Back pain can significantly impact your daily life, affecting your ability to work, exercise, and even sleep comfortably.
Frequently Asked Questions
What does a physiotherapist actually do for back pain — what happens in a session?
A first session involves a postural and movement assessment to identify the root cause (muscle imbalance, disc-related, facet joint, or postural). Treatment then typically includes manual therapy (joint mobilisation, soft tissue massage to reduce tension), a personalised exercise programme targeting core stability and flexibility, and electrotherapy if indicated (TENS or ultrasound to reduce acute pain and inflammation). Sessions are typically 30–45 minutes, 1–2 times per week for 4–6 weeks. Most patients see measurable improvement within 3–4 sessions; if not, imaging is usually requested.
Which physiotherapy exercises are most effective for lower back pain?
The best-evidenced exercises for non-specific lower back pain are core stability exercises: bird-dog (opposite arm-leg raise), dead bug, glute bridge, and modified plank. For herniated disc specifically, McKenzie extension exercises (prone press-ups, standing back bends) relieve disc-related leg pain in most patients. For facet-joint or postural back pain, flexion-based (cat-cow, child's pose, knee-to-chest) work better. Pilates and yoga have both shown evidence for chronic lower back pain at 8–12 weeks. Avoid sit-ups and double leg raises — they load the lumbar discs and often worsen pain.
When is physiotherapy not enough and surgery needed for back pain?
Physiotherapy is the first-line treatment for the vast majority of back pain — only 5–10% of back pain cases eventually need surgery. Red flags that suggest surgery may be needed: persistent leg pain (sciatica) beyond 6–12 weeks of PT without improvement; loss of bladder or bowel control (emergency); progressive neurological weakness (foot drop); severe disc herniation with nerve compression confirmed on MRI. Surgery is considered only after conservative management (PT, medication, injections) has genuinely failed — not before. Spinal fusion has a mixed evidence base for non-specific back pain and is usually a last resort.
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