Will back pain go away on its own?

Most people with a bad back hope the same thing: give it a few days and it will sort itself out. So, will back pain go away on its own? Sometimes it does. But the long-term studies tell a less comfortable story.

The first six weeks

The early news is mostly good. A review pooled 33 groups of patients, more than 11,000 people, and tracked their pain from when it started. In groups with a new, acute episode, average pain fell from 52 out of 100 to 23 after six weeks, 12 after six months and 6 after a year. In groups whose pain was already persistent, it fell more slowly: from 51 to 33 at six weeks and 23 at a year (Menezes Costa et al., 2012).

Most of the improvement happened in those first six weeks. After that, progress slowed.

That matches official advice. The NHS says back pain usually improves within a few weeks, but can sometimes last longer or keep coming back (NHS). The WHO says that in most cases of acute low back pain, symptoms go away on their own and most people recover well (WHO, 2023).

What happens a year later

A review of 11 studies followed people who saw their family doctor about low back pain. Three months later, 67% still had pain. A year later, 65% still did (Itz et al., 2013).

How does that fit with an average score of 6 out of 100? The two reviews measured different things. One averaged how much it hurt; the other counted how many people had any pain at all. A little leftover pain barely moves an average, but it still counts as “not recovered”.

The definition of recovery matters too. In studies where recovery meant no pain at all, 71% still had pain at a year; with looser definitions it was 57%. The figure also varied by country, from 41% in Australian studies to 69% in European and US ones. The authors’ conclusion was blunt: the assumption that most people recover on their own is not justified.

The pain usually gets better in the first weeks. It just often doesn’t go all the way.

So, will back pain go away on its own?

Partly, for most people. The worst usually settles within weeks. A low level of pain often lingers, and for a smaller group it becomes long-term.

A large Lancet review describes who is more at risk of that. Pain that is very intense at the start, psychological distress, and pain in several parts of the body at once all raise the odds that back pain becomes persistent and disabling (Hartvigsen et al., 2018).

Why there is rarely a clear cause

About 90% of low back pain is “non-specific”, the WHO says. That does not mean the pain is imagined. It means that for nearly all people with back pain, no specific source can be identified, and only a small proportion have a well-understood cause such as a fracture, cancer or infection (Hartvigsen et al., 2018). The pain may involve the joints, discs or muscles of the lower back, such as the erector spinae running either side of the spine, but an examination usually cannot pin it on one of them.

Do you need a scan?

Usually not. A review of 33 imaging studies in 3,110 people without back pain found disc degeneration in 37% of 20-year-olds, rising to 96% of 80-year-olds. Disc bulges went from 30% to 84%. The authors concluded that many of these findings are part of normal ageing and not linked to pain (Brinjikji et al., 2015).

That is why NICE advises against routine imaging for low back pain outside specialist settings (NICE NG59). A scan report of “wear and tear” can sound alarming while describing changes that many pain-free people of the same age also have.

And when it does go away

Another study followed 250 people whose back pain had cleared up. Within twelve months, 69% had it again. For 40%, the new episode was bad enough to limit their normal day, and 41% went back for care (da Silva et al., 2019). Half had a new episode within about 139 days, a little over four and a half months.

The same study looked at what predicted a return. Three things stood out: frequent awkward postures, sitting for more than five hours a day, and having had more than two previous episodes. For desk workers the second one is hard to avoid. Long stretches of sedentary behaviour add up quickly, as we show in How much of your year do you spend sitting?

This is the pattern many desk workers know: a few bad days, a visit to a physio, relief, a few good weeks, and then it’s back.

It is also why the World Health Organization counts low back pain as the leading cause of disability worldwide. In 2020 it affected 619 million people (WHO, 2023).

What actually helps

The good news is that the most reliable answer is also the most ordinary one: exercise.

• For people whose back pain has become long-term, a Cochrane review of 249 exercise trials found that exercise therapy reduces pain compared with no treatment or usual care, based on the 35 trials (about 2,700 people) that made that comparison (Hayden et al., 2021). On a 0 to 100 scale, people who exercised rated their pain about 15 points better around three months in. The effect on day-to-day disability was smaller, about 7 points. The authors rated the evidence as moderate certainty: the trials used exercise in different ways, and many were small, with 98 people on average.
• For keeping pain from returning, exercise combined with education lowered the risk of a new episode in the following year by about 45%. Exercise on its own lowered it by about a third (Steffens et al., 2016). That review pooled 21 trials with more than 30,000 people. The evidence was moderate quality for exercise with education and low to very low for exercise alone. Education on its own, back belts and shoe insoles did not appear to prevent back pain.

Stay active rather than resting

Rest feels like the sensible thing, but it is not what the evidence supports. In acute low back pain, a Cochrane review found small improvements in pain and function when people were advised to stay active rather than rest in bed (Dahm et al., 2010). The NHS advises staying active and trying to continue with your daily activities, and not staying in bed for long periods.

NICE’s guideline says the same in its own terms: give people information about back pain and encourage them to continue with normal activities, and consider a group exercise programme for an episode or flare-up. It also advises against belts and corsets for managing low back pain (NICE NG59). If you are tempted by a gadget that holds you upright, see Do posture correctors work?

The catch is the word regular. Most of us exercise while it hurts and stop when it doesn’t, which is exactly when the next episode starts building.

Habits that help at a desk

None of these replaces exercise or a proper assessment. They are simply ways to spend fewer hours in one position.

• Break up the sitting. Get up and move regularly, even briefly. Our guide to microbreaks looks at how often.
• Fit the desk to you. Use the desk height calculator and office chair setup guide, and if you work from the sofa or kitchen table, the home office guide.
• Carry on with normal life during a flare, as far as the pain allows, rather than waiting for it to go before you move.
• Keep going when it stops hurting. Short, regular sessions are easier to keep up than big plans, though for the lower back they are a start rather than the whole answer (Is two minutes of exercise enough?).

There is more on why sitting affects the lower back in lower back pain from sitting.

When to see a doctor

The NHS advises seeing a GP if the pain has not improved after a few weeks of treating it at home, is stopping you doing your day-to-day activities, or you are worried or struggling to cope. See a GP too if you have back pain and you have lost weight without trying, there is a lump or swelling in your back or it has changed shape, the pain does not improve with rest or is worse at night, it is worse when you sneeze, cough or poo, or it comes from the top of your back, between the shoulders, rather than the lower back (see pain between the shoulder blades).

Ask for an urgent GP appointment or get help from 111 if you feel hot, cold, shivery or generally unwell, or the pain is severe and starts suddenly or is getting worse quickly.

Call 999 or go to A&E if back pain comes with:

• pain, tingling, weakness or numbness in both legs
• loss of feeling around your genitals or anus
• changes in your bladder or bowels, such as difficulty peeing, or peeing or pooing yourself
• changes in how your penis or vagina feels during sex, or problems getting an erection or reaching orgasm
• chest pain
• pain that started after a serious accident, such as a car accident

If the pain does not get better after a few weeks, the NHS lists group exercise and physiotherapy among the treatments that may be recommended, and in many areas you can refer yourself to an NHS musculoskeletal service without seeing a GP first. If you are thinking of going private, see how much physiotherapy costs.

Where Bavelu fits

Bavelu exists for the weeks when nothing hurts. Its daily sessions were designed and filmed by physiotherapists and come in a short and a full version, and its desk routines take two to four minutes, so they still happen when there is no pain to remind you.

If your pain is severe, sudden, getting worse, follows an injury, or comes with numbness or weakness, see a doctor first. The app is exercise guidance, not a diagnosis or a treatment.