Low back pain is the leading cause of disability worldwide and is becoming more common as our population ages.
Most people who have an episode of low back pain recover within six weeks, but two-thirds still have pain after three months. By 12 months, pain may linger but is usually less intense.
Still, recurrence is common and in a small number of people it may become persistent and disabling. Chronic back pain affects well-being, daily functioning and social life.
A series on low back pain by the global medical journal The Lancet outlined that most sufferers aren't getting the most effective treatment.
The articles state that recommended first-line treatments – such as advice to stay active and to exercise – are often overlooked.
Instead, many health professionals seem to favour less effective treatments such as rest, opioids, spinal injections and surgery.
So, here's what evidence shows you need to do to improve your low back pain.
Risk factors for low back pain
The cause of most people's low back pain remains unknown. But we do know of a number of risk factors that could increase the chance of developing low back pain.
These include a physically demanding job that involves lifting, bending and being in awkward postures. Lifestyle factors such as smoking, obesity and low levels of physical activity are also associated with developing low back pain.
People with low back pain should see a health professional to rule out the more serious causes of pain such as fracture, malignancy (cancer) or infection.
Once patients are cleared of these, the current guidelines from Denmark, the UK and the US advise self-management and psychological therapies as the initial response for persistent low back pain.
These include staying active, doing appropriate exercises and undertaking a psychological program to help manage the pain.
Exercises such as Tai Chi, yoga, motor control (to restore strength, co-ordination and control of the deep core stabilising muscles supporting the spine) and aerobic exercises (such as walking, swimming, cycling and general muscle reconditioning exercises) are recommended.
If any of these therapies fail or stop working, the guidelines point to manual and physical therapies such as spinal manipulation (Denmark, UK, US), massage (UK and US) and yoga and acupuncture (US) – particularly for low back pain lasting more than 12 weeks.