Back problems

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What are back problems?

Back problems are a range of conditions related to the bones, joints, connective tissue, muscles and nerves of the back. Back problems are a significant cause of disability and lost productivity.

‘Back problems’ describes a range of conditions related to the bones, joints, connective tissue, muscles and nerves of the back. These conditions can affect the neck (cervical spine), upper back (thoracic spine) and lower back (lumbar spine) as well as the sacrum and tailbone (coccyx).

Back problems reported on these webpages include:

  • disc disorders (such as herniated discs or disc degeneration)
  • sciatica and curvature of the spine
  • back pain/problems not elsewhere classified.

Note: back problems associated with another condition, such as osteoporosis are not included. For this reason, the total prevalence of back problems is likely to be underestimated.

The diagram shows the 5 sections of the spine. The cervical spine is at the top of the spine, forming the neck. The thoracic spine sits underneath and attaches to rib cage. The lumber spine makes up the lower region of the back. Beneath that, the sacrum connects to the pelvis and the coccyx forms the bottom of the spine.

Back problems include:

  • episodes of ‘non-specific’ pain in the lower, middle and upper back that are sometimes associated with injury but often may arise and settle for no apparent reason
  • ‘sciatica’ – a back problem with pain shooting down one leg often accompanied by tingling, numbness or weakness in that leg. A similar problem in the neck will cause arm symptoms.
  • narrowing in the canal of the lumbar spine through which the spinal cord passes. This is more common in older people and causes difficulty walking as well as symptoms in both legs.
  • less common conditions such as infection or fracture that are managed differently to the more common back problems
  • ‘whiplash’ following a motor vehicle accident.

Back problems can have many causes, relating to work, sport and lifestyle issues, injuries, diseases such as arthritis, disc disease and osteoporosis. Sometimes back pain is the result of a health condition beyond the spine such as a kidney stone or shingles. Factors that may increase the risk of developing back problems include age, physical fitness, smoking, being overweight, and the type of work a person does (ABS 2019).

Pain is the main symptom in most back problems. Back problems are a common reason for pain among younger and middle-aged adults, but can start in childhood (Raspe et al. 2004). Back problems are often recurrent and may need to be managed as a long-term health condition.

How common are back problems?

About 4.0 million Australians (16% of the total population) have back problems, based on self-reported data from the Australian Bureau of Statistics (ABS) 2017–18 National Health Survey (NHS).

1 in 6 Australians (16%) have back problems.

Back problems are least common among people from birth to age 24 (Figure 1). The overall prevalence of back problems, after accounting for differences in age, is similar for males (16%) and females (15%).

Figure 1: Prevalence of back problems, by age and sex 2017–18

The vertical bar chart shows that back problems are most common among males aged 55–64 (31%25) and females aged 65–74 (26%25). They are least common among people from birth to age 24 (3%25 in males and 4%25 in females). The prevalence of back problems for males and females is similar.

Note: refers to people who self-reported having back pain and problems (current and long term).

Source: AIHW analysis of ABS 2019a (Data table).

Aboriginal and Torres Strait Islander people

According to self-reported data from to the ABS 2018–19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS), the prevalence of back problems among Aboriginal and Torres Strait Islander people was 12.6%, affecting about 102,000 people – including about 14,000 who live in remote areas (9.4% of the remote Indigenous population).

After adjusting for age, males (17.0%) and females (17.3%) had similar rates of back pain and problems. The proportion of Indigenous Australians (17.1%) and non-Indigenous Australians (15.7%) affected was also similar (Figure 2).

Figure 2: Prevalence of back problems by Indigenous status, 2018-19

The vertical bar chart shows that, after adjusting for age, the prevalence of back problems was relatively similar in Indigenous Australians (13%25 of males, 15%25 of females) compared with Total Australians (13%25 of males, 12%25 of females).

Note: Rates are age-standardised to the Australian population as at 30 June 2001.

Source: ABS 2019 (Data table).

Inequalities

According to self-reported data from the 2017–18 National Health Survey, prevalence of back problems was similar in Major cities (16%), Inner regional (17%) and Outer regional and Remote (15%) areas of Australia. Those living in the lowest socioeconomic areas were 1.4 times as likely to have back problems compared with those living in the highest socioeconomic areas (18% and 13%) (Figure 3).

Figure 3: Prevalence of back problems, by remoteness and socioeconomic area, 2017–18

The horizontal bar chart shows that the prevalence of back problems between Major cities, Inner regional areas, and Outer regional/Remote Australia was relatively similar. People living in the lowest socioeconomic areas were more likely to have back problems (19%25 in males and 18%25 in females) compared with those in the highest socioeconomic areas (14%25 in males, 13%25 in females).

Note: Rates are age-standardised to the Australian population as at 30 June 2001.

Source: AIHW analysis of ABS 2019b (Data table).

Impact of back problems

Back problems often lead to poorer quality of life, psychological distress, bodily pain, and disability.

Burden of disease

Back pain and problems were the second leading cause of disease burden in Australia

Back pain and problems are a large contributor to illness, pain, and disability in Australia. Based on data from the Australian Burden of Disease Study 2015, back pain and problems were the second leading cause of burden overall, accounting for 4.1% of Australia’s total disease burden.

Back pain and problems were the third leading cause of disease burden for both males and females, representing 3.9% and 4.4% of total disease burden, respectively (AIHW 2019a).

Among males, back pain and problems were the second leading cause of disease burden for those aged 25–44 and 45–54 and the third leading cause for those aged 55–64. Among females, they were the leading cause for those aged 45–54 and the second leading cause for those aged 25–44.

Almost all of the burden caused by back pain and problems was non-fatal burden, where back pain and problems were the number one leading cause of non-fatal disease burden among males, females and overall, accounting for 8.1% of total non-fatal disease burden in Australia.

Additionally, in 2015–16, back pain and problems cost the Australian health system an estimated $2.8 billion, representing 23% of disease expenditure on musculoskeletal conditions and 2.4% of total health expenditure (AIHW 2019b).

Perceived health status

People with back pain and problems are 2.4x as likely to have poor health compared with those without back problems

People aged 15 and over with back problems were less likely to perceive their health as excellent compared with those without the condition according to the 2017–18 National Health Survey (NHS). After adjusting for age, people with back problems were 2.4 times as likely to rate their health as poor (6.5%) compared with those without back problems (2.7%) (Figure 4).

Figure 4: Self-assessed health of people aged 15 and over with and without back problems, 2017–18

The vertical bar chart shows that people aged 15 and over with back problems are less likely to perceive their health as excellent (10%25) or very good (33%25) compared with people without back problems (24%25 and 37%25 respectively). People with back problems were more likely to rate their health as good (34%25), fair (16%25) or poor (7%25), compared with people without back problems (28%25, 9%25, and 3%25 respectively).

Note: Rates are age-standardised to the Australian population as at 30 June 2001.

Source: AIHW analysis of ABS 2019 (Data table).

Pain

2.6x as likely to experience severe and very severe bodily pain

People with back problems were 2.6 times as likely to experience severe (11%) and very severe (3.1%) bodily pain compared with those without the condition (4.6% and 1.0%, respectively) according to self-reported data from the 2017–18 NHS (Figure 5).

Figure 5: Pain(a) experienced by people aged 18 and over with and without back problems, 2017–18

The vertical bar chart shows that people aged 18 and over with back problems were more than twice as likely to report moderate (34%25) or severe (11%25) bodily pain and three times as likely to report very severe (3%25) bodily pain compared with those without the condition (15%25, 5%25 and 1.0%25 respectively). People with back problems were less likely to report their levels of bodily pain as very mild (20%25) or none (11%25) compared with people without back problems (26%25 and 37%25 respectively).

a. Bodily pain experienced in the 4 weeks prior to interview.

Note: Rates are age-standardised to the Australian population as at 30 June 2001.

Source: AIHW analysis of ABS 2019 (Data table).

Impact on activity

38% of people with back problems said that bodily pain interfered with their daily activities at least 'moderately'

In 2017–18, 38% of people with back problems said that bodily pain interfered with their daily activities at least 'moderately', compared with 17% of people without back problems. Of people with back problems, 5.8% said bodily pain had an 'extreme' impact on their activity, compared with 2.4% of people without back problems (Figure 6).

Figure 6: Extent that bodily pain interferes in daily activities in people with and without back problems, 2017–18

The vertical bar chart shows that people with back problems were more likely to describe their bodily pain as interfering with their daily activities ‘a little bit’ (29%25), ‘moderately’ (20%25), ‘quite a bit’ (13%25), and ‘extremely’ (5.8%25) compared with people without back problems (19%25, 9.6%25, 4.6%25 and 2.4%25, respectively). People with back problems were less likely to describe no interference in daily activities (22%25) or no bodily pain (11%25) compared with people without back problems (27%25 and 37%25, respectively).

Note: Rates are age-standardised to the Australian population as at 30 June 2001.

Source: AIHW analysis of ABS 2019 (Data table).

Psychological distress

2.5x as likely to report very high levels of psychological distress

Overall, people aged 18 and over with back problems were 2.5 times as likely to report experiencing very high levels of psychological distress (8.1%) than those without the condition (3.2%) after adjusting for age (Figure 7).

Figure 7: Psychological distress (a) experienced by people aged 18 and over with and without back problems, 2017–18

The vertical bar chart shows that people aged 18 and over with back problems were more likely to report levels of psychological distress that were moderate (28%25), high (16%25) or very high (8%25) compared with people without back problems (22%25, 8%25, and 3%25 respectively). People with back problems were less likely to report low levels of psychological distress (48%25) compared with people without back problems (67%25).

(a) Psychological distress is measured using the Kessler Psychological Distress Scale (K10), which involves 10 questions about negative emotional states experienced in the previous 4 weeks. The scores are grouped into Low: K10 score 10–15, Moderate: 16–21, High: 22–29, Very high: 30–50.

Note: Rates are age-standardised to the Australian population as at 30 June 2001.

Source: AIHW analysis of ABS 2019 (Data table).

Workforce participation

According to self-reported data from the 2017–18 NHS, people aged 15–64 with back problems are less likely to be employed (73%) compared with people without back problems (77%) and more likely to not be in the labour force (22% compared with 19%). There is little difference in the proportion of people who were unemployed with (5%) and without (4%) back problems (Figure 8).

Figure 8: Workforce participation of people aged 15–64 with and without back problems, 2017–18

The vertical bar chart shows that there was very little difference in the workforce participation of 15–64 year olds with and without back problems. Slightly less people with back problems were employed (73%25) compared with people without back problems (77%25), and a similar proportion of people with back problems were unemployed (5%25) or not in the labour force (22%25) compared with people without back problems (4%25 and 19%25 respectively).

Note: Rates are age-standardised to the Australian population as at 30 June 2001.

Source: AIHW analysis of ABS 2019 (Data table).

Treatment and management of back problems

Pain is the main symptom of most back problems and treatment can be complex. This can be further complicated by comorbid conditions. Some general treatment strategies for chronic diseases, for example, lifestyle modifications such as diet, exercise, weight control, and reducing smoking, may benefit people with back problems (Bauer et al. 2014).

The most common back problem is non-specific low back pain. The most recent Australian clinical practice guidelines for management of non-specific low back pain encourages reassurance, self-management and physical therapy as first line care, supplemented by non-pharmacological therapies such as heat, massage, acupuncture and mindfulness where appropriate (Almeida et al. 2018). Medications are discouraged except where first and second-line non-pharmacological interventions are unsuccessful, and when they are prescribed, the lowest effective dose for the shortest amount of time possible is advised (Almeida et al. 2018).

Non-steroidal anti-inflammatory drugs (NSAIDS) should be the first-line medication when non-pharmacological management is inadequate (Almeida et al. 2018). Opioids should only be used when other treatments have failed after cautious assessment of risk versus benefits for the individual (Almeida et al. 2018). Paracetamol and surgery are no longer recommended for non-specific low back pain (Almeida et al. 2018).

Reliable and up to date information on how to manage back pain is provided at MyBackPain.org.au, a resource funded by Australia’s National Health and Medical Research Council, and developed by Arthritis Australia, the University of Queensland and Cochrane Back and Neck.

General practitioners and back pain treatment

General practitioners (GPs) are usually the first point of contact with the health care system for people with back problems. Back problems are among the most commonly managed conditions in general practice (Almeida et al. 2018). In 2015–16, 3.1 of every 100 GP-patient encounters for chronic conditions were for the management of back problems. This has increased significantly from 2.6 of every 100 GP-patient encounters in 2006–07 (Figure 9).

There is currently no nationally consistent primary health care data collection monitoring provision of care by GPs. The statistics on general practice activities are based on Bettering the Evaluation and Care of Health (BEACH) data, which are derived from a sample survey of GPs and their encounters with patients and should be interpreted with caution.

Figure 9: Rate of back complaints managed by GPs, 2006–07 to 2015–16

The vertical bar chart shows that in 2015–16, 3.1 of every 100 GP–patient encounters were for the management of back problems. This has increased significantly from 2.6 of every 100 GP-patient encounters in 2006–07.

Source: Britt et al. 2016 (Data table).

Hospitalisation and the treatment of back problems

Data from the AIHW National Hospital Morbidity Database (NHMD) show that in 2020–21:

  • There were 192,000 hospitalisations with a principal diagnosis of back problems.
  • The rate of hospitalisations was greater for females than males (820 per 100,000 compared with 680 per 100,000). This was true for all age groups from 45–49 years and over.
  • The rate of hospitalisation for back problems increased with age.

  • The average length of stay for overnight hospitalisations showed a similar pattern for males and females across age groups (Figure 10).

Figure 10: Rate of hospitalisation for back problems, by sex and age, 2020–21

This line bar chart compares the rate (per 100,000 population) of hospitalisations for back problems, across various age groups by sex, in 2020–21. The hospitalisation rate was highest in the 80–84 age group for both males and females.

Back problem hospitalisations were composed of:

  • back or spine pain (53%), of which lower-back-pain (27% of all back problem hospitalisations), neck-pain (6.3%), and radiculopathy (5.9%) were the most common
  • vertebrae and disc disorders (41%), of which spinal stenosis (12%), lumbar and other intervertebral disc disorders with radiculopathy (8.9%), and spondylosis (7.3%) are common examples
  • deforming dorsopathies (4.3%)
  • other dorsopathies (1.4%).

 Note: all percentages above represent proportion of total back problems hospitalisations.

From 2015–16 to 2020–21, the hospitalisation rate for back problems among Australians remained relatively stable with the exception of 2019–20 when there was a dip in the hospitalisation rate. This is likely due to widespread public health mandates to pause elective surgery due to the COVID-19 pandemic. The hospitalisation rate was higher for females compared with males across all years. Just under half of all hospitalisations with a principal diagnosis of back problems stay overnight in hospital. Of these, the average length of stay in hospital was 5.5 days in 2020–21 (Figure 11). Data prior to 2015–16 are not presented because rehabilitation hospitalisations were coded differently before this year.

Figure 11: Rate of hospitalisations for back problems (principal diagnosis) by sex, 2015–16 to 2020–21

The line chart shows that between 2015–16 and 2020–21, hospitalisation rates (per 100,000 population) for back problems remained relatively stable and was higher for females compared with males

Comorbidities of back problems

People with back problems often have other chronic diseases and long-term conditions. These are referred to as 'comorbidities' – two or more health problems occurring at the same time. Comorbidities often share common risk factors, and may interact to determine the health status of individuals. As people age, they are more likely to develop more than one chronic condition.

This information is based on self-reported data from the Australian Bureau of Statistics (ABS) 2017–18 National Health Survey (NHS), and was last updated in March 2019.

Selected comorbidities

An estimated 2.5 million Australians aged 45 and over have back problems, based on self-reported data from the 2017–18 National Health Survey. Of these, almost 3 in 4 people (74% of the total population of people with back problems) report also having one or more of the following selected chronic conditions (Figure 13):

  • heart, stroke and vascular disease
  • kidney disease
  • arthritis
  • mental and behavioural conditions
  • asthma
  • diabetes
  • chronic obstructive pulmonary disease (COPD)
  • osteoporosis
  • cancer.

In addition, almost 1 in 2 (46%) have two or more other chronic conditions (Figure 12).

Figure 12: Number of selected chronic conditions in people aged 45 years and over with back problems, 2017–18

The vertical bar chart shows the percentage of people aged 45 years and over with back problems only (26%25), with one other chronic condition (28%25), or with 2 or more other chronic conditions (46%25).

Note: the 9 other selected chronic conditions are heart, stroke and vascular disease, asthma, arthritis, cancer, COPD, diabetes, kidney disease, mental and behavioural conditions, and osteoporosis.

Source: AIHW analysis of ABS 2019 (Data table).

Types of comorbid chronic conditions in people with back problems

Among people aged 45 years and over with back problems:

  • 48% have arthritis, compared with 29% without back problems.
  • 34% have mental and behavioural conditions, compared with 18% without back problems.
  • 17% have asthma, compared with 11% without back problems.
  • 16% have heart, stroke and vascular disease, compared with 10% without back problems (Data table).

These proportions remained similar even after accounting for differences in the age structure of the populations (Figure 13).

Figure 13: Prevalence of other chronic conditions in people aged 45 years and over with and without back problems, 2017–18

Vertical bar chart showing the percentage of people with and without back problems who also experience other chronic conditions (arthritis, mental and behavioural conditions, asthma, heart, stroke and vascular disease, osteoporosis, diabetes, COPD, cancer, and kidney disease).

Notes:

1. Age-standardised to the 2001 Australian population.

2. Proportions do not total 100% as one person may have more than one additional diagnosis.

Source: AIHW analysis of ABS 2019 (Data table).