Lower back pain: causes, what helps and when to worry

What lower back pain usually is

Lower back pain is one of the most common reasons people see a GP or physio in the UK, and most adults will have at least one episode. In the large majority of cases there is no single damaged structure that a scan or test can point to, which is why clinicians call it non-specific low back pain. That label sounds vague, but it is actually reassuring: it means there is no sign of anything serious.

Pain in the back is real and it can be severe, but severe does not mean damaged. The discs, joints, muscles and ligaments of the spine are strong and adaptable. A sore back after a weekend of heavy gardening or a clumsy deadlift is usually a sensitised back, not a broken one.

It is rarely one thing. Most episodes build from a mix of factors that load the back beyond what it is currently used to, or lower its tolerance for a while:

• A sudden jump in load: moving house, a new training block, a long drive followed by lifting suitcases
• Long spells in one position, such as a desk day with few breaks
• Poor sleep, high stress and low mood, which all turn up pain sensitivity
• Low general fitness or a long break from activity
• A previous episode, which is one of the strongest predictors of another

Office workers, manual workers, new lifters and experienced athletes all get back pain. Posture on its own is a weaker cause than most people think. There is no single correct way to sit or stand, and the best posture is usually your next one.

Typical symptoms

Non-specific back pain is usually felt across the lower back, sometimes more on one side, and may spread into the buttock or the back of the thigh. It often feels stiff first thing, eases as you get moving, then flares with particular positions such as bending to put socks on or getting out of the car.

Muscle spasm can leave you feeling locked or tilted to one side for the first day or two. That is a protective response and it usually settles. Pain that travels below the knee, especially with pins and needles or numbness, points more towards an irritated nerve, which we cover in our guide to sciatica.

What a physio assessment looks at

The first job is to screen for the rare serious causes, so expect questions about your general health, bladder and bowel function, weight, sleep and any history of cancer or recent illness. After that, the assessment is about understanding your back rather than hunting for one fault.

• How the pain started, what eases it and what aggravates it
• How you move: bending, squatting, walking, getting up from the floor
• Nerve checks such as reflexes, sensation and strength if you have leg symptoms
• Your training, work and daily routine, and what you want to get back to
• Worries and beliefs about your back, because fear of movement can keep pain going

Most people do not need an X-ray or MRI. UK guidance advises against routine imaging for non-specific back pain because scans often show age-related changes that are just as common in people with no pain at all. Seeing them can make people more worried without changing the treatment.

What usually helps

The strongest evidence supports staying active and following a structured, progressive exercise programme. The type of exercise matters less than doing something you will stick to: strength work, walking, Pilates-style control work and swimming have all been shown to help. Manual therapy such as joint mobilisation or soft tissue work can ease pain in the short term, and it is most useful alongside exercise rather than instead of it.

For lifters, the plan usually means modifying rather than stopping. That might be swapping barbell deadlifts for a lighter hinge, reducing range or load for a few weeks, then building back up. Bed rest is not recommended because it tends to slow recovery. Speak to a pharmacist or your GP if you need pain relief to keep moving.

What you can start with at home

If none of the warning signs below apply, these are safe starting points for most people. Work in a range that feels manageable: some discomfort, up to about 3 or 4 out of 10, is fine as long as it settles within 24 hours.

1. Walk daily, starting with whatever you can manage comfortably and adding a few minutes each day.
2. Knee rocks and pelvic tilts lying on your back, 10 to 15 slow repetitions a few times a day.
3. A glute bridge, 2 to 3 sets of 10, kept smooth and comfortable.
4. The bird dog for gentle trunk control, 2 sets of 6 to 8 each side.
5. Break up sitting every 30 to 45 minutes, even if it is just to stand and walk to the kettle.

Heat can ease muscle guarding in the first few days, and many people find it more comfortable than ice. If you sit at a desk all day, our guide to training around a desk job has more ideas for keeping your back moving.

How long recovery usually takes

Many people with a new episode of non-specific low back pain feel noticeably better within 2 to 6 weeks, although stiffness or twinges can hang around for longer. Back pain does tend to recur, so the aim is not only to settle this episode but to build a back that copes with more load next time.

If pain is still limiting you after around 6 weeks, or keeps coming back, get a proper assessment. Persistent back pain responds well to a graded plan too; it just needs more patience. At Lycan Strength the on-site physio can assess you and build a plan around your training, and members get 20% off treatment. You can book a physio appointment online or call 07428 442526.

When to get urgent help

Serious causes of back pain are rare, but these symptoms need checking quickly:

• Call 999 or go to A&E if you have numbness around your genitals, buttocks or inner thighs, new difficulty passing urine or controlling your bladder or bowels, or weakness in both legs. These can be signs of cauda equina syndrome, which is an emergency.
• Call NHS 111 or see your GP urgently if back pain comes with a fever or feeling very unwell, follows a significant fall or accident, or is severe and constant at night whatever position you are in.
• See your GP if you have unexplained weight loss, a history of cancer, long-term steroid use or osteoporosis, or numbness or weakness in one leg that is getting worse.

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