If you have a generally achy lower back that is relieved by sitting…
If you have an achy lower back that’s triggered by long periods of standing or walking and relieved by sitting, you might need to work on your core strength.
“It could be that your muscular system isn’t supporting your spine as well as it could and you are putting pressure on your joints,” says Brown. “You often see it when people are hypermobile. They are standing at the end of the range of the extension, which can lead to lower back ache.”
Tight hip flexors – the muscles which attach the pelvis to the thigh bone – can add to the problem by increasing the curvature of the lower spine and upper back, leading to lower back and hip pain.
“These people require a strength training approach,” says Brown. “You need to work on core strength and hip mobility.”
If you’re over 55 and your back pain is triggered by walking…
“This could be neurogenic claudication,” says Brown.
“It takes eight to 10 minutes of walking – you could almost set a clock by it – then they’ll start to get some symptoms. It might be pain and might be tingling and numbness that spreads out from the buttocks, or weakness in the legs. Then sitting will relieve those symptoms.”
This particular problem does respond to surgery, but most of us won’t need it as the problem progresses very slowly. Physiotherapy can help. “If you’re standing, moving, walking and you’re not in that arch back position, you’re going to do better. And if you have better hip mobility, you’re going to do better.”
If you have shooting pain that radiates down one or both legs…
Pain that starts in your back that radiates down your leg is known as sciatica. “Typically you feel it in the foot and this is coming from irritation of the nerve roots when they come out of the back,” explains Prof Underwood. “It’s not always clear what causes it. But there is a proportion that is caused by a bit of weakness in the disc, where it bulges or protrudes, it can press on the nerve root.
“Keep moving within the limits of the pain and take pain killers. Anti-inflammatory drugs, like ibuprofen to reduce the inflammation around the nerves, are probably your best choice.”
The vast majority of us will get better within a few weeks, but if the pain continues surgery may help. “If an MRI scan shows a disc pressing on the nerve on the same nerve root, you may surgery to remove where the disc is pressing,” he says.
If you have frozen shoulder or shoulder pain…
“With a frozen shoulder, we call it adhesive capsulitis,” says Underwood. “We don’t know what causes it.” One theory suggests that there may be an autoimmune component to the process, where the body attacks healthy tissue spiralling into a growing inflammatory response.
“It is characterised by pain and stiffness in the shoulder, but it’s difficult to tell it apart from problems with the rotator cuff or with the ligaments that move the shoulder. Either way, the treatment is the same and it usually gets better whatever you do.” Advice for a frozen shoulder? “It’s back to ibuprofen and keep moving,” says Underwood. “Some doctors recommend a steroid injection into the joint. But they probably only have a short term effect.”
If you have osteoporosis…
The pain might be caused by a compression fracture, particularly in women who are 75 or older. “The internal structure of vertebra loses density and can collapse on itself,” says Brown. “Typically it’s acute pain when it happens but it resolves over a few weeks. People just need to keep moving and working with a physio.”
If you have osteoporosis your GP can prescribe drugs that reduce further bone loss or parathyroid hormone treatment that stimulates new bone. However, parathyroid treatments are only used in a small number of people for whom other treatments aren’t working. It’s also important to make sure you’re getting enough calcium and vitamin D.