The Back Pain Guide

Back pain is very common, and it is rarely caused by anything serious. How bad the pain feels does not always match how serious the problem is. Most episodes settle within days to a few weeks, and you recover fastest by staying active, not by resting.

Reviewed by Dr. Kshitij Chaudhary, Last reviewed September 2026

At our spine clinic at P.D. Hinduja Hospital, Mahim, Mumbai, back pain is one of the problems we see most often. This guide follows the order in which people usually need answers: easing the pain first, then getting moving, then knowing when to get checked, and finally how to stop it coming back.

5 things to remember

Numbers to remember

When should I get checked?

No red flags? Then start with Stage 1.

Stage 1: Today. Ease the pain

Most people manage most attacks themselves. Control the pain, change how you do things for a while, and keep moving.

Painkillers

• Use them. They are tools that help you keep moving, not a cure on their own.
• Paracetamol is the simplest and usually the safest choice (for example Dolo or Crocin). Take it at the dose on the pack, every 4 to 6 hours. Do not take more than 4 g (eight 500 mg tablets) in 24 hours. Ask your doctor first if you have liver disease or drink alcohol heavily.
• Anti-inflammatory tablets such as ibuprofen can also help. Take them after food, at the lowest dose, for the shortest time.

• Use painkillers for a few days to a couple of weeks. If you need them for longer, see your doctor.

Heat and cold

• In the first 48 hours, try an ice pack wrapped in a damp cloth for 5 to 10 minutes.
• Many people prefer heat: a hot water bag, a warm bath or a warm shower. Use whichever feels better.

Massage, manipulation and other treatments

These are also tools. Their job is to ease pain so you can keep moving.

• Gentle massage can ease pain and muscle spasm.
• Manipulation by a trained professional can help.
• Acupuncture may help some people.
• TENS (Transcutaneous Electrical Nerve Stimulation) uses small electrical pulses through skin pads to ease pain.
• SWD (Short Wave Diathermy) uses deep heat to relax muscles and ease stiffness.

We offer all of these. None is a quick fix. Most of the benefit comes in the first 8 to 10 sessions, so do not carry on for months without progress. If a treatment is not helping, review it with your doctor.

Should I rest in bed?

Only for a day or two, and only if the pain is severe. It is a short-term necessity, not a treatment.

Doctors used to advise weeks of bed rest. We now know it usually slows recovery. You get stiff, muscles weaken, fitness drops, your mood can fall, and getting going again gets harder.

"Motion is lotion." Movement helps your back heal. The most important step is to get moving again as soon as you can.

Stuck with morning stiffness? See The rolled towel trick for morning back stiffness and Sleeping positions and mattresses.

Stage 2: This week. Keep moving

Staying active is the single most useful thing you can do. It builds muscle, keeps you flexible, strengthens bones, lifts your mood and releases natural pain relievers.

How do I stay active?

How to start, even with pain:

• Walking
• Swimming
• Exercise bike
• Yoga, dancing or a gentle fitness class
• Most daily activities and hobbies

Start gently and do a little more each day. Different things suit different people, so try a few. Once the first pain settles, yoga or Pilates can build strength in your trunk and help protect your back.

What if it hurts? Stiff joints and muscles can feel sore when you start again. That is normal and does not mean damage. It eases as you get fitter.

Don't wait for a better time. It will not be easier next week or next month. The longer you wait, the harder it gets.

Ready-made routines:

• Core Exercises for Your Lower Back: how to find and rebuild your deep core
• Everyday Body Mechanics: sitting, standing, lifting, sleeping and getting in and out of a chair or bed
• More in the Exercise Programs library

How do I manage everyday activities?

Keep moving, avoid staying in one position for long, move before you stiffen up, and do a little more each day. Change how you do things instead of stopping them.

Should I go to work?

Yes, if you possibly can. Back pain causes up to 40% of missed work days, and long time off is one of the biggest risks for pain that lasts. Staying busy distracts you from the pain, and your back is not usually worse at work than at home.

• Heavy job? Ask colleagues for help. Small changes make a big difference.
• Seeing a doctor or therapist? Tell them what you do and that you want to stay at work. Suggest your own workarounds.
• Already off work? Go back as soon as you can, usually within days or a couple of weeks, even with some pain. Ask for lighter duties for a week or two if needed.

If you are not back after a month, plan your return with your doctor, therapist and employer. After 1 month off, there is about a 10% chance you will still be off work a year later.

Stage 3: Weeks 2 to 3. Is it improving?

Most people are clearly better by now. If you are not, this stage helps you work out what kind of pain you have, whether you need a scan, and when to see a doctor.

When should I book a review?

Book a review if:

• You have followed this advice for 2 to 3 weeks and are not improving
• Pain stops you working, sleeping or doing daily tasks
• Pain travels down a leg below the knee, or is getting worse
• You still need painkillers after a couple of weeks
• You are 15 to 35, with night pain and morning stiffness that lasts more than an hour
• You simply want to be sure things are on track. That is a good enough reason.

Not sure about the advice you have been given? Send your MRI for a second opinion → Request an appointment online →

What kind of back pain do I have?

Not all back pain is the same. Where you feel it most helps decide what to do.

A few other patterns have their own pages: pain at the very bottom of the spine, see Tail bone pain; pain all over the body with tiredness, see Fibromyalgia: Your Questions Answered; a vertebra that has slipped forward, see Spondylolisthesis.

Why is back pain rarely serious?

Your spine is strong. It is one of the strongest parts of your body: solid bones, cushioning discs, tough ligaments and powerful muscles. Most simple strains do not cause lasting damage.

Back pain is part of normal life. It is not a disease. Since we began walking on two legs, our spine has had to cope with a lot, and sometimes it protests.

What is usually going on. Most back pain comes from muscles, ligaments and small joints that are out of condition and not moving well. The answer is to get the back moving and working again.

Do I need a scan?

Usually not. For this type of back pain, "less is more."

• In people without red flags, scans rarely change treatment. One large estimate is that only about 1 in 2,500 back X-rays finds something that changes what the doctor does.
• In one study of 98 people with no back pain at all, about two out of three had disc changes on MRI.
• These changes are the "wrinkles on the inside", like grey hair. They are normal signs of ageing and do not mean damage. See Degenerative Disc Disease.
• A scan can do harm if the report leaves you afraid of your own back. Fear makes people stop moving, and moving is what helps.
• A scan is useful when there are red flags, or when surgery is being considered.

Already have a report? Read How to Read Your Spine MRI Report before you worry about the wording.

Other common worries

• "Is it a slipped disc?" Only a few people with back pain have one, and even then it usually settles by itself. See Herniated Disc (Slipped Disc) and Will my slipped disc cause paralysis?
• "The doctor can't find the exact cause." That is frustrating, but it usually means no serious damage was found.

More on common beliefs: Common myths about low back pain.

How do I get the most from treatment?

Most back pain can be managed on your own, but it is fine to check with a professional if you are unsure. There is no quick fix, so be realistic.

Doctors and therapists can: confirm there is no serious disease, reassure you, suggest ways to control pain, and help you plan your recovery.

You can help by: accepting reassurance instead of letting worry slow your recovery. It is not just the therapist who does the work. You do too. If you want to stay active and at work, say so.

Long-lasting or recurring pain. A team approach can help, including physiotherapy and CBT (cognitive behavioural therapy), which helps you change how you think about and respond to pain.

Stage 4: After. Stop it coming back

Back pain often returns, and what you believe and do matters as much as any treatment.

What makes back pain last longer?

Pain that lasts is often driven more by what people believe and do than by what a scan shows. Doctors call these "yellow flags". They build up slowly, so you may not notice them in yourself:

• Believing back pain is severely disabling, or a sign of permanent harm
• Fear of movement, so you stop doing things
• Low mood, and pulling away from friends and daily life
• Relying on treatments alone, and waiting for a therapist to "fix" you

What the airport baggage handler study showed. Airport workers who were off work with back pain were taught that they could function despite some pain, and were slowly eased back into activity. They recovered much better. The researchers' conclusion: "If the worker didn't mind some pain, the back pain actually didn't matter."

Which are you: the Avoider or the Coper?

• The Avoider is frightened, rests a lot and waits for the pain to pass. The pain lasts longer and more time is lost from work.
• The Coper knows the pain will improve and carries on as normally as possible. They recover faster and enjoy life more.

How to be a Coper

• ✅ Live life as normally as you can
• ✅ Keep up daily activities, but avoid very heavy lifting
• ✅ Stay fit with walking, cycling, swimming or yoga, even after you feel better
• ✅ Start gently and do a little more each day
• ✅ Stay at work, or return early with lighter duties if needed
• ✅ Expect some aches and twinges. They are normal.

What to avoid

• ❌ Relying on painkillers or treatments alone
• ❌ Staying home or giving up things you enjoy
• ❌ Believing "hurt" always means "harm"
• ❌ Listening to other people's horror stories
• ❌ Bed rest for more than a day or two

How do I stop it coming back? Your back resilience plan

About 1 in 3 people have another episode within 6 months. So stop seeing each episode as a separate accident, and see it as a vulnerability to manage with a "back resilience plan". Your mindset and daily habits are critical.

• ✅ Know your triggers. Notice which positions and activities set it off, and which ease it.
• ✅ Keep daily habits. Walk every day, take breaks from sitting, and exercise regularly.
• ✅ Look after the basics. Sleep well and manage stress. If you smoke, read Smoking and Low Back Pain.
• ✅ Know who to call. Decide in advance which doctor or physiotherapist you will contact early if it flares up.
• ✅ Keep the right mindset. Notice the pain without focusing on it, and stay active through minor twinges.

How can I reduce stress and tension?

Stress and worry can make pain feel worse, and tension can cause painful muscle spasm. Trust the advice here: serious damage is rare and the outlook is good. Exercise is one of the best ways to ease tension. Controlled breathing and muscle relaxation also help.

A simple relaxation exercise

1. Don't try too hard to relax.
2. Get comfortable, sitting or lying down, somewhere quiet.
3. Breathe in slowly and deeply. Hold for 15 to 20 seconds, then breathe out.
4. Focus on something calm and repetitive.
5. Let go as you breathe out. Think about the breath, not about relaxing.

You may feel calmer quickly. Deep relaxation can take 10 to 15 minutes.

This page is for general information and does not replace a medical consultation. Please see a doctor for advice about your own symptoms.

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About Dr. Kshitij Chaudhary

This page was written by Dr. Kshitij Chaudhary, a fellowship-trained spine surgeon at P.D. Hinduja Hospital, Mumbai, trained in complex spine surgery at Harvard Medical School (Beth Israel Deaconess) and the Twin Cities Spine Center, Minneapolis. 🏃🏾About Dr. Chaudhary