Back Pain

Low back pain is pain felt between the bottom of your ribs and the top of your legs. In about 9 out of 10 cases no specific structural cause is found, which is why clinicians often call it non-specific low back pain. Most episodes settle over a few weeks, but for many people the pain returns or carries on for months.

What low back pain is, and what it is not

For most people, low back pain is not a sign of a damaged or crumbling spine. The World Health Organization reports that about 90% of cases have no identifiable structural cause. Scans often show worn discs and joints that are common with age and do not explain the pain, which is one reason Ontario Health advises imaging only when specific warning signs are present.

It is also not usually something to wait out lying down. Canadian guidance points the other way: staying as active as you reasonably can, with adjustments while symptoms settle, is part of standard care. Recurrence is normal rather than a sign of failure, and about 40% of Canadian adults have another episode within a year of the first. Pain that runs down a leg with numbness or weakness, or that follows a specific injury, is assessed differently, and related pain is covered on our pages for peripheral neuropathic pain and soft tissue injury.

Signs and symptoms

• Aching, stiffness or sharp pain in the lower back
• Pain that worsens with certain movements, such as bending, lifting, or sitting or standing for a long time
• Muscle tightness or spasm across the lower back
• Pain that spreads into the buttock or down the back of one leg
• Numbness, pins and needles, or weakness in a leg or foot
• Trouble sleeping, working or doing usual activities because of the pain
• Worry, low mood or fear of movement, which often travel with long-lasting back pain

The pattern varies widely. Some people have one episode and no more, others have flares that come and go for years, and the amount of pain does not track neatly with what a scan shows.

What raises the risk

Some risk factors cannot be changed:

• Getting older, since rates of chronic back problems are higher in older age groups in Canada
• Being female, which is linked to higher reported rates of chronic back disorders in Canadian survey data
• A previous episode of low back pain, which is the strongest predictor of another episode

Others can often be worked on, usually with support from a health care team:

• Work involving heavy lifting, repeated bending, twisting, or whole-body vibration
• Long periods of physical inactivity, and low back and core muscle strength
• Smoking and carrying extra body weight
• High stress, poor sleep and low mood, which are linked to pain lasting longer

How low back pain is diagnosed in Canada

Most low back pain is assessed by a family doctor, nurse practitioner, physiotherapist or chiropractor without any scan. The clinician takes a history and does a physical examination, and screens for warning signs that could point to a serious cause such as nerve compression, infection, fracture, cancer or inflammatory arthritis. Ontario Health’s quality standard states that imaging such as X-ray, CT or MRI should be used only when those warning signs are present, because scans often show changes that are common with age and do not explain the pain. Imaging is nonetheless rising in Ontario, from 12.4% of people scanned within 180 days of a first low back pain visit in 2019 to 2020, to 16.8% in 2024 to 2025.

Treatment and day-to-day management

Clinical research for Back Pain is enrolling. See the current studies ↓

Care is aimed at easing pain, keeping you moving and getting you back to the things you normally do. Depending on your symptoms and what a clinician finds, a health care team may discuss:

• Education and self-management support, including what to expect over the course of an episode and advice on staying active and returning to normal activity
• Physiotherapy, exercise therapy and structured movement programs, plus manual therapy such as spinal manipulation delivered by physiotherapists, chiropractors or osteopaths
• Psychological approaches for pain, including cognitive behavioural therapy, and support for stress, sleep and mood where these are affecting recovery
• Non-opioid pain medicines chosen with a clinician, such as anti-inflammatory medicines, along with heat therapy
• Specialist referral, injections and surgery, which are reserved for people with specific findings such as nerve compression or a confirmed serious cause

Opioids for chronic non-cancer back pain are addressed in Canada by the 2024 Canadian Opioid Prescribing Guideline, which frames them as a shared decision reached after other options have been considered. Which of these fits you depends on your own examination, your work and your other health conditions, and those are decisions for you and your own clinician.

When to talk to a doctor

• Call 911 or go to an emergency department immediately if you have new trouble starting to urinate, loss of bladder or bowel control, numbness in the groin, buttocks or inner thighs, known as the saddle area, or new weakness in both legs. These are warning signs of cauda equina syndrome, a surgical emergency.
• Seek urgent medical assessment if back pain follows a significant fall, crash or other major injury, or if it comes with fever, chills or a recent infection, since these can point to a fracture or a spinal infection.
• Book a prompt appointment if you have a history of cancer, unexplained weight loss, pain at night that is not eased by changing position, or leg weakness or numbness that is getting worse.

Why clinical research matters for low back pain

Because most low back pain has no identifiable structural cause, researchers still cannot reliably tell who will recover in weeks and who will go on to months or years of pain, and there is no way to match a person to the treatment most likely to help them. Trials under way are testing non-opioid pain medicines and drugs aimed at specific pain-signalling pathways, exercise and psychological programs delivered digitally or by video, spinal cord stimulation and other neuromodulation devices, and stratified care models that sort people by their risk of a poor recovery. Others are examining how to reduce unnecessary imaging and how to support people to stay at or return to work.

Clinical studies are how those questions get answered. Taking part is voluntary, you give informed consent before anything begins, and you can stop at any time without affecting the care you get from your own doctor. Joining a study does not mean giving up your current treatment, and no one can say in advance whether a study will help you personally.

Learn more from Canadian sources

• Ontario Health: Low Back Pain quality standard
• Canadian Chiropractic Guideline Initiative: low back pain guidance and red flags
• Pain BC: pain support line, education and self-management programs
• Health Canada: Canadian Pain Task Force reports