Physiotherapy for lower back pain

Expert reviewer, Judith Smith, MSK Clinical Lead, Bupa UK
Next review due July 2021

Physiotherapy is a type of treatment that helps to improve the movement and function of your joints and muscles. If you have back pain, physiotherapy can help to reduce it and get you back to normal mobility. It can also help you to make changes that reduce the chances of hurting your back again. Physiotherapists use a wide range of treatments and techniques to help with back pain, as well as offering advice on looking after your back.

A man standing looking at a river

Why would I need physiotherapy for back pain?

If you have back pain that’s causing you significant problems or doesn’t seem to be improving after a few weeks, if could be worth seeing a physiotherapist. Physiotherapy can be useful for various types of back pain. It may help with the following.

  • Non-specific lower back pain – this is back pain where no specific cause (such as an underlying medical condition or injury) has been identified.
  • Sciatic pain – this is pain that spreads from your back down your legs; it may be caused by a prolapsed disc. A prolapsed disc is when a disc in your spine bulges out of its normal shape and presses on a nerve.
  • Back pain caused by ageing of the discs in your spine (degenerative disc disease).
  • Spinal stenosis – this is when the space around your spinal cord narrows, putting pressure on your spinal cord.

Your GP may refer you to a physiotherapist or you might arrange an appointment yourself (for more information, see our section: Finding a physiotherapist). Your GP or physiotherapist may recommend physiotherapy as part of a treatment package that includes an exercise programme, painkillers and psychological support. Having a combination of treatments like this may give you the best chance of getting rid of your back pain.

Physiotherapist, osteopath or chiropractor?

Physiotherapists, chiropractors and osteopaths are all health professionals who treat back pain with manual therapies, but their approaches to treatment are slightly different.

  • Physiotherapists focus on restoring movement and function to your whole body after you’ve been affected by illness or injury. They look at how the nerves, muscles and bones in your body are affected, and how treatment with exercise therapy and manual therapies can help. They’ll encourage you to take an active part in your rehabilitation, rather than relying on passive treatments.
  • Osteopaths look at the health of your body as a whole and aim to make sure all your bones, muscles and joints are functioning smoothly together. They focus on manual therapies to get your body back to a state of balance.
  • Chiropractors have a specialist interest in neck and back pain. They look at your body as a whole and how problems with your bones, muscles and joints affect your nervous system and general health. Their focus is on manipulation of the spine – but they may use other techniques too.

It’s your choice which type of practitioner you see, though if you’re seeking NHS treatment, it will depend what services are available in your area. If you’re booking treatment privately, think about what you’re hoping to get out of therapy and which approach appeals to you the most. It can be worth contacting a few different practitioners to discuss your circumstances. If you have health insurance, contact your insurance provider to see what you may be covered for.

What will happen when I see a physiotherapist?

When you first see a physiotherapist, they’ll take a detailed medical history. They’ll ask you questions about any medical conditions you have, your lifestyle and any medications you take. They’ll also want to know what symptoms you’ve been experiencing, and what tends to trigger them. Next, they’ll do a detailed physical examination, including looking at how you move and how your back is functioning. They may also do a neurological assessment to see how well your nerves are functioning. You may need to remove some of your outer clothes when you go for physiotherapy, so that your physiotherapist can see and feel your back. You can ask to have a chaperone if you’d prefer to have one with you.

Your physiotherapist will explain what treatment they recommend, and how they expect this might help your back pain. They should also warn you about any potential risks of the treatment. If you’re unsure about anything, don’t be afraid to ask. It’s important that you fully understand what your physiotherapist is proposing because you’ll be asked to sign your consent to go ahead with treatment.

Active therapy

Active therapies are exercises and movements that you do yourself. They’re the most important part of any treatment. Generally, keeping active in any way is the best thing for back pain. Exercises can help to improve flexibility, mobility and strength in your lower back. A physiotherapist can advise you on exactly what exercises are right for you, and how to perform them. Below we’ve included an overview of the different types of exercise you’re likely to come across.

Aerobic exercise

This is any exercise that gets you moving and increases your heart rate. It is the most important part of any treatment programme. Aerobic exercise can help with any stiffness you may have and will keep you mobile. It will also help to manage your weight, and can give your wellbeing a boost too. Your physiotherapist is likely to recommend low-impact aerobic exercises to start with; these include walking, swimming, and using exercise bikes and step machines. They’ll encourage you to do more as you feel able to. You’ll usually be advised to do some aerobic exercise for 20 to 30 minutes, up to 5 times a week. But you may need to start with shorter periods of activity.

Stretching exercises

These aim to improve flexibility in your spine and reduce any tension in the muscles supporting your spine. You’re likely to be asked to do these every day. A typical stretching exercise is to lie on your back and pull your knees in towards you to gently stretch your back. Or, you may be asked to stand and bend forward to stretch your hamstring muscles in the backs of your legs. This can reduce stress in your lower back.

Strengthening exercises

Exercises that aim to strengthen your core muscles can sometimes be a part of exercise programmes for back pain. Your core muscles are yjr abdominal muscles around your stomach, the muscles in your back, and those around your pelvis. These exercises can be helpful in the short term. However, there’s growing evidence that core exercises don’t seem to be any more beneficial than general exercise in the long term. So this type of exercise may not be something that your physiotherapist focuses on. Being active in general is more important.

Manual therapies

Your physiotherapist may also suggest trying one of the following manual (‘hands on’) techniques. This will always be in combination with an exercise programme.

  • Mobilisation. In mobilisation, your physiotherapist will use slow, gentle movements to stretch your spine. It aims to return your back to its normal range of motion.
  • Manipulation. In manipulation, your physiotherapist will make a quicker thrusting action with their hands at a particular point of your spine. You might hear a ‘pop’ sound when they do this.

In the past, physiotherapists used to offer other treatments such as transcutaneous electrical nerve stimulation (TENS) and acupuncture. However, these treatments are not recommended in guidelines for back pain because there’s limited evidence about how useful they are. You shouldn’t be offered these treatments now. Massage is another therapy where there is little evidence for how well it works. It’s not usually recommended for treatment of low back pain.

What to expect after physiotherapy

At the end of your first session, your physiotherapist will usually advise you how many sessions you’ll need and how frequently you’ll need them. This will depend on how badly your back pain is affecting you and how you’re managing with your symptoms. You may just need a one-off consultation, or they may recommend a course of physiotherapy appointments over a number of months.

Your physiotherapist will also give you some advice about what you can do at home to help your back pain. This may include things such as how to improve your posture, and how to make sure your car seat or office chair is adjusted properly.

Physiotherapy will be only one part of your treatment for back pain. Making lifestyle changes and keeping as active as possible, plus completing any other treatment you’re given, will help you to get better faster. It will also mean there’s less chance of your back pain coming back.

How can physiotherapy help me?

If your back pain has lasted more than a few weeks, an exercise programme with a physiotherapist can provide relief and get you moving again. Manual therapies such as manipulation and mobilisation have been shown to be helpful too. The pain relief and improvement in functionality you get with physiotherapy can last long enough for you to start getting back to your normal activities. Keeping active is the best thing for back pain. It can get you back to work faster, you’re less likely to have long-term problems, and you’re less likely to get back pain again.

It’s hard to get good evidence about how well specific exercises work for back pain. It’s not thought that one type of exercise is any better than another. Your physiotherapist will assess what they think will work best for you and your particular problem.

Your GP or physiotherapist may assess how your back pain is affecting you using a questionnaire to make sure you receive the most appropriate treatment. There’s some evidence that people who have been assessed in this way, may get the most benefit from physiotherapy.

Are there any side-effects from physiotherapy?

You may find that certain exercises and movements make your back pain worse. Your physiotherapist should monitor this and show you which exercises to avoid, and which ones will help relieve your pain.

Manual therapies such as manipulation can be associated with side-effects. These usually aren’t serious and only last for a short time. For instance, you may feel some stiffness or discomfort in the area in which you received the treatment. It’s possible that manipulation could cause a more serious injury, but this is very rare. Your physiotherapist should talk to you about the risks of manual therapies before they carry out any treatment.

Your physiotherapist should also check how you’re feeling as they do any ‘hands on’ therapy, and will stop if you have any pain or discomfort.

Finding a physiotherapist

Your GP may need to refer you to see a physiotherapist through the NHS or you may be able to book an NHS physiotherapist yourself directly. This is known as self-referral. Ask at your GP surgery to see whether this is available in your area.

Alternatively, you may wish to book an appointment with a private physiotherapist. You can search online directories to find a private physiotherapist in your area. If you have private health insurance, check with your insurer first before booking an appointment.

When booking your own physiotherapist, it’s important to make sure they are registered with the Health & Care Professions Council (HCPC). This means they have completed approved standards of training and follow the HCPC rules of professional conduct. To confirm a physiotherapist’s registration, check the HCPC website at

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  • Produced by Pippa Coulter, Freelance Health Editor, July 2018
    Expert reviewer, Judith Smith, MSK Clinical Lead, Bupa UK
    Next review due July 2021