Lower Back Pain: Causes, Symptoms and How Physio Helps

Lower back pain is the single most common reason people call me. It is also the condition surrounded by the most outdated advice. Somewhere along the way we were all told that a sore back means something has slipped, crumbled or worn out, and that the safest response is to stop moving. Neither of those things is usually true, and believing them tends to make recovery slower rather than faster.

Over ten years of clinical practice I have assessed a great many backs, from warehouse workers in Speke to office staff in the city centre and retired patients easing back into gardening. What follows is what lower back pain actually is, what causes it, what a proper assessment looks like, and what genuinely helps.

What we mean by lower back pain

Most lower back pain is what we call non-specific. That sounds dismissive, but it is not. It means the pain is coming from the ordinary structures of the lower spine, the muscles, joints, discs and ligaments working together, without a single identifiable culprit and without any sinister disease behind it. Around the large majority of back pain falls into this group.

It also means the picture on a scan often matters less than people expect. Disc bulges, mild degeneration and wear-and-tear changes appear routinely on the scans of people with no pain whatsoever. Findings like these are closer to grey hair than to damage. That is why NICE guidance discourages routine imaging for simple back pain, and why I spend far more of an assessment watching how you move than speculating about what a scan might show.

Common causes

A few patterns come up again and again:

• A sudden overload. Lifting something awkwardly, twisting to catch a falling box, or a long day of unfamiliar work such as moving house. The tissue was fine yesterday; today it has been asked to do more than it was ready for.
• A gradual build-up. No single incident, just weeks of long driving, long sitting, poor sleep and no regular movement, until the back becomes irritable.
• Deconditioning. Backs, like everything else, need loading to stay robust. Long periods of inactivity leave the surrounding muscles less able to share the work.
• Nerve involvement. When a disc irritates a nerve root, pain can travel into the buttock and down the leg. That is sciatica rather than simple back pain, and it needs a slightly different plan.
• Stress, worry and poor sleep. These genuinely turn up the volume on pain. Ignoring them is ignoring a big part of the problem.

Symptoms and what they tell me

Typical non-specific back pain feels achy, sometimes sharp on certain movements, often worse first thing in the morning or after sitting still. It may spread across the belt line or into the top of the buttocks. It usually eases with gentle movement and varies from day to day. That variability is reassuring, because damaged tissue does not fluctuate hour to hour, but a sensitised nervous system does.

Pain travelling below the knee, particularly with pins and needles or numbness, points towards nerve irritation. Morning stiffness lasting well over an hour in a younger adult, with pain that improves rather than worsens with exercise, makes me think about inflammatory causes and may warrant a GP referral.

Red flags: see a doctor urgently

Rare, but important. Seek same-day medical attention if you develop:

• numbness or altered sensation around your saddle area, genitals or inner thighs
• new difficulty passing urine, or loss of bladder or bowel control
• weakness in both legs, or rapidly progressing weakness in one
• back pain with fever, unexplained weight loss, or a history of cancer
• significant back pain after a fall or accident, especially if you have osteoporosis

These need assessment by a doctor, not a physiotherapist.

What an assessment involves

A first appointment with me runs to about an hour. I take a careful history, because how the pain behaves across a day tells me more than any single test. Then I watch you move: bending, arching, rotating, standing from a chair, walking. I check hip and thoracic spine mobility, test strength through the hips and trunk, and if there is leg pain I screen the nerves properly with reflex, power and sensation testing.

By the end you should understand what is going on in plain English, what the likely timeline is, and what the first two weeks of your programme looks like. If something in the picture does not fit, I will say so and refer you on.

Because I work as a home visiting physiotherapist, that assessment happens in your own home, which has a quiet advantage: I get to see the chair you actually sit in, the bed you sleep in and the stairs you climb.

Evidence-based treatment

Effective back pain treatment in Liverpool or anywhere else rests on a few pillars, and passive treatment alone is not one of them.

Education and reassurance. Understanding that hurt does not equal harm changes behaviour, and behaviour changes outcomes. Research consistently shows that people who believe their back is fragile do worse than those who do not.

Graded exercise. This is the mainstay. Mobility work early, then progressive strengthening for the hips, trunk and back extensors, then loading that resembles the thing you actually want to do. The specific style matters far less than doing it consistently.

Staying active. Continue work and daily life where you reasonably can, adapting rather than stopping. Walking is underrated.

Hands-on treatment. Manual therapy, soft tissue work and joint mobilisation can meaningfully reduce pain in the short term, which makes exercise easier. I use it as a door-opener, never as the whole plan.

Addressing sleep and stress. Fixing a poor sleep routine sometimes does more for a back than any exercise sheet.

What you can do this week

Keep moving within comfort. Walk daily, even briefly. Break up long sitting every 30 to 40 minutes. Use heat for comfort if it helps. Start gentle mobility work such as knee rolls and pelvic tilts. Avoid the temptation to test the painful movement repeatedly to see if it still hurts, and avoid complete rest beyond a day or two.

You can read more about how the condition behaves over time in my guide to back pain, and about leg pain specifically in my page on sciatica treatment.

When to get help

If your back has not clearly improved after four to six weeks, if it keeps flaring every few months, or if it is stopping you working or sleeping, an assessment is worth it. Recurrent back pain rarely resolves by waiting it out, but it responds well to a structured programme.

I offer home visits across Liverpool and Merseyside at £90 a session and online video consultations UK-wide at £60, evenings Monday to Friday, plus Saturday and Sunday daytimes. No GP referral is needed. Book at /portal/book or call me on +44 7443 357020 and we will get a plan in place.