Low back is a common condition. Unfortunately, it is only possible to accurately diagnose a very small number of patients with back pain. This can lead to frustration for both patient and clinician.

Roughly 1% of back pain problems are due to a complex cause, e.g. infection or a rare form of arthritis. The remaining 99% of patients have some type of mechanical fault, but current clinical tests and imaging techniques cannot always tell us exactly where the problem lies.

In fact x-rays provide very little information and too much exposure to radiation can be harmful. MRI scans only tell us what is worn, not necessarily what is damaged enough to cause pain.

Some clinical tests are more accurate than others. Tests for sciatica (pain in the leg coming from the back) are quite sensitive, but tests for joint or other problems in the back are not so reliable.

Pain in the back or neck could be coming from a disc (discogenic pain), a joint (arthrogenic pain), muscles (myogenic pain) or inflamed nerves (neurogenic pain). Often pain comes from more than one source.

Surgery is only appropriate for less than 2% of patients with back pain, although non-surgical procedures such as injections can help some patients, particularly those with sciatica.

The worst thing a patient can do during a back pain episode is to completely rest the back. This may do more harm than good. Short walks interspersed by equally short periods of rest are recommended by most experts. Paracetamol is often as effective as most prescription painkillers (never exceed the recommended dose).

A TENS machine can be a useful alternative to medications for some patients, but these devices lack strong evidence for their use. If you are keen to purchase one, I recommend the Boots model using programmes A and B. However, don't expect an instant cure!

It is important to stretch your back muscles as you recover from a bout of low back pain. This may involve slowly touching your toes on a regular basis. Contrary to popular belief, this exercise is safe if you do it slowly and gradually.

Often advice on back care is inaccurate. You don't need to bend your knees every time you pick something up off the floor, unless of course it is heavy, in which case you should bend the knees and keep the load close to your body (watch out for slippy floors!).

If you suddenly develop back pain, the first rule is DON’T PANIC! Most back sprains are due to minor trauma that does not lead to long term problems, even if the pain is severe. Slipped discs are not as common as the media or your mate at the pub makes out.

If you feel your back muscles are in spasm, be reassured that this is normal. The muscles go into spasm to protect the injured tissues. This is a good thing! Protective muscle spasm aids faster healing.

Even if the muscle spasm is severe, you are best shrug your shoulders and simply recognise that it is doing you good – not harm. You don't have to call an ambulance or hotfoot it to your nearest Accident & Emergency Department (unless you can't wee: see below).

Anti-inflammatories from your chemist can help reduce pain, but be careful if you have any stomach problems or severe asthma. For best effect, start the tablets three days after you first get back pain (i.e. not straight away). Taking them for two to four weeks should be adequate. Your GP can prescribe you stronger anti-inflammatories if needed. By the way, paracetemol is a very effective painkiller.

Painful backs heal quicker with walking and gentle activity. Obviously the muscle spasm will restrict some simple every day activities (like putting your socks on). Don’t force your body too hard. Allow for the muscle spasm to settle down after a few days. In the meantime stay as active as you can, even if you can’t do everything as normal.

The worst thing to do is to go to bed for a week. Bed rest is bad. It weakens muscles and makes the muscle spasm last much longer than is necessary. By all means lie down a few hours a day for a two or three days, but don’t immobilise yourself completely.

People with back pain often experience shooting pains or an ache in their buttocks and legs. This is referred pain and it is to be expected. It doesn’t necessarily mean you have trapped a nerve. In fact only 5% of patients with leg pain actually have a trapped nerve.

Manipulation (being expertly pulled about by a physiotherapist, chiropractor or osteopath) works occasionally to very good effect, but it is not the wonder cure that you might expect. Not all patients with back pain don’t need to be pulled about in this way.

Acupuncture has become very fashionable for a wide range of conditions, including back pain. The evidence for its use is quite weak. Any benefits obtained may be entirely down to placebo (power of the mind over the body). That is not to say patients should not try it, but yet again, it is not a wonder cure.

There are no perfect exercises that will guarantee to 'cure' your back. However, stretching your back fully each day may protect your back (such as touching your toes each day), as will group exercises such as Pilates and Tai Chi.

Pain all the way down the leg which is WORSE than the back (or with no back pain at all) is probably a trapped nerve. Take yourself to see a GP. Be aware that 90% of trapped nerves heal perfectly well within 12 weeks without the need for surgery, but an injection in the spine may help some people get better quicker.

If you have mega-severe back pain, a numb anus and you can't urinate for more than 12 hours (even though you want to) go to your nearest Accident & Emergency Department. They will know what to do.

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