What kind of back pain is this?

Pain in the back with no identifiable structural culprit and no nerve compression. It is the default and the majority of cases. Muscles, joints, ligaments and discs may all contribute, and the exact source often cannot be pinned down even with imaging.

Aching or stiffness across the low back, often after an awkward movement or a stressful period. Varies day to day. Nothing travelling below the knee.

Staying active, gradually returning to normal, and building strength over time. Most of the movement approaches in this guide are aimed squarely at this group.

Overstretched or overloaded soft tissue, often from lifting, twisting, or an unaccustomed effort. Can be intensely painful and frightening, including spasm that locks you up, but it is not damage to anything structural.

Sudden onset tied to a specific movement. Sore and tight, worse with certain movements, easing over days to a few weeks. Pain stays in the back and buttock.

Gentle movement early rather than bed rest, heat, walking, and time. Massage or manual therapy can take the edge off. It nearly always settles.

The facet joints are the small paired joints at the back of each spinal segment, and they can become irritated or arthritic. Estimates put facet joint involvement in roughly a quarter to 40% of low back pain, though it is often overlooked and hard to confirm.

Localised pain to one side of the spine, often worse leaning backwards, twisting, or standing a long time, and eased by sitting or bending forward. Can refer into the buttock or thigh, but rarely below the knee.

Movement and strengthening, and avoiding sustained arching while it is irritable. Where pain is persistent and clearly facet-driven, specialists sometimes use diagnostic blocks or radiofrequency treatment.

The joints where the base of the spine meets the pelvis. Commonly missed, and frequently mistaken for a disc problem. More common after pregnancy, trauma, or spinal fusion.

Pain low down and off to one side, often pinpointed near the dimple above the buttock. Worse standing on one leg, rolling over in bed, or climbing stairs. Can refer into the buttock and back of the thigh.

Targeted hip and trunk strengthening, manual therapy, and managing load. Injections are sometimes used to confirm the source and settle it.

Disc changes are extremely common and often completely painless. Problems arise when a disc bulges or herniates enough to irritate or compress a nerve root, producing leg symptoms, or when the disc itself becomes a pain source.

Pain often worse with sitting, bending forward, coughing or sneezing. When a nerve is involved, pain, tingling or numbness travels below the knee, sometimes with weakness.

Most herniations shrink and settle on their own over weeks to months. Directional approaches, avoiding what provokes it, and time. If a nerve stays compressed and symptoms will not settle, injections or surgery become reasonable options.

Not every disc problem is a full herniation. A tear in the outer ring of the disc can happen, and cause pain, without any material actually pushing out — see annular tear below for that distinction.

The disc's outer wall (the annulus) is a tough ring of fibres holding the softer material inside in place. A tear or fissure in that ring is called an annular tear, and it is a different, earlier thing than a herniation: a herniation only happens if the tear is large enough for the inner material to actually push or leak through. You can have an annular tear with nothing pushing out at all.

Often severe, localised low back pain rather than leg pain, since there is usually no nerve involved unless a herniation develops alongside it. Worse with sitting, bending forward, or straining — coughing, sneezing, lifting — much like a herniation's triggers, because it is the same structure under the same loads.

The same conservative approach as for other disc-related pain: activity modification, avoiding what provokes it, and time. Ordinary mechanical back pain, including this, is generally benign and settles on its own. If it is found incidentally on a scan and is not causing symptoms, it typically needs no treatment at all.

This is a genuinely confusing part of a scan report, because annular tears show up on MRI scans of a great many people with no back pain whatsoever, so finding one does not automatically explain your pain. On imaging it is often described as a “high-intensity zone”, and it is worth asking your clinician whether they think it is actually driving your symptoms or is an incidental finding. There is some evidence that a tear at this stage can be a precursor to a full herniation later, which is one reason persistent pain here is worth monitoring rather than ignoring — even though most people never progress to that point.

Narrowing of the space around the spinal cord or nerves, usually from age-related changes. More common over 60.

Legs ache, tire or feel heavy after walking a certain distance, and ease when you sit or lean forward over a trolley or bike. Standing upright and walking downhill often make it worse.

Flexion-based exercise, walking built around your tolerance, cycling, and strengthening. Injections and, for some who do not improve, decompression surgery.

A vertebra shifts forward relative to the one below, either from a stress fracture in younger athletes or from degeneration later in life. Often found incidentally and not always the cause of the pain.

Back pain worse with arching and prolonged standing, sometimes with leg symptoms if nerves are crowded. May ease with sitting.

Trunk and hip strengthening, avoiding aggravating end-range extension, and activity modification. Most cases are managed without surgery.

Pain at the coccyx, the small bone at the very base of the spine. It is a different problem from low back pain and often gets lumped in with it, which is why people end up doing core programmes that do nothing for it. Most cases follow a fall onto the tailbone, childbirth, or long periods sitting on hard surfaces, and some appear for no clear reason. It is more common in women.

Sharp or aching pain pinpointed right at the tailbone, between the buttocks. Markedly worse when sitting, especially leaning back, and often worst of all when standing up from a chair. Often eased by sitting on one buttock, standing, or walking. Pain rarely travels down the leg. A useful tell: pressing directly on the coccyx itself reproduces the pain — that local tenderness on direct pressure is what generally separates coccydynia from other causes of sit-down pain.

Taking the pressure off is the first move: a wedge or U-shaped cushion with a cutout under the tailbone, sitting on your sit bones rather than rocking back, and avoiding long spells on hard seats. Anti-inflammatories, heat, and stool softeners if going to the toilet hurts. A pelvic health physiotherapist is the specialist who actually treats this, using manual mobilisation of the coccyx and pelvic floor work. TENS is commonly used as an adjunct. If it stays stubborn, image-guided steroid or nerve-block injections help a substantial proportion of people. Surgery to remove the coccyx exists but is rare and a last resort.

Most cases settle with conservative care, though it can take weeks to months and a minority becomes long-lasting. Two common mimics sit right next door and are worth ruling out, because the treatment differs: ischial bursitis and high hamstring tendinopathy also flare with sitting, but the pain sits over the sit bone (ischial tuberosity) to one side rather than the midline coccyx, and hamstring tendinopathy specifically flares with stretching, running, or lunging — things that do not typically bother a coccyx. Sacroiliac pain, sciatica and, rarely, fracture or something more serious can also mimic it, so persistent tailbone pain that is not improving deserves proper assessment rather than another cushion.

Neck pain is the second biggest cause of disability worldwide after low back pain, and upper back (thoracic) pain affects roughly one in five women and one in ten men. Most of it is mechanical and settles, but the treatment picture is not identical to the low back, so applying lumbar advice here can miss.

Stiffness and aching in the neck, between the shoulder blades or across the shoulders. Often worse after long spells at a desk or phone, or after a sudden strain. May come with headaches starting at the base of the skull. If a nerve is involved, pain, pins and needles or weakness travels down the arm.

Exercise has the strongest support: strengthening the neck, shoulder blade and upper limb, plus range-of-motion work. Guidelines also back manual therapy — notably thoracic (upper back) manipulation alongside neck mobilisation — and reassurance and education. For nerve-related arm pain, intermittent cervical traction combined with exercise and mobilisation is recommended. Keep moving rather than bracing the neck.

Most of the named methods listed further down this page were designed for the lower back, so they do not all transfer directly — this section and a neck-focused physiotherapist matter more here than the method list does. Whiplash after a car collision and neck-related headaches are recognised subgroups with their own management. Seek prompt assessment for neck pain after significant trauma, or with arm weakness, unsteadiness, or problems with your hands.

More than half of pregnant women get low back pain, and somewhere between 10 and 65% get pelvic girdle pain — pain at the sacroiliac joints, the pubic joint at the front, or the buttocks. It commonly persists after birth, though it is roughly half as common postpartum. It is frequently dismissed as just part of pregnancy, which is a shame, because it is treatable.

Pelvic girdle pain: pain low down at the back of the pelvis, in the buttock, or over the pubic bone, worse with walking, stairs, standing on one leg, rolling over in bed, or getting in and out of a car. Low back pain in pregnancy behaves more like ordinary mechanical back pain, worse with prolonged postures and load.

Staying active. Exercise during pregnancy reduces the severity of back and pelvic pain, though it does not reliably prevent it. Walking, low-impact aerobic exercise, and adapted yoga or Pilates are generally considered safe. For pelvic girdle pain specifically: individualised physiotherapy, targeted stabilising exercise, pelvic support belts, manual therapy, and acupuncture all have guideline support. A pelvic health physiotherapist is the person to ask for.

Always clear exercise with your midwife or doctor, since there are situations where activity should be limited. Persistent pelvic girdle pain after birth is not something to simply wait out — it responds to treatment, and getting help early is better than assuming it will fade on its own.

The hip joint sits right next to the low back and the SI joint, and problems there are commonly mistaken for back pain, or missed entirely because everyone is focused on the spine. There are two different patterns worth knowing.

An ache on the point of the hip or outer thigh, worse lying on that side at night, worse climbing stairs, worse sitting with legs crossed, and often tender if you press directly on the bony point of the hip. Common, and more frequent in women 40 to 60.

Deep groin pain rather than back pain, sometimes with catching, clicking or a feeling of the hip giving way. Worse with prolonged sitting, getting in and out of a car, or putting on socks and shoes. Pain with the hip rotated inward is a common trigger.

Both patterns can radiate into the buttock and even the low back, closely mimicking SI joint or disc-referred pain. Low back pain and hip pain also frequently occur together, which makes it harder to tell which one is actually driving things.

A clinician can often tell hip from spine in minutes using a few movement tests — rotating, crossing, or loading the hip in specific ways reproduces hip pain but not spinal pain. For outer hip pain: activity modification, hip and glute strengthening, and sometimes an injection. For deep hip pain: strengthening, activity modification, and imaging if it persists, since labral and impingement problems sometimes need a specialist opinion.