Lower back pain can feel sharp, stiff, aching, or “locked”. It may stay in the lower spine or travel into your buttock or leg. Either way, it can limit work, sleep, exercise, and confidence.

Although many flare-ups settle, recurring symptoms often need a clearer plan. A physiotherapist can assess what is driving your lower back pain, then guide you with practical steps to improve movement and build capacity. If you are unsure what is happening, start with our Back Pain guide, common causes of back pain, or sciatica guide.

Lower back pain quick summary

Common lower back pain contributors include:

• muscle or ligament strain
• disc irritation
• lumbar facet or sacroiliac joint pain
• nerve irritation such as sciatica
• load, movement, and recovery issues

What is lower back pain?

Lower back pain usually comes from the lumbar spine, which is the lower part of your back. Symptoms can involve muscles, joints, discs, or nerve sensitivity. Often, more than one structure contributes, which is why a focused assessment matters. Many episodes improve with the right mix of movement, education, and graded strengthening.

Why does lower back pain start?

Common contributors include:

• Muscle or ligament strain: a sudden twist, heavy lift, or a spike in activity can overload tissues. See pulled back muscle.
• Disc irritation: disc-related symptoms can feel worse with bending, sitting, or coughing. See bulging disc.
• Joint pain: lumbar facet or sacroiliac joint irritation can refer pain into the buttock or hip. See lumbar facet joint pain and sacroiliac joint pain (SIJ).
• Nerve irritation: pain, pins and needles, or numbness down the leg may relate to nerve sensitivity. See sciatica.
• Inflammatory or bone-related conditions: these are less common, but they matter, especially when pain behaves differently or you feel unwell.

People also ask: should I rest or keep moving with lower back pain?

For most people, gentle movement beats bed rest. Walking, light mobility, and staying active within tolerable limits often helps symptoms settle and keeps your back moving. If movement makes symptoms rapidly worse, or you feel leg weakness or numbness, get assessed.

How do you investigate lower back pain?

A physiotherapist will look at how you move, how your back and hips tolerate load, and how your symptoms behave with specific tests. They will also check for signs that suggest you should see a GP for further assessment. This helps separate a typical lower back pain flare-up from presentations that need extra investigation.

Sometimes, physiotherapists use real-time ultrasound to help you learn how to activate key stabilising muscles. Read more about ultrasound physiotherapy for lower back pain.

Red flags that need prompt medical review

Seek urgent medical care if you have any of the following:

• new problems with bladder or bowel control
• numbness in the saddle area (groin or genitals)
• progressive leg weakness
• fever, unexplained weight loss, or feeling very unwell
• severe pain after a significant fall, crash, or trauma

What helps lower back pain?

Most plans work best when they combine education, movement, and graded strengthening.

1) Physiotherapy treatment and education

A physiotherapist may use hands-on treatment, targeted exercise, and coaching on pacing and lifting. Many people improve when they build strength and tolerance gradually. Start here: back pain relief with physiotherapy.

2) Strength and core control

Improving trunk and hip strength can reduce flare-ups and improve confidence with daily tasks and sport. See core stability training and deep core muscles guide.

3) Posture and load management

Posture alone rarely causes pain, but your habits can load sensitive tissues. Small changes across your day can help. See good back posture tips and posture correction.

4) Pain tools you can use at home

Heat, short walks, and simple mobility often help early. Some people also use a TENS machine as part of a broader plan. If that interests you, see What is a TENS Machine?, TENS Machine Info, and How to Use a TENS Machine.

5) Other treatment options and when they fit

Some options can support comfort while you build strength and movement capacity. In most cases, they work best as add-ons rather than stand-alone fixes.

• Massage: may help reduce muscle tension and improve short-term comfort, especially during flare-ups. Consider back massage or therapeutic massage alongside rehab.
• Dry needling or acupuncture: some people find these helpful for short-term symptom relief, particularly when protective muscle guarding is high. See dry needling and acupuncture.
• Medication advice: a GP or pharmacist can advise whether medication is appropriate for your situation, especially if pain is affecting sleep or function.
• Injections: injections are usually considered when symptoms suggest nerve irritation, for example strong leg pain with sciatica, and progress stalls despite appropriate care.
• Radiofrequency procedures: these may suit selected chronic facet joint cases after medical assessment and diagnostic testing.
• Surgery: surgery is uncommon for simple lower back pain. However, urgent review matters for red flags, and surgery may be considered when symptoms and imaging match and there is progressive weakness or persistent sciatica that does not improve with conservative care.

What to do next

If your symptoms are new, start with light movement, avoid long periods of sitting, and keep loads sensible for a few days. If lower back pain keeps returning, travels down the leg, or limits normal life, book an assessment so you can get a clear diagnosis and a step-by-step plan.

Related articles on PhysioWorks

1. Back pain guide
   • Start here if you are unsure what is driving your symptoms.
2. Pulled back muscle
   • Common causes, symptoms, and treatment options.
3. Bulging disc
   • When discs become sensitive and how rehab can help.
4. Sciatica
   • Leg symptoms, nerve irritation, and next steps.
5. Core stability training
   • Build support and control for the spine and hips.
6. Good back posture tips
   • Simple changes that reduce strain across your day.
7. Back pain during pregnancy
   • Common contributors and safe strategies.

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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.
4. Lara-Palomo IC, et al. Efficacy of dry needling for chronic low back pain: a systematic review and meta-analysis. 2023.
5. Brotis AG, et al. Epidural steroid injections in lumbar disc herniation: a systematic review. 2025.