🔙 Men's Health

Lower Back Pain

The most common cause of work absence in Nigeria — and how to manage it.

Lower back pain affects 8 out of 10 people at some point in their lives. In Lagos, it is one of the top reasons for GP visits and work absenteeism. The good news: 90% of acute back pain resolves within 6–12 weeks, and most does not require imaging, injections, or surgery. The right approach makes a significant difference.

Signs and Symptoms

✓ Pain in the lower back — may be dull, aching, sharp, or burning

✓ Pain radiating into the buttocks or thigh (referred pain)

✓ Sciatica — sharp or burning pain radiating from the back down the leg to the foot, often with tingling

✓ Stiffness — worse in the morning, improving with movement

✓ Pain worsening with prolonged sitting, standing, or bending

✓ Pain relieved by movement and changing position

✓ Muscle spasm

✓ Reduced range of motion

Risk Factors

Sedentary work with prolonged sitting
Heavy manual labour, particularly with repetitive lifting
Poor posture — especially when using phones and computers
Being overweight — increases spinal load
Previous back injury or episode
Psychological stress — strongly associated with chronic back pain
Smoking — reduces disc nutrition and healing
Age — disc degeneration increases with age
Weak core muscles

When to Seek Help

Now"Red flags" — back pain with loss of bladder or bowel control, numbness in the groin or inner thighs (saddle anaesthesia), or progressive leg weakness — possible cauda equina syndrome, a surgical emergency.

NowSevere back pain after a fall, road traffic accident, or in an older adult — possible fracture.

SoonBack pain with fever, unexplained weight loss, or pain in someone with cancer history — needs investigation to exclude serious pathology.

SoonSciatica (leg pain below the knee) not improving after 4–6 weeks — assessment to guide further management.

RoutineAcute non-specific back pain — see a GP for diagnosis, reassurance, and advice. Most will not need imaging.

Tests & Diagnosis

🧪 Clinical Assessment

The most important diagnostic tool — history and physical examination identifies red flags, sciatica, and the most likely cause. Most non-specific back pain requires no investigation.

🧪 X-ray

Limited value for most back pain — does not show discs, nerves, or muscles. Useful only for suspected fracture, infection, or significant bony pathology.

🧪 MRI Lumbar Spine

The investigation of choice when surgery, infection, malignancy, or cauda equina syndrome is suspected. Not needed for routine back pain — disc "bulges" on MRI are common in asymptomatic people.

🧪 Blood Tests (ESR, CRP, FBC, PSA)

When infection, inflammatory arthritis, or malignancy is considered — guided by red flags.

Treatment Options

Keep Moving — The Most Important Advice

Bed rest worsens and prolongs back pain. Continue as much normal activity as possible. Walking, gentle stretching, and returning to normal activities as soon as possible leads to faster recovery than rest.

Pain Management for the Acute Phase

Regular ibuprofen or naproxen (with food) for 1–2 weeks — more effective than paracetamol alone for acute back pain. Short-term muscle relaxants (diazepam, cyclobenzaprine) for significant muscle spasm. Avoid opioids for non-specific back pain — they worsen long-term outcomes.

Heat Application

Local heat (hot water bottle, heat pad) is effective for muscle spasm and acute pain — apply for 15–20 minutes several times daily.

Physiotherapy

Exercise-based physiotherapy — core strengthening, McKenzie exercises, stretching — is the most evidence-based long-term treatment for recurrent and chronic back pain. Referral after 4–6 weeks of acute pain.

Addressing Psychological Factors

Fear of movement (kinesiophobia) and catastrophising thoughts about back pain significantly worsen outcomes. A pain management approach addressing beliefs about pain, not just physical symptoms, improves long-term function.

Surgery (Rarely Required)

Surgery is indicated for true nerve compression with progressive deficit (leg weakness, foot drop) or cauda equina syndrome. For non-specific back pain or uncomplicated sciatica, surgery is rarely better than conservative treatment long-term.

Frequently Asked Questions

Should I have an MRI for my back pain?

Probably not — unless red flags are present (see above). MRI commonly shows "disc bulges" and "degeneration" in pain-free people. These findings on MRI often increase anxiety without guiding better treatment. MRI is indicated when surgery is being considered or serious pathology is suspected.

How long will my back pain last?

90% of acute back pain episodes improve significantly within 6–12 weeks. The key to recovery is staying active — bed rest prolongs recovery. A minority develop chronic pain, which requires a different management approach.

Is my back pain caused by my kidneys?

Kidney pain is usually felt in the flank (side of the back, below the rib cage) rather than the lower lumbar area, and is often associated with fever, painful urination, or blood in the urine. If these features are present — see a doctor urgently.

Can poor posture cause back pain?

Prolonged poor posture (sitting with the spine collapsed, looking down at a phone for hours) contributes to back pain. However, there is no single "correct" posture — variation and movement are more important than maintaining any fixed position.

Can I exercise with back pain?

Yes — this is one of the most important messages. Gentle walking, swimming, and specific back exercises reduce pain and speed recovery. Complete avoidance of activity extends the episode and risks chronic pain.