Back pain can affect the mid-back, lower back and nearby muscles and joints. Symptoms may stay around the spine or spread into the buttock or leg.

If your pain sits mainly in the lumbar area, start with lower back pain. If pain, tingling or pins and needles travel into the leg, review sciatica.

This hub helps you choose the back pain guide that best matches your symptoms. It also explains common causes, assessment, treatment and when to seek medical advice. For service information, see back pain physiotherapy.

Back Pain Decision Guide

Choose the pattern that most closely matches your symptoms. These pathways can help you find the most relevant guide, but they do not confirm a diagnosis because several back conditions can feel similar.

What is back pain?

Back pain describes pain in the thoracic spine, lumbar spine or nearby soft tissues. Some people feel local pain only. Others experience symptoms into the buttock or leg.

More than one structure or factor can contribute. Therefore, the overall symptom pattern often provides more useful information than trying to blame one tissue too early.

What commonly causes back pain?

Back pain may involve muscle strain, joint irritation, disc-related pain, nerve irritation, reduced physical capacity or repeated overload. Symptoms may start after lifting, sport, prolonged sitting, awkward twisting or a sudden increase in activity.

However, back pain does not always have one isolated cause. Assessment considers how your symptoms respond to movement, posture, loading and recovery.

Common back pain conditions

Back pain is an umbrella term rather than one diagnosis. These guides explain common conditions and symptom patterns in more detail.

How do symptom patterns help guide assessment?

A physiotherapist considers where symptoms travel, which movements aggravate them and how they change over time. One painful movement alone does not confirm a diagnosis.

Back pain when bending

Pain that worsens with bending, sitting, lifting or getting out of a chair may occur with disc-related pain, muscle strain or another load-sensitive presentation.

Back pain with leg pain

Pain, tingling or numbness travelling into the leg may occur with nerve irritation. Heavy or cramping legs brought on by walking and relieved by sitting can occur with spinal stenosis.

Back pain after lifting

Pain after lifting, twisting or awkward loading may involve muscle strain, protective muscle spasm or lumbar joint irritation.

Back stiffness after sitting

Long periods of desk work, driving or other static postures can reduce movement tolerance. Useful resources include good back posture tips, posture exercises and targeted back exercises.

Should you rest or keep moving with back pain?

For many people with uncomplicated back pain, gentle movement is more helpful than prolonged bed rest. Short walks, easy mobility and light activity within tolerable limits can help maintain movement and confidence.

You may need to reduce aggravating loads for a short time. However, prolonged inactivity can reduce strength and activity tolerance.

How is back pain assessed?

A physiotherapist may assess your movement, symptom behaviour, nerve symptoms, strength and activity tolerance. Assessment may include bending, extending, walking, sitting and relevant loading tasks.

The assessment also considers whether your presentation is suitable for physiotherapy or whether medical review or further investigation may be appropriate.

How can physiotherapy help back pain?

Back pain physiotherapy may include education, symptom-management strategies, hands-on treatment when appropriate and progressive exercise. Your program should reflect your symptoms, physical capacity and goals.

1. Settle aggravating symptoms

   Temporarily modify painful loads while maintaining comfortable movement and everyday activity where possible.

2. Restore movement and control

   Gradually improve comfortable spinal and hip movement and introduce appropriate strength exercises.

3. Build capacity

   Progress strength, endurance and relevant tasks for work, sport, parenting and daily activities.

4. Return to normal activity

   Increase lifting, gym, sport and other activities progressively rather than making sudden jumps in workload.

How can you reduce future back pain flare-ups?

Regular activity, graded strengthening and sensible load management may help reduce recurring back pain. Build capacity in your trunk, hips and legs, then practise the activities that matter to you.

A maintenance plan may include walking, core stability training and a small number of targeted back exercises.

Recurring symptoms can reflect a mismatch between current capacity and life demands. Workload, sudden activity increases, prolonged sitting, sleep and stress may all influence symptoms. Repeat pain does not necessarily mean that serious damage has occurred.

Back Pain FAQs

What to do next

If your back pain is recent and there are no warning signs, gentle movement, shorter periods of sitting and a gradual return to normal activity may be useful.

If symptoms persist, keep returning, spread into the leg or significantly limit your normal activities, consider an assessment. You can also read more about back pain physiotherapy.

References

1. 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
2. Hayden JA, Ellis J, Ogilvie R, et al. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;9(9):CD009790. doi:10.1002/14651858.CD009790.pub2
3. Pocovi NC, Lin CWC, French SD, et al. Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia. Lancet. 2024;404(10448):134–144. doi:10.1016/S0140-6736(24)00755-4