Persistent low back pain is back pain that has lasted for more than three months. In most cases it does not mean there is ongoing damage: the back is usually structurally sound, and the pain reflects a sensitive, protective system influenced by sleep, stress, activity levels and beliefs about the back. It is one of the most common long-term health problems, and the best evidence supports exercise, staying active and approaches that rebuild confidence in movement.
Also known as chronic low back pain, long-term back pain, chronic primary low back pain
Anatomy: where the problem is
Side view of the lower back. Highlighted in the diagram: back muscles, facet joints and discs.
Symptoms
- Back pain on most days for more than three months
- Pain that varies from day to day and flares up from time to time
- Stiffness, especially after rest or first thing in the morning
- Pain that may spread into the buttocks or thighs
- Avoiding bending, lifting or activities for fear of making it worse
- Poor sleep, tiredness or low mood alongside the pain
Causes and risk factors
- No single structural cause is found in most people
- A nervous system that has become more sensitive over time
- Reduced activity and loss of strength and fitness
- Poor sleep, stress, anxiety and low mood
- Fear of movement and unhelpful beliefs that the back is damaged or fragile
- Physically heavy work, smoking and being overweight are linked to a higher risk
What the evidence says helps
- Scans rarely help. Changes such as disc bulges and wear are common in people with no pain at all, and NICE advises against routine imaging for low back pain.52
- Exercise is the main treatment. A Cochrane review of 249 trials found that exercise reduces pain and improves function compared with no treatment or usual care, and no single type of exercise is clearly best.3
- NICE recommends manual therapy and psychological approaches only as part of a package that includes exercise, and recommends against opioids for long-term back pain.2
- In a large trial, an approach that combines coaching on movement, pain education and lifestyle (cognitive functional therapy) produced large, lasting improvements in activity compared with usual care.4
- Staying at work or returning as early as possible, with adjustments if needed, is linked to better outcomes.2
Things you can try at home
- Keep moving: choose an activity you enjoy and can do regularly, such as walking, swimming or strength training
- Build up gradually and expect some discomfort: hurt does not mean harm
- Pace activities on bad days instead of stopping altogether
- Prioritise sleep and find ways to manage stress
- Relax into movements such as bending, and avoid bracing or holding your back rigid
- Plan for flare-ups: they are common, and they settle
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- Loss of bladder or bowel control, or numbness around the genitals or back passage: go to A&E
- Weakness or numbness in both legs, or weakness that is getting worse: go to A&E
- Back pain after a serious accident, such as a car crash or a fall from height: call 999
- Back pain with a fever, unexplained weight loss, a history of cancer or feeling generally unwell: see your GP urgently
- Constant pain that does not ease with rest or changes of position, especially at night: see your GP
How Apollo can help
We begin by listening to your story and checking for the small number of causes that need medical attention. We explain what is known about persistent pain, which many people find changes how they feel about their back. Treatment combines hands-on care to ease pain in the short term with a graded exercise plan built around the activities you want to return to. Supervised clinical exercise, Reformer Pilates and strength testing with our VALD equipment are available to help you progress and see measurable change.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
Why has my back pain lasted so long?
In most people, persistent back pain is not caused by ongoing damage. Pain can continue because the nervous system has become more sensitive, and it is influenced by sleep, stress, activity levels and worry about the back. These are all things that can be worked on.
Do I need an MRI scan for chronic back pain?
Usually not. Scans often show changes such as disc bulges that are just as common in people without pain, and they rarely change treatment. A scan is used when there are signs of nerve compression or another specific condition.
What is the best exercise for chronic back pain?
Research has not found one type of exercise to be clearly better than the others. Walking, strength training, Pilates and general fitness work can all help. The best choice is the one you enjoy and will keep doing.
References
- Hartvigsen J, et al. (2018). What low back pain is and why we need to pay attention. The Lancet 391:2356-2367. View source
- National Institute for Health and Care Excellence (2016, updated 2020). Low back pain and sciatica in over 16s: assessment and management. NICE guideline NG59. View source
- Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW (2021). Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews 2021. View source
- Kent P, et al. (2023). Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial. The Lancet 401:1866-1877. View source
- Brinjikji W, et al. (2014). Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology 36:811-816. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
