything dangerous. Most episodes improve, guidelines agree on what helps, and the main risk is getting care that does more harm than good. This page is the overview; each section links to the detail.
New loss of bladder or bowel control, numbness around the genitals or buttocks, weakness in both legs, or back pain with fever, after significant trauma, or with a history of cancer and unexplained weight loss. See red flags.
How common it is
Low back pain affects people of every age and in every country. It is now the leading cause of disability worldwide, and the years people live with disability from it rose by 54% between 1990 and 2015, mostly because populations grew and aged.1
What causes it
For nearly everyone with low back pain, no single structure can be identified as the cause. This is called non-specific low back pain. Only a small share has a specific serious cause, such as a fracture, cancer or an infection.1 See non-specific back pain.
Things that make an episode more likely or harder to shake include lifting and awkward loads at work, long unbroken sitting, poor sleep, stress and low activity. Scan findings such as disc wear are common in people without pain, so they often do not explain it; see how the spine changes with age.
What helps
The 2018 Lancet series and the NICE guideline (last updated in 2026) agree on the basics:23
| Approach | What the evidence says |
|---|---|
| Information and reassurance, stay active | First line for everyone |
| Exercise | Recommended; NICE suggests considering a group exercise programme |
| Psychological approaches | Advised for persistent pain in the 2018 Lancet series; NICE withdrew its recommendation in 2026 after reviewing newer evidence |
| Anti-inflammatory painkillers (NSAIDs) | Can be considered for short periods, with attention to risks |
| Paracetamol on its own | Not recommended by NICE |
| Imaging | Not for non-specific back pain; only if red flags are present or the result would change management |
| Belts, corsets, traction, TENS, acupuncture | Not recommended by NICE |
Details and a ranked list are in what works for back pain.
Preventing the next episode
Exercise, alone or with education, is the best supported way to prevent recurrence.2 Walking counts: in the WalkBack trial, a progressive walking programme with education reduced recurrences and roughly doubled the time until the next episode.4 See walking for back pain.
Sitting and posture
Long uninterrupted sitting makes existing back pain more disabling, though sitting time alone is a weak predictor of new pain; see does sitting cause back pain?. No single posture has been shown to prevent back pain; see posture and pain. Breaking up long sitting bouts is the part worth changing; see sitting breaks.
When to see a clinician
Book an appointment if pain is severe, keeps getting worse, has lasted more than a few weeks, or comes with leg pain, numbness or weakness. Seek urgent care for any red flag listed above.
Footnotes
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What low back pain is and why we need to pay attention (Lancet Low Back Pain Series). 2018. ↩ ↩2
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Prevention and treatment of low back pain: evidence, challenges, and promising directions. 2018. ↩ ↩2
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Low back pain and sciatica in over 16s: assessment and management (NICE guideline NG59). 2026. ↩
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Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence (WalkBack). 2024. ↩
The Lancet Series call to action to reduce low value care for low back pain: an update. 2020.
General information, not medical advice. Every claim carries its source; where the evidence is thin, the page says so.Editorial policy · How we grade evidence · All sources · Disclaimer