What is the Best Treatment for Lower Back Pain?

John Miller Physiotherapist

Article by John Miller

What is the Best Back Pain Treatment Approach?

A 40-year-old woman looking joyful and refreshed, after back pain treatment, wearing a 'PhysioWorks' top in a park.
Successful Back Pain Treatment

Back pain is a common issue affecting many people. Treatment for back pain should be tailored to individual needs, considering factors like underlying causes, genetics, and overall health. This article discusses effective treatment options for back pain and the importance of personalised care.

As physiotherapists, we follow the latest Low Back Pain Clinical Standards as the basis of your individualised back care assessment and treatment. These guidelines were updated in 2022.


1. Early Clinical Assessment

Assessing patients early in each new presentation of back pain is crucial. During the initial clinical assessment, consider:

  • Targeted history: Document pain, past history, functional capacity, and health comorbidities. Identify any signs of specific or serious pathology.
  • Physical examination: Evaluate movement, functional capacity, and pain interference.
  • Neurological examination: Focus on patients with back pain that extends to the legs.

2. Referral and Monitoring

Refer or conduct investigations if there’s a suspicion of serious underlying pathology. Immediate referral to an emergency department is necessary for suspected cauda equina compression, spinal infection, or acute severe neurological deficit. Consider imaging if there’s a suspicion of a fracture.

Imaging for Serious Pathology

Imaging is vital for identifying serious pathology when suspected. It’s not recommended for those without features indicating serious pathology, as it often doesn’t change management plans and can cause unnecessary concerns. MRI is preferred over CT and X-ray due to better sensitivity and safety.

3. Psychosocial Factors

Screen for psychosocial factors using risk assessment tools like STaRT Back or Örebro. Assess elements that might delay recovery, including:

  • Patient concerns, beliefs, and pain-related fears
  • Avoidance and protective behaviours
  • Pain-related distress, lifestyle factors, and social stressors
  • History of mental health issues

4. Patient Education and Advice

Educate patients about the positive natural history of back pain and the low risk of serious underlying disease. Encourage relaxed, graded movement and activity, and returning to work and social activities. Explain that movement won’t cause harm and there are no “bad” movements or postures. Provide written explanations and tailored educational resources to reinforce key messages.

5. Self-Management and Physical Activity

Advise patients to maintain or gradually return to normal activities, including spinal movement and physical activity. Prolonged bed rest should be discouraged. Support patients to self-manage symptoms by:

  • Prioritising active management strategies
  • Mapping out a plan for graded movement and activity
  • Setting SMART goals (specific, measurable, achievable, relevant, and time-bound)

6. Physical and Psychological Interventions

Based on psychosocial risk assessment findings, advise active coping strategies to optimise physical and psychological health. For most with new back pain, additional therapies aren’t necessary as the pain usually improves naturally. Offer hands-on therapies as an adjunct to facilitate independent symptom management.

7. Judicious Use of Pain Medicines

Physiotherapists can’t provide specific advice on pain medication. Patients with severe, distressing pain should consult a GP for pain management. The goal of pain medicines is to reduce pain to support continued physical activity and work, not to eliminate pain completely. Combine pain medicines with physical activity and self-management strategies to improve function and mobility.

8. Review and Referral

If pain persists or worsens, reassess to reconsider diagnosis, check for alerting features (red flags), and review psychosocial factors and self-management engagement. Refer to ED if new concerning features are identified. For disabling back or leg pain, refer to:

  • GP for review and pain management
  • Specialist physiotherapy for high levels of pain-related fear and distress
  • Psychologist for psychological comorbidities
  • Imaging and surgical review if severe neurological signs and symptoms persist


Personalised care is essential in back pain treatment. An early assessment, patient education, and a mix of physical and psychological interventions can significantly improve outcomes.

What to Do?

If you’re experiencing back pain, seek advice from your physiotherapist. They can guide you through personalised treatment options and help you manage your back pain effectively.

Back Pain Treatment FAQs

1. What is the best treatment for back pain?

Personalised care involving early assessment, patient education, physical activity, and a mix of physical and psychological interventions is considered the best treatment for back pain.

2. What is the fastest way to relieve back pain?

The fastest way to relieve back pain often involves a combination of limited rest, active movement and physical therapy. Consult your physiotherapist for tailored advice.

3. How can physiotherapy help with back pain?

Physiotherapy helps by assessing your condition, providing personalised treatment plans, and guiding you through exercises and self-management strategies to reduce pain and improve mobility.

4. What are the best exercises for lower back pain?

Yes, graded exercise therapy and regular physical activity can help relieve back pain. A physiotherapist can guide you through exercises tailored to your condition. Exercises like gentle stretching, core strengthening, and low-impact aerobic activities are often recommended. Your physiotherapist can provide exercises tailored to your needs. Not all exercises suit every type of lower back pain. Personalised advice is your fastest solution to resolving your back pain.

5. When should I see a physiotherapist for back pain?

You should see a physiotherapist if your back pain persists for more than a few days, interferes with daily activities, or if you experience symptoms like numbness or weakness. More severe symptoms like loss of bladder or boqwel control and leg weakness should be investigated by a visit to an Emergency Department.

6. Can weight loss help reduce back pain?

Yes, losing excess weight can reduce the strain on your lower back and alleviate pain. Combining a healthy diet with regular exercise is highly encouraged. Seek professional guidance if you would like a safe and steady transition to an active pain-free lifestyle.

7. How do you treat severe back pain?

Treating severe back pain may require a combination of physiotherapy, medications, and lifestyle changes. Your physiotherapist can create a specific treatment plan based on your condition. Certain red flags may require an ED appointment.

8. When should I seek medical attention for back pain?

Seek medical attention if you experience severe pain, neurological deficits, or symptoms of serious conditions like cauda equina syndrome. Early assessment and appropriate referral are crucial.

9. Is imaging necessary for back pain?

Imaging is necessary only if there’s a suspicion of serious pathology. For most people with back pain, imaging doesn’t change the management plan and can cause unnecessary concerns.

10. Can psychological factors affect back pain?

Yes, psychological factors like stress, anxiety, and depression can affect back pain. Addressing these factors through appropriate interventions can enhance recovery.

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