Back Pain

Back pain can affect bending, lifting, sitting, standing, walking, sleeping and many other everyday activities. Symptoms may begin suddenly after a particular movement or develop gradually without an obvious injury.

At Core Physio, your physiotherapist will consider more than the location of the pain. The assessment will explore how the problem developed, which movements affect it and how it influences your work, exercise and normal daily life.

Treatment is personalised around your symptoms, physical abilities and goals. Depending on the assessment, your plan may include advice, movement, progressive exercise, strength rehabilitation and hands-on physiotherapy where appropriate.

Understanding Back Pain

The back contains bones, joints, discs, muscles, ligaments, nerves and other tissues that work together during movement and physical activity.

Symptoms can affect different regions, including:

The lower back
The middle or upper back
One or both sides of the back
The area around the pelvis or buttocks
The back alongside symptoms extending into a leg

Many episodes do not have one clearly identifiable cause. Pain may arise following an increase in activity, a strain, repeated physical demands or a combination of several factors.

Some people improve within a relatively short period, while others experience recurring flare-ups or symptoms that remain present for longer.

Common Back Pain Symptoms

The experience varies considerably between individuals. You may notice:

An ache or discomfort across the lower back
Sharp pain during a particular movement
Stiffness after sitting or resting
Difficulty bending or straightening
Pain while lifting or carrying
Discomfort during prolonged standing
Symptoms after walking or exercising
Muscular tightness or spasms
Pain extending towards the buttock or leg
Reduced confidence in normal movement

The intensity of symptoms can also change during the day. Some activities may feel comfortable, while others temporarily increase the pain.

An individual assessment helps determine whether physiotherapy is appropriate and which approach is most relevant to you.

What Can Cause Back Pain?

Back pain can develop for many reasons, and it is not always possible or necessary to identify one damaged structure.

Possible contributing factors include:

A sudden or unfamiliar movement
Lifting or carrying
A fall, collision or sporting injury
A rapid increase in exercise or training
Repeated physical work
Prolonged periods of reduced activity
Reduced strength or physical capacity
Previous episodes of pain
Changes in sleep, recovery or general health
Stress and concern about movement

Medical conditions involving discs, nerves, joints, inflammatory disease, infection or fractures can also cause symptoms. However, serious underlying causes are uncommon.

Your physiotherapist will consider whether the presentation appears suitable for routine musculoskeletal care or requires medical investigation.

Lower Back Pain

Lower back pain affects the area between the bottom of the ribs and the pelvis. It may remain localised or extend towards the hips, buttocks or legs.

Commonly affected activities include:

Getting out of bed
Moving from sitting to standing
Bending to the floor
Lifting and carrying
Sitting at a desk
Driving
Walking or running
Working in low or awkward positions

A physiotherapy assessment can examine how you move, which tasks provoke symptoms and whether strength, mobility or activity tolerance needs to be developed.

Persistent or Recurring Symptoms

Some episodes settle and do not return. Others may recur during particular activities or remain present for several months.

Persistent symptoms do not automatically mean that the back is continuing to become more damaged. Pain can remain sensitive even after the original irritation has settled.

Factors such as reduced activity, loss of physical confidence, poor sleep, stress, previous painful experiences and concern about movement can influence recovery.

Rehabilitation may therefore address:

Comfortable movement
Strength and physical capacity
Gradual exposure to feared activities
Work or exercise demands
Pacing and activity progression
Confidence in using the back normally
Strategies for managing future flare-ups

The purpose is not to suggest that symptoms are imagined. Instead, treatment recognises that persistent pain can be influenced by several physical and non-physical factors.

Back Pain and Sciatica

Sciatica describes symptoms associated with irritation or compression of the sciatic nerve or its contributing nerve roots.

Symptoms may include:

Pain extending from the back or buttock into a leg
Tingling or pins and needles
Numbness
Burning or electric-shock sensations
Weakness in part of the leg or foot

Not all leg pain is sciatica, and symptoms do not always begin with noticeable lower back pain.

Your physiotherapist may assess sensation, strength, reflexes and movements that place demand on the nervous system. The findings will help determine whether physiotherapy is suitable or whether medical or specialist assessment is required.

When May Physiotherapy Help?

Physiotherapy may be useful when symptoms are affecting normal movement, work, exercise or physical confidence.

Consider arranging an assessment when:

The pain is not improving as expected
Symptoms repeatedly return
You are uncertain which activities are safe
Movement has become increasingly restricted
You have reduced your normal activity considerably
Sitting, standing or walking has become difficult
You are struggling with work-related tasks
Pain is preventing exercise or sport
You need help returning to activity after a flare-up
You would benefit from a structured rehabilitation plan

You do not need to know the exact cause before booking. Establishing the likely nature of the problem and deciding on appropriate next steps form part of the assessment.

Your Initial Physiotherapy Assessment

The first appointment begins with a detailed conversation about what you have been experiencing.

Your physiotherapist may ask:

When the symptoms started
Whether they began suddenly or gradually
Where you feel pain or altered sensation
Which movements increase or reduce the symptoms
Whether pain extends into the buttock or leg
How the problem affects sleep and daily activity
Whether you have experienced similar symptoms before
What your work involves
Which exercise or sport you normally complete
What treatment, medication or investigations you have already received
Whether you have any relevant medical conditions
What you would like to return to doing

Bring any relevant scan reports, consultant letters or other medical information to the appointment.

Your Physical Assessment

The physical assessment will be adapted to your symptoms and abilities.

Your physiotherapist may examine:

Comfortable movement of the back
Hip and lower-limb movement
Muscular strength
Balance and movement control
Walking
Bending, lifting or squatting
Sensation and reflexes where relevant
Movements associated with your work or exercise

You may not need every test. The examination should focus on the findings most likely to influence your treatment plan.

Your physiotherapist will explain what the assessment suggests and discuss whether treatment can begin or whether another healthcare professional should be involved.

Your Treatment Plan

Care will be based on the assessment rather than following one standard programme for everyone.

Your plan may include:

Advice about the likely nature of the problem
Guidance for managing a painful flare-up
Help remaining appropriately active
Exercises to restore comfortable movement
Progressive strengthening
Walking or general physical activity
Movement and lifting practice
Hands-on treatment where appropriate
A gradual return to work or exercise
Strategies for managing recurring symptoms

Treatment should be reviewed according to meaningful changes in movement, function and your ability to complete the activities that matter to you.

Exercise for Back Pain

There is no single exercise that is best for everyone. The most suitable programme depends on your symptoms, current abilities and goals.

Exercises may initially focus on:

Comfortable spinal movement
Hip mobility
Gentle muscular activation
Walking or another manageable activity
Regaining confidence in normal movement

As your abilities improve, the programme may progress towards:

Stronger resistance exercises
Lifting and carrying
Squatting and bending
Longer periods of walking or standing
Running or sporting movements
Exercises that reproduce the demands of your work

A temporary increase in familiar discomfort does not always mean that an exercise is harmful. However, the programme should remain manageable and be adjusted when symptoms become excessive or do not settle as expected.

Remaining Active During Recovery

Back pain can make resting feel like the safest option. Short periods of reduced activity may occasionally be helpful during a severe flare-up, but prolonged bed rest can make it harder to regain normal movement and strength.

Where it is safe to do so, you may be advised to:

Continue normal gentle activity
Change position regularly
Take short walks
Break larger tasks into manageable stages
Temporarily reduce rather than completely stop exercise
Gradually increase activity as symptoms allow

Your physiotherapist can help you find an appropriate starting point and build activity gradually rather than alternating between complete rest and doing too much at once.

Hands-On Treatment

Hands-on physiotherapy may be considered when it can support the wider rehabilitation plan.

Techniques may include:

Joint mobilisation
Soft-tissue treatment
Massage techniques
Guided movement
Manipulation where appropriate

Manual treatment is not required for every person and should not be the only part of care. It cannot independently rebuild strength, endurance or tolerance for physical activity.

Where it is used, hands-on treatment may help manage symptoms or make movement more comfortable while you continue with exercise and active rehabilitation.

Back Pain at Work

Symptoms can affect people in both physically demanding and desk-based occupations.

Work may involve:

Prolonged sitting
Standing for long periods
Driving
Lifting and carrying
Bending or twisting
Repeated movements
Working at floor level
Operating tools or machinery

Your physiotherapist can consider the actual demands of your role and help you prepare for them.

This could involve temporarily modifying particular duties, increasing movement during the working day or progressively building the strength and endurance needed for more demanding tasks.

No single sitting or standing position must be maintained perfectly throughout the day. Regular movement and changing position are often more practical than trying to hold one posture continuously.

Returning to the Gym or Sport

Reduced pain is only one part of returning to full physical activity. You may also need to restore strength, confidence and tolerance for repeated movement.

Rehabilitation can progress towards activities such as:

Weight training
Running
Cycling
Swimming
Golf or racket sports
Contact or field sports
Exercise classes
Manual or physically demanding work

The programme should reflect the movements, loads and duration required by your chosen activity.

A gradual return can reduce the risk of moving directly from limited activity into full training before your body is prepared for the demand.

Do I Need a Scan?

Most people do not need an X-ray or MRI before beginning physiotherapy.

Scan findings do not always explain why someone is experiencing pain. Changes can appear on imaging in people who do not have symptoms, while considerable discomfort may occur without a serious structural problem.

Imaging may be considered when:

A serious underlying condition is suspected
There has been significant trauma
The result is likely to change treatment
Symptoms suggest specialist assessment is required
Progress is different from what would normally be expected

Your physiotherapist can explain whether the presentation appears suitable for treatment or whether medical investigation should be requested.

Back Pain and Posture

People are often told that pain is caused by one incorrect posture. In reality, there is no single position that everyone must maintain throughout the day.

Remaining in any position for a long period may become uncomfortable, even when that position is described as good posture.

More practical strategies may include:

Changing position regularly
Using a comfortable workstation
Taking brief movement breaks
Alternating between sitting and standing where possible
Building tolerance for the positions required by your work
Increasing general strength and activity

The aim is not to become anxious about every movement or sitting position. Instead, your physiotherapist can help you identify realistic changes that suit your routine.

Lifting and Back Pain

Lifting is a normal activity that the back can usually be prepared to tolerate.

During a painful flare-up, the amount lifted or the way a task is performed may need to be adjusted temporarily. Avoiding lifting indefinitely can reduce confidence and physical capacity.

Rehabilitation may therefore include:

Practising bending and lifting
Starting with manageable resistance
Gradually increasing load
Changing the height or position of an object
Building leg, hip and back strength
Preparing for repeated work or sporting demands

There is not one compulsory lifting technique for every object or individual. The most appropriate strategy depends on the load, task, environment and your current abilities.

Managing a Back Pain Flare-Up

A flare-up does not necessarily mean that a new injury has occurred. Symptoms can temporarily increase following unusual activity, reduced sleep, illness, stress or a rapid change in physical demand.

During a flare-up, it may help to:

Reduce particularly aggravating activities temporarily
Continue gentle movement where possible
Use previously helpful exercises
Break tasks into smaller stages
Avoid prolonged bed rest
Return gradually to normal activity
Seek advice when symptoms are unusual or worsening

Your physiotherapist can help you develop an individual plan for responding to future episodes without becoming unnecessarily inactive.

When May Back Pain Require Medical Advice?

Most episodes are not caused by a serious medical condition. Nevertheless, some symptoms require prompt assessment.

Contact your GP or NHS 111 when:

The pain is severe and begins suddenly
Symptoms are getting worse rapidly
You feel hot, cold, shivery or generally unwell
The problem is not improving after several weeks
Pain is preventing normal daily activity
You have lost weight without trying
There is unexplained swelling or a change in the shape of the back
Pain is consistently worse at night or does not improve with rest
Symptoms began following an accident or fall
You have a history of cancer, infection or significant bone weakness

Your physiotherapist may also recommend medical assessment if the examination identifies symptoms outside the expected pattern of a routine musculoskeletal problem.

When Is Emergency Assessment Required?

Call 999 or attend A&E immediately when back pain occurs with:

Pain, weakness, tingling or numbness affecting both legs
Loss of feeling around the genitals, buttocks or anus
Difficulty controlling or emptying the bladder
Loss of bowel control
Changes in sexual sensation or function
Chest pain
Symptoms following a serious accident

These symptoms can indicate a condition requiring urgent medical investigation. Do not wait for a routine physiotherapy appointment.

Physiotherapy for Back Pain at Core Physio

Core Physio provides personalised assessment and rehabilitation for lower back pain, recurring symptoms, movement restriction and selected cases involving leg or sciatic-type symptoms.

Appointments may include education, movement, progressive strengthening and hands-on treatment according to your assessment.

Physiotherapy is available at our London Bridge clinic and East Dulwich clinic.

You can also explore our broader Physiotherapy service and the other Medical Conditions We Treat.

Frequently Asked Questions

Do I need a GP referral?

You can normally book private physiotherapy directly without first seeing your GP. Some private health insurers may require authorisation or a referral before agreeing to cover treatment.

Should I rest until the pain has gone?

Prolonged bed rest is generally not recommended for uncomplicated back pain. Remaining gently active and gradually returning to normal activities can help preserve movement and strength.

Will I need an MRI scan?

Most people do not require imaging before beginning physiotherapy. A scan may be considered when serious pathology is suspected or when the result is likely to change your management.

Is back pain always caused by a slipped disc?

No. Symptoms can have many possible causes, and it is often not possible to identify one structure responsible for the pain. Disc-related problems are only one possible presentation.

Can physiotherapy help with sciatica?

Physiotherapy may be suitable for some people with sciatic-type symptoms. The assessment will consider pain, sensation, strength and neurological signs before an appropriate plan is recommended.

Will I receive exercises?

Most rehabilitation plans include movement or strengthening exercises. These will be selected according to your symptoms, abilities and goals rather than using the same programme for everyone.

Does physiotherapy include massage?

Hands-on treatment may include massage or other manual techniques when appropriate. However, these are normally used alongside exercise, education and active rehabilitation rather than as the only treatment.

Can I continue working?

Many people can continue working, although particular duties may need to be adjusted temporarily. Your physiotherapist can consider the physical requirements of your role and help plan a gradual return to more demanding tasks.

Can I continue exercising?

This depends on your symptoms and the activity involved. Complete rest is not always required, but exercise intensity, volume or particular movements may need to be modified temporarily.

How many appointments will I need?

The number varies according to the problem, how long it has been present, your goals and your response to treatment. Your physiotherapist will discuss the recommended plan after the assessment.

Can back pain return after treatment?

Symptoms can recur. Rehabilitation may therefore include strategies for managing flare-ups, maintaining activity and gradually rebuilding physical capacity when pain returns.

When should I seek urgent help?

Seek immediate medical assessment for bladder or bowel changes, numbness around the genitals or anus, symptoms affecting both legs, chest pain or pain following a serious accident.