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Physiotherapy for lower back pain

Expert reviewer, Michelle Njagi, Senior MSK Physiotherapist at Bupa
Next review due December 2023

Physiotherapy is a treatment that helps to improve the movement and function of joints and muscles. It can help to reduce back pain and get you get moving normally again. It can also help to reduce the risk of hurting your back again. Physiotherapists use many treatments and techniques to help with back pain. They also offer advice on looking after your back.

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Why would I need physiotherapy for back pain?

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

  • Non-specific lower back pain – where no cause (such as an underlying medical condition or injury) has been identified.
  • Sciatic pain – this spreads from your back down your legs and may be caused by a prolapsed disc (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 – when the space around your spinal cord narrows, putting pressure on your spinal cord and causing pain.

Your GP may refer you to a physiotherapist or you can arrange an appointment yourself. For more information on this, see our section on finding a physiotherapist below.

Your GP or physiotherapist may recommend physiotherapy as part of a treatment package that includes hands-on manual therapy, 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. Your physiotherapist will also help you to understand what’s causing your pain so you can take steps to manage it.

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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 working 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.

You can choose which type of practitioner you see. But if you’re seeking NHS treatment, it will depend on the services available in your area. In some parts of the UK, you can refer yourself for physiotherapy. In others, you will need to be referred by your GP or hospital doctor. Osteopathy and chiropractic are not generally available on the NHS.

If you’re booking treatment privately, think about what you’re hoping to gain, and which approach appeals to you most. It’s worth contacting a few different practitioners to discuss your circumstances. If you have health insurance, contact your insurance provider to see what you are 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 about any medical conditions you have, your lifestyle, your work environment and any medications you take. They’ll also want to know what symptoms you’ve had, 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 working. They may also do a neurological assessment to see how well your nerves are working. You may need to remove some 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 prefer.

Your physiotherapist will explain the treatment they recommend, and how they expect this to 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 recommending because you’ll be asked to give your consent to go ahead with treatment.

Exercise and staying active

Generally, keeping active is the best thing for back pain. And exercise is the most important part of any treatment. Exercises can help to improve flexibility, mobility and strength in your lower back. Some people find it easier to exercise with others, so your GP or physiotherapist may suggest joining a group exercise programme.

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. Your physiotherapist may 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. They will probably advise aerobic exercise for 20 to 30 minutes, up to 5 times a week. But you may need to start with shorter periods.

Stretching exercises

Stretching improves flexibility in your spine and reduces tension in the muscles supporting your spine. You usually do these exercises every day. A typical stretching exercise is to lie on your back and pull your knees up towards you to gently stretch your back. Or, standing and bending forward to stretch your hamstring muscles in the backs of your legs. This can reduce stress in your lower back.

Strengthening exercises

Exercises to strengthen core muscles can sometimes be a part of exercise programmes for back pain. Your core muscles are the abdominal muscles around your stomach, the muscles in your back, and those around your pelvis. These exercises can be helpful in the short term. But there’s growing evidence that core exercises are no more helpful than general exercise in the long term. So, this may not be something 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 alongside an exercise programme.

  • Mobilisation means your physiotherapist will use slow, gentle movements to stretch your spine. The aim is to return your back to its normal range of motion.
  • Manipulation means your physiotherapist will make quick thrusting movements with their hands at a particular point of your spine. You might hear a ‘pop’ sound when they do this.

Physiotherapists used to offer other treatments such as transcutaneous electrical nerve stimulation (TENS) and acupuncture. But these treatments are not recommended in guidelines for back pain because there’s not enough evidence that they help yet. Massage is another therapy where there is little evidence for how well it works. It may be used for treatment of low back pain, but only alongside an exercise programme.

What to expect after physiotherapy

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

Your physiotherapist will also give you some advice about what you can do at home to help your back pain. This may include how to improve your posture, and how to make sure your car seat or office chair is adjusted properly. Sitting at a desk all day can play a big part in causing back problems. Your physiotherapist may make recommendations about your chair and screen height and advise you on how often to take a break and move around during the day.

You will usually also have a home exercise programme. This is a series of exercises that take around 15 to 20 minutes to complete. You usually do these between three and five times a week. Your physiotherapist will adjust the programme at each appointment, as you make progress.

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?

Even if you’ve had back pain for some time, 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 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 better than any another. Your physiotherapist will assess what they think will work best for you and your particular problem.

To make sure you receive the most appropriate treatment, your GP or physiotherapist may use a questionnaire to assess how your back pain is affecting you. 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 have 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 that was treated. If your home exercises include movements that your muscles are not used to, it can cause your muscles to ache the following day. This can last up to 72 hours after exercising. It’s perfectly normal and will lessen as your muscles adapt and strengthen.

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 stop if you have any pain or discomfort.

Finding a physiotherapist

Your GP may need to refer you to 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 if 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 what is covered with your insurer 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 www.hcpc-uk.org.

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  • Reviewed by Liz Woolf, Freelance Health Editor, December 2020
    Expert reviewer, Michelle Njagi, Senior MSK Physiotherapist at Bupa
    Next review due December 2023

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