Physiotherapy for lower back pain

Physiotherapy is a treatment that helps to improve the movement and function of your body. Different physiotherapy techniques can help to ease lower back pain, restore normal movement, and lower the risk of your pain returning. Physiotherapists can also offer advice on how to look after your back, helping to prevent future problems.

About physiotherapy for lower back pain

Physiotherapists focus on restoring movement and function to your whole body after an illness or injury. They look at:

• how well your nerves, muscles, and bones are working
• whether treatments such as exercise and manual therapies are likely to help your lower back pain

Your physiotherapist will encourage you to take an active role in your rehabilitation, rather than relying only on your physiotherapist’s treatments at your appointments.

Find a physiotherapist

Your GP may refer you to a physiotherapist through the NHS, or you may be able to book an NHS physiotherapist yourself. This is called self-referral. Ask your GP surgery if this is available in your area.

You can also have private physiotherapy. You can search online directories to find a local private physiotherapist. If you have private health insurance, check what your insurer covers before you book an appointment.

If you book your own physiotherapist, make sure they’re registered with the Health & Care Professions Council (HCPC). This means they’ve completed approved standards of training and follow the HCPC rules of professional conduct.

Physiotherapy procedure

When you first see a physiotherapist, they’ll ask you about:

• your symptoms
• when these started
• what makes them better or worse
• what triggers them

Your physiotherapist will also ask about:

• your medical history
• any medical conditions you have
• your lifestyle
• your work environment
• any medicines you take

Next, your physiotherapist will examine you to see:

• how easily you move
• how well your back is working
• how well your nerves are working, if necessary

You may be asked to remove some clothes so your physiotherapist can see and feel your back. You can ask for a chaperone, or you are welcome to bring someone with you to the appointment. The physiotherapist will explain what they’re going to do and why.

Your physiotherapist will explain:

• the benefits of physiotherapy
• the treatment they recommend
• how the treatment may help your lower back pain
• any potential risks of having physiotherapy treatment

If you’re unsure about anything, don’t be afraid to ask. It’s important that you fully understand what your physiotherapist recommends, because they’ll ask you to give your consent before going ahead with treatment.

Your GP or physiotherapist may recommend physiotherapy as part of a treatment package that includes:

• hands-on manual therapy
• an exercise programme
• painkillers
• psychological support

Having a combination of treatments may give you the best chance of easing your lower back pain. Your physiotherapist will also help you to understand what’s causing your lower back pain so you can take steps to manage it.

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

Exercise and staying active

Keeping active is the best thing for lower back pain. If you’re employed and pain is affecting your work, it can help you return to work faster. You’re also less likely to have long-term problems or get lower back pain again. Even if you’ve had lower back pain for some time, an exercise programme with a physiotherapist can ease your symptoms and get you moving again.

Exercises can help to improve flexibility, mobility, and strength in your lower back. Some people find it easier to exercise with other people, so your GP or physiotherapist may suggest you join a group exercise programme.

A physiotherapist can advise you on exactly what exercises are right for you, and how to do them. Below is an overview of the different types of exercise that physiotherapists usually recommend.

Aerobic exercise

This is any exercise that gets you moving and increases your heart rate. Aerobic exercise can help with any stiffness and keep you mobile. It will also help to manage your weight and can give your mental wellbeing a boost.

Your physiotherapist may recommend you start with low-impact aerobic exercises, such as walking, swimming, and using exercise bikes and step machines. They’ll encourage you to increase your activity as your strength and mobility improve. They’ll probably advise you to exercise for around 30 minutes, at least 5 times a week, but their recommendations will be specific to you.

Stretching exercises

Stretching improves flexibility in your spine and reduces tension in the muscles that support your spine. You usually do these exercises every day. A typical stretching exercise is to lie on your back with your knees bent and your feet on the bed. Then let your legs gently roll to the left-hand side and then over to the right-hand side. Ask your physiotherapist about other stretching exercises you can do.

Strengthening exercises

Physiotherapy exercises for lower back pain to strengthen core muscles will often be included as part of an exercise programme. Your core muscles are the tummy (abdominal) muscles around your stomach, the muscles in your back, the buttock (gluteal) muscles, and those around your pelvis.

Manual therapies

Your physiotherapist may suggest manual (hands-on) techniques to treat your lower back pain. This will always be alongside an exercise programme.

• Mobilisation. Your physiotherapist will use slow, gentle, rhythmical movements to stretch your spine and help your back return to its normal range of motion.
• Manipulation. Your physiotherapist will do controlled thrusting movements with their hands at a particular point of your spine. You might hear a ‘pop’ sound when they do this but don’t worry; this is normal.15,16 Not all physiotherapists use this technique. They won’t do it unless they’ve explained the reasons for doing so. You’ll need to give your consent for this procedure to be done.
• Massage. Your physiotherapist may use massage to treat lower back pain.

Physiotherapists used to offer other treatments, such as transcutaneous electrical nerve stimulation (TENS) and acupuncture. These treatments aren’t recommended in guidelines for lower back pain because there isn’t enough evidence that they work. But some people find them helpful. Ask your physiotherapist for more information.

Uses of physiotherapy

If lower back pain is causing you 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, and may help the following.

• Non-specific lower back pain – where no cause (such as a health condition or injury) has been found.
• Sciatic pain (sciatica). This spreads from your back down your legs. It 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 and facet joints in your spine (degenerative disc disease).
• Spinal stenosis. This is when the space around your spinal cord narrows.18 This then puts pressure on your spinal cord and causes pain.

Aftercare for physiotherapy

Your physiotherapist will give you some advice about what you can do at home to help your lower back pain. This may include how to:

• improve your posture
• make sure your car seat or office chair is set up properly

Sitting at a desk all day can play a big part in back problems. Your physiotherapist may give you some recommendations about your workstation setup, including your chair and screen height. They may advise you on how often to take a break and move around during the day.

They’ll also usually give you a home exercise programme. This is a series of exercises to do at home between your physiotherapy appointments. Your physiotherapist will adjust the programme at each appointment, as you make progress.

Physiotherapy will only be one part of your treatment for lower back pain. You may also need to make some changes to your lifestyle and keep as active as possible. Your physiotherapist may advise you to:

• do some regular exercise to keep your back mobile and strong for everyday activities
• lose any excess weight – if you have a high body mass index (BMI) or are overweight, it can put an unnecessary load on your spine and add to your pain and discomfort

Side-effects of physiotherapy

You may find that certain exercises and movements make your lower back pain more uncomfortable for a short time. 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 are rare, usually minor and don’t last for very long. You may feel some stiffness or discomfort in the area that was treated.

If your home exercises include movements that your muscles aren’t used to, it can cause your muscles to ache the following day. This is normal and will get better as your muscles adapt and get stronger. This is why it’s important to follow your physiotherapist’s advice and avoid increasing your activity too quickly.

It’s possible that manipulation could cause a more serious injury, but this is rare. Your physiotherapist should talk to you about the risks of manual therapies before they do 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.

Alternatives to physiotherapy

Different types of manual therapy can treat lower back pain. These all take a slightly different approach. In addition to physiotherapy, manual therapies are used by the following.

• 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, like osteopaths, look at your body as a whole. They’re interested in 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.

Manual therapy can be done in many different ways. It can vary according to different types of training and also between individual practitioners.

It’s your choice which type of practitioner you see. But if you would like NHS treatment, you’ll most likely be offered physiotherapy because the other services are often not funded.