Lower Back Pain: Causes, Treatment & Exercises
Complete guide to understanding, managing, and recovering from lower back pain.
Introduction
Lower back pain is one of the most common reasons people see a physiotherapist - and one of the most treatable. Whether you've just injured your back or have chronic pain, understanding what's happening is the first step to recovery.
This guide covers everything you need to know: what causes lower back pain, when to see a physio, exercises you can do at home, and realistic recovery timelines.
The good news: Most lower back pain improves significantly with the right approach.
What is Lower Back Pain?
Lower back pain (lumbar pain) is discomfort in the area between your ribs and hips. It can range from a dull ache to sharp, shooting pain.
Common Causes
Muscle Strain (Most Common)
Lifting something heavy incorrectly
Poor posture over time
Sudden awkward movement
Weak core muscles
Recovery: 2-6 weeks with proper care
Disc Problems
Bulging or herniated disc pressing on nerves
Causes sharp pain, sometimes radiating down the leg
Recovery: 4-12 weeks (sometimes longer)
Facet Joint Pain
Wear and tear in the small joints of the spine
Often worsens with backward bending
Recovery: 4-8 weeks with treatment
Sacroiliac Joint Dysfunction
Pain in the lower back/buttock area
Often one-sided
Recovery: 4-8 weeks with physio
Arthritis
Osteoarthritis of the spine
Chronic condition, but very manageable
Recovery: Ongoing management, not "cure"
Poor Posture (Long-Term)
Desk work, phone use, bad sitting habits
Builds up over months/years
Recovery: 8-12 weeks to retrain posture habits
When to See a Physiotherapist
See a physio if you have:
Pain lasting more than 2 weeks
Pain that worsens despite rest
Pain radiating down your leg (sciatica)
Weakness in your legs or feet
Loss of bladder/bowel control (see GP immediately)
Pain after injury or trauma
You probably don't need a physio for:
Mild pain that improves with rest and exercise
Minor muscle soreness after activity
See your GP first if:
You have severe pain
You have numbness/tingling down both legs
You have loss of bladder control
You've had recent trauma/fall
You have fever + back pain (possible infection)
Most lower back pain doesn't need imaging (X-ray, MRI). Your physio can diagnose through assessment.
What Happens at Your First Physio Appointment
Assessment (15-20 minutes)
Your physio will ask:
When did it start?
What movements make it worse?
Have you had this before?
What's your job/activity level?
What are your goals?
Examination (15-20 minutes)
Tests to find where the pain is coming from
Checks for nerve involvement
Assesses movement and flexibility
Tests core strength
Diagnosis & Explanation
What's actually wrong (in plain language)
Why it happened
Recovery timeline
Treatment plan
First Treatment (10-15 minutes)
Gentle treatment or massage
Exercises to start
Advice on activity and posture
Total time: 45-60 minutes
Self-Care: What You Can Do at Home
Immediate Pain Relief (First 48 hours)
Rest (but not too much)
Avoid heavy lifting and twisting
Stay mobile - short walks are good
Don't stay in bed all day
Ice or Heat
Ice for first 48 hours (reduces inflammation)
Heat after 48 hours (eases stiffness)
15-20 minutes at a time, several times daily
Pain Relief
Over-the-counter paracetamol or ibuprofen
Follow package instructions
Don't exceed recommended doses
Good Positions
Lying down with pillow under knees
Sitting upright in supportive chair
Avoid slouching on sofa
Ongoing Self-Care (Beyond First 48 Hours)
Core Strengthening Exercises
Pelvic Tilts
Lie on back, knees bent
Gently tilt pelvis to flatten lower back against floor
Hold 5 seconds, repeat 15 times
Do 2-3 times daily
Dead Bug
Lie on back, arms up, legs bent at 90°
Slowly lower one arm and opposite leg
Return and repeat other side
10 repetitions each side, 2-3 times daily
Bird Dog
On hands and knees
Extend one arm forward and opposite leg back
Hold 3-5 seconds, return
10 each side, 2-3 times daily
Glute Bridges
Lie on back, knees bent, feet flat
Push hips up to create straight line
Hold 5 seconds, lower
15 repetitions, 2-3 times daily
Stretches
Knee to Chest
Lie on back, pull one knee toward chest
Hold 30 seconds, repeat other side
2-3 times daily
Cat-Cow Stretch
On hands and knees
Arch back (cow) then round it (cat)
Alternate slowly, 10 times
2-3 times daily
Posture Habits
Sit upright, shoulders relaxed
Use lumbar support pillow
Take breaks from sitting every 30 minutes
Bend knees when lifting (not your back)
Keep weight close to your body
Activity
Walk daily (builds core strength, reduces stiffness)
Avoid heavy lifting for 4-6 weeks
No twisting movements until pain-free
Gradually return to normal activities
Recovery Timeline
Acute (New) Lower Back Pain
Week 1-2: Pain worst, movement limited. Focus on rest, ice, gentle movement.
Week 2-4: Pain decreasing, starting exercises. Should be significantly better.
Week 4-6: Nearly pain-free, building strength. Most people are back to normal.
Week 6+: Full recovery, return to sport/heavy activity.
Chronic Lower Back Pain (lasting months)
Takes longer to resolve (8-12 weeks)
Requires consistent exercise and posture changes
May never completely disappear but becomes very manageable
Physio is very effective
Disc Hernia/Sciatica
Initial pain: 2-4 weeks (often worst at start)
Improving phase: 4-8 weeks
Full recovery: 8-12 weeks
Some people recover faster, some need longer
Physiotherapy Treatment for Lower Back Pain
What Your Physio Might Do
Manual Therapy
Soft tissue massage
Joint mobilization/manipulation
Gentle stretching
Exercises
Guided strengthening and stretching
Progression as you improve
Home exercise program
Education
How to move safely
Posture correction
Ergonomic advice for work/home
Modalities (if needed)
Heat therapy
TENS machine
Acupuncture (some physios)
How Many Sessions?
Acute pain: 4-8 sessions over 2-4 weeks
Chronic pain: 8-12 sessions over 4-6 weeks
Some people improve in 2-3 sessions
Others need ongoing management
Prevention: Stop It Happening Again
Core Strength
Strong core muscles support your spine. Do your exercises 3-4 times per week permanently.
Good Posture
Sit upright
Use lumbar support
Take regular breaks from sitting
Lifting Technique
Bend knees, not back
Keep weight close
Avoid twisting while lifting
Stay Active
Regular walking
Swimming or water exercises (excellent for back)
Avoid prolonged sitting
Manage Stress
Stress increases muscle tension
Yoga, stretching, relaxation help
Good sleep is important
Healthy Weight
Extra weight stresses lower back
Maintaining healthy weight reduces strain
Common Questions About Lower Back Pain
Q: Should I rest completely or stay active?
A: Stay gently active. Bed rest makes it worse. Walk short distances, do light exercises, but avoid heavy lifting and twisting.
Q: When can I return to sport?
A: Usually 4-6 weeks for pain-free, simple activities. Return to sport gradually over 6-8 weeks. Check with your physio first.
Q: Do I need an MRI or X-ray?
A: Usually no. Most back pain doesn't need imaging. Your physio can diagnose through assessment. Imaging is only needed if specific issues are suspected.
Q: Is my back permanently damaged?
A: No. Most lower back pain fully resolves. Even herniated discs usually heal. Your physio will assess and reassure you.
Q: Can I do exercises while in pain?
A: Yes, but gently. Gentle movement helps recovery. Severe pain means rest and see a physio. Moderate pain: gentle exercises are fine.
Q: How long before I can lift heavy things again?
A: Usually 4-6 weeks. Start with light weights (2-3kg) and progress gradually. Never lift heavy things if you're in pain.
What NOT to Do
Don't:
Assume your back is "permanently damaged" (it's usually not)
Stay in bed for extended periods
Avoid all movement (movement helps)
Slouch or sit poorly
Lift heavy things while in acute pain
Push through sharp pain during exercises
Stop exercises too early (they prevent recurrence)
Products That Might Help
Support Items
Lumbar support pillow (for sitting)
Ergonomic chair cushion
Back support belt (for heavy work, temporary)
Exercise Equipment
Yoga mat
Foam roller
Resistance bands
Heat/Cold
Reusable heat pack
Ice pack
Wheat bag
Ready to Get Better?
Lower back pain is very treatable. With the right physio and consistent home exercises, most people recover fully within 4-8 weeks.
Related Guides
Sciatica Treatment (pain radiating down leg)
Posture & Core Strength (prevent future pain)
Sports Injury Recovery (if you injured your back during sport)