Lower back pain is pain, aching or stiffness around the lumbar spine. It may stay in your back or spread into the buttock or leg. Most uncomplicated episodes improve with sensible activity, gradual movement and time, although recurring, worsening or leg-related symptoms may need assessment.

Lower back pain does not always come from one damaged structure. Muscles, joints, discs, ligaments, nerves, recent workload, sleep, stress and general health can all influence symptoms.

Start with our Back Pain guide if you are unsure where your symptoms fit. If pain travels into your leg, our sciatica guide may also help.

What is lower back pain?

The lumbar spine forms the lower part of your back. Pain in this region may involve sensitivity in muscles, joints, discs, ligaments or nearby nerves. In many cases, several factors contribute rather than one identifiable painful structure.

Symptoms also vary considerably. Some people mainly notice local stiffness or aching. Others develop pain into the buttock or leg, pins and needles, numbness or reduced confidence with bending, lifting, sitting or exercise.

Why does lower back pain start?

Lower back pain may begin after an obvious movement or load, or it may develop without one clear event. Common triggers include lifting, bending, sport, prolonged sitting, unfamiliar exercise or a sudden increase in workload.

Should I rest or keep moving with lower back pain?

For most uncomplicated lower back pain, prolonged bed rest is not recommended. Gentle activity such as walking, changing position and comfortable movement can help maintain mobility and confidence.

You do not need to force painful movements. Temporarily reduce activities that cause a major or lasting increase in symptoms, then build them back gradually as your back settles.

If walking, bending or lifting causes rapidly increasing leg pain, numbness or weakness, arrange an assessment. Seek urgent medical care if you develop any of the warning signs listed below.

How is lower back pain assessed?

The first step is usually a clinical assessment rather than a scan. Your physiotherapist will ask how your symptoms started, where you feel them, whether they travel into your leg and how sitting, walking, bending, lifting, work and exercise affect you.

Your assessment may include lumbar and hip movement, strength, neurological testing when appropriate, functional tasks and your response to different positions or loads. The aim is to identify factors contributing to your symptoms and decide what is most useful to address.

X-rays, CT scans and MRI are not routinely required for uncomplicated lower back pain. Imaging may be appropriate when your history or examination raises concern about fracture, significant neurological change, serious disease or another condition that could alter management.

Some physiotherapists may also use real-time ultrasound as visual feedback during selected rehabilitation exercises. It is not the primary investigation for lower back pain. Read more about ultrasound physiotherapy for lower back pain.

What helps lower back pain?

Management usually works best when it matches your symptoms, goals and current capacity. For many people, the main components are education, continued activity, graded exercise and a gradual return to normal loads.

The World Health Organization guideline for chronic primary low back pain supports education and exercise as part of non-surgical management.

1. Keep moving where you can

   Walking, changing position and comfortable daily activity can help limit unnecessary inactivity. Adjust the amount of activity to how your symptoms respond.

2. Understand what affects your symptoms

   A physiotherapist can help identify movements, loads and other factors that aggravate or settle your symptoms. Understanding the pattern often makes recovery less uncertain.

3. Build strength and movement capacity

   Progressive exercise can improve trunk and hip strength, endurance and confidence with lifting, work, sport and everyday activity. There is no single best exercise for every person with lower back pain.

4. Progress loads gradually

   Avoid jumping suddenly from very little activity to demanding lifting, training or work. Increase volume and intensity progressively as symptoms and capacity allow.

5. Use symptom-relief strategies selectively

   Heat, pacing, gentle walking and short movement breaks may help during a flare-up. TENS is sometimes used for temporary symptom relief, although it is not routinely required and should not replace active management or appropriate assessment.

How can physiotherapy help lower back pain?

Physiotherapy may help when pain keeps returning, limits work or exercise, feels unpredictable or includes leg symptoms. Treatment should match your presentation rather than relying on one technique or quick fix.

A physiotherapist may use education, exercise, activity modification and selected hands-on treatment to help you move more comfortably and rebuild capacity. The emphasis usually shifts towards independent movement and graded loading as symptoms improve.

Hands-on treatment may provide short-term help with movement or symptoms for some people. It usually works best as one part of a broader plan that includes education, activity and exercise.

Learn more about back pain relief with physiotherapy and back pain physiotherapy.

What happens at your first physiotherapy appointment?

Your physiotherapist will ask about your symptoms, medical history, daily activities, work demands, exercise goals and any leg symptoms. They will then assess the movements and tasks most relevant to your problem.

Related lower back pain guides

These guides explain common symptom patterns and useful next steps.

Lower back pain FAQs

What should you do next?

If your symptoms are mild and improving, continue comfortable activity and gradually return to your usual routine. Avoid prolonged bed rest and increase lifting, exercise and sport progressively.

Consider physiotherapy if lower back pain keeps returning, limits your normal activities, feels difficult to manage or includes ongoing leg symptoms. An assessment can help clarify the pattern and give you a practical progression based on your needs.

References

1. World Health Organization. WHO guideline for non-surgical management of chronic primary low back pain in adults. Geneva: World Health Organization; 2023.
2. George SZ, Fritz JM, Silfies SP, et al. Interventions for the management of acute and chronic low back pain: revision 2021. J Orthop Sports Phys Ther. 2021;51(11):CPG1-CPG60. doi:10.2519/jospt.2021.0304.
3. Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;9:CD009790. doi:10.1002/14651858.CD009790.pub2.
4. Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356-2367. doi:10.1016/S0140-6736(18)30480-X.