Private lower back pain clinic in London, same-day physiotherapy.

Arrange an appointment the same day if you have back pain with

• a fever, or feeling generally unwell;
• unexplained weight loss, or a history of cancer;
• a significant injury such as a fall or road accident, or osteoporosis and a minor fall;
• pain that is constant, unrelated to movement, or wakes you every night;
• a weakened immune system, long-term steroid use, or injecting drug use;
• first onset of significant back pain under the age of 20 or over 55.

What is actually going on

In the great majority of cases no single structure is to blame and no specific diagnosis is needed. Muscles, joints, ligaments and discs all share nerve supply, and the back is very good at producing severe pain from minor irritation. Spasm — the muscles tightening protectively — accounts for a lot of the pain and much of the difficulty moving.

Scans are not usually helpful early on. Almost everyone over 30 has changes on an MRI that are simply part of normal ageing, and finding them does not change the treatment. Imaging is used when the examination suggests a specific problem, not to explain ordinary back pain.

What to do

Pain relief

An anti-inflammatory such as ibuprofen or naproxen, taken regularly at the lowest effective dose for the shortest time, is the first choice for back pain. Take it with food. Anti-inflammatory gels rubbed into the area also work and carry fewer risks.

Check with a pharmacist or with us before taking anti-inflammatories if you have asthma, indigestion or a stomach ulcer, kidney problems, high blood pressure or heart disease, or if you take blood thinners. If they do not suit you, we can discuss alternatives.

Sciatica

Sciatica is pain travelling from the back or buttock down the leg, often past the knee, sometimes with pins and needles or numbness. It happens when a nerve root is irritated, commonly by a disc bulge.

• The leg pain is often worse than the back pain, and can be sharp or burning.
• Most cases settle over six to eight weeks, though some take longer.
• The same principles apply — keep moving, use anti-inflammatories, avoid prolonged sitting.
• Come back to us if the leg is becoming weaker, the numbness is spreading, or there is no improvement after six weeks. Nerve root injections and specialist opinion are options when conservative treatment is not enough.

Getting back to normal, and staying there

• Build up walking distance week by week.
• Once the acute pain settles, regular exercise of any kind you will actually do — walking, swimming, Pilates, yoga, strength work — is the best protection against another episode.
• Back pain often recurs. A recurrence is not a sign of damage accumulating; treat it the same way and it usually settles faster than the first time.