Lower back pain
What’s really going on, and what actually helps
The short answer
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First, some reassurance
Lower back pain is extraordinarily common. Most of us will have it at some point, and the great majority of the time it is not a sign of serious damage.
I say that early because fear is one of the biggest obstacles to recovery. People who believe their back is fragile move less, guard more, and take longer to get better. People who understand that their back is strong and resilient tend to recover faster. That is not positive thinking — it is one of the more consistent findings in back pain research.
So what is actually causing it?
In most cases, no single structure is to blame. The honest answer is that back pain is usually a combination of things: a sensitive area of tissue, muscles working hard to protect it, a movement pattern that keeps aggravating it, and often a background of stress, poor sleep or simply not moving enough.
That is why the specific label matters less than people hope. What matters far more is what makes it worse, what makes it better, and how we get you moving again.
A word about scans. MRI scans of people with no back pain at all routinely show disc bulges and degenerative changes. These findings become more common with every decade of life — rather like grey hair. Finding one on a scan does not mean it is causing your pain, and chasing scan findings can send people down an unhelpful road.
What actually helps
Keep moving. This is the single most important thing. Bed rest was standard advice decades ago and we now know it makes things worse. Gentle, regular movement — walking, changing position often, moving within comfort — is what settles a back.
Stay at work if you can. Even modified duties. People who stay in work recover faster than those who stop.
Move through range every day. Gentle rotations, cat-cow, pelvic tilts. The back likes variety and dislikes stillness.
Build strength as it settles. Once the acute pain eases, strengthening the hips, trunk and legs is what stops it coming back. This is the step most people skip — and it is why the pain returns.
Sleep and stress matter. Pain is amplified by poor sleep and high stress. It is not “all in your head” — it is real physiology, and it is worth addressing.
Use warmth if it helps. Heat, a warm bath, or hydrotherapy for those whose backs are too painful to exercise on land. Water lets a guarded back move again.
What is less useful than you might hope
Long-term rest. Endless passive treatments that feel nice but change nothing. Waiting for a scan before doing anything. Being told your back is “out of place” or “crumbling” — that language does more harm than most people realise, and it is rarely accurate.
The warning signs that need urgent attention
These are uncommon, but they matter. Seek urgent medical help — A&E or 111 — if you have back pain together with any of the following:
Difficulty passing urine, or loss of control of your bladder or bowels
Numbness or altered sensation around your back passage, genitals or inner thighs — the area a saddle would touch
Numbness, weakness or pins and needles in both legs
Sudden, severe pain following a significant fall or accident
Back pain with unexplained weight loss, fever, or a history of cancer
Please do not sit on these. They are rare, but they are the ones we do not wait on.
When should you see a physiotherapist?
If your pain has not started to settle within two or three weeks, if it keeps coming back, if it is travelling down your leg, or if you are simply worried and want someone to look at it properly — come in.
You do not need a GP referral to see me. At an assessment I will examine you, explain in plain English what I think is going on, and give you a plan. Most people leave feeling considerably less worried than when they arrived, which is often half the battle.
Frequently asked questions
Should I rest if my back hurts?
Only briefly, if at all. Prolonged rest delays recovery. Gentle movement within your comfort is the better route.
Do I need an MRI scan for back pain?
Usually not. Scans are helpful when there are specific warning signs, but for ordinary back pain they often find age-related changes that are unrelated to your symptoms and can cause unnecessary alarm.
How long does lower back pain take to settle?
Many episodes ease significantly within a few weeks. If yours is not improving in that time, get it assessed rather than waiting.
Is walking good for back pain?
Yes, for most people it is one of the best things you can do. Start with what you can manage and build gradually.
Can hydrotherapy help my back?
It can be excellent, particularly if your back is so painful that exercising on land is difficult. The water takes the load off and lets you move sooner.
Ready to talk it through? If your back is not settling, do not soldier on. Book an assessment and let us find out what is really going on — and what will actually help. Book an assessment · 01789 000 000 · info@richardjonesphysio.co.uk |
This article is general information, not individual medical advice. Every body is different — if you’re in pain or unsure, please get assessed properly.
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