Lower back pain: when to see a physiotherapist, and what helps

Lower back pain is one of the most common reasons people see a physiotherapist. It can be frightening, especially if it came on suddenly, but the good news is that most back pain is not caused by serious damage and improves within days to weeks. The right kind of movement usually helps it settle faster and makes it less likely to come back.

First, the warning signs

See a doctor urgently if back pain comes with any of these:

• numbness around your genitals or buttocks, or new difficulty passing urine or controlling your bladder or bowels

• weakness in one or both legs that is getting worse

• fever, or feeling generally unwell

• unexplained weight loss, or a history of cancer

• pain after a significant fall or accident

• severe pain at night that does not ease when you change position

These are uncommon, but they need a doctor's attention first.

What helps in the first few days

• Keep moving gently. Short walks, a few times a day, as comfort allows. Long bed rest tends to make backs stiffer and slower to recover.

• Change position often. Avoid sitting or standing in one position for long.

• Heat or cold for 15 to 20 minutes at a time, whichever feels better.

• Pain relief, as advised by your doctor or pharmacist, can help you keep moving.

• Carry on with daily activities as much as you can, doing less of what clearly makes it worse.

Pain does not always mean harm. Moving carefully, even if it is a little uncomfortable, is generally safe and helpful.

When to see a physiotherapist

• the pain is not easing after a week or two

• it keeps coming back

• it spreads into your buttock or leg

• it is stopping you working, sleeping or looking after yourself

• you are worried about what is causing it

You do not need a referral to see a physiotherapist.

What physiotherapy involves

Assessment. The physiotherapist will ask how it started, what makes it worse and better, and check the warning signs above. They will watch how you move, test your strength, reflexes and sensation if the pain spreads into the leg, and explain what they think is going on.

Treatment usually combines:

• exercises to restore movement and build strength in the back, hips and trunk

• hands-on treatment, such as mobilisation or soft tissue work, to ease pain and stiffness

• advice on posture, lifting, sleeping position and pacing your activity

• a home programme, which is often the most important part

Some clinics also use electrotherapy such as TENS or IFT for pain relief, usually alongside exercise rather than instead of it.

How long it takes

Many people improve within a few weeks. Pain that has lasted months usually takes longer, and the focus shifts to building strength, confidence and habits that keep the back healthy. Your physiotherapist should give you an estimate and check your progress against it.

Stopping it coming back

• stay active: walking, swimming, cycling and strength exercise all help

• build strength in the trunk, hips and legs

• take breaks from sitting, at least every 30 to 45 minutes

• lift with your knees bent and the load close to your body

• keep doing your home exercises after you feel better

Find a physiotherapist for back pain

Search for physiotherapists who treat back pain near you on PhysioDesk Reach, see their fees and reviews, and contact them directly. Many offer home visits.

This article is general information, not medical advice. If you have any of the warning signs above, or you are unsure, see a doctor.