Back Pain

BACK PAIN

Back pain is one of the most common things physios treat, and the approach depends on whether it’s acute, sub-acute, or chronic, plus what’s actually causing it. 

Here’s how physiotherapy typically handles it:

1. *Assessment first*

A good physio won’t jump straight to exercises. They’ll check:

- *Movement patterns*: What hurts, what eases it, what makes it worse

- *Range of motion, strength, posture*: Looking for tight hips, weak glutes/core, stiff thoracic spine

- *Nerve involvement*: If there’s sciatica, numbness, tingling down the leg

- *Red flags*: Night pain, unexplained weight loss, loss of bowel/bladder control - these need medical referral

2. *Pain management & mobility phase*

For acute pain, the goal is to calm it down and get you moving safely.

- *Manual therapy*: Joint mobilizations, soft tissue release to reduce stiffness and muscle spasm

- *Heat/ice, TENS*: Used selectively for short-term relief

- *Gentle mobility*: Cat-cow, pelvic tilts, nerve glides if nerves are involved

- *Education*: How to move, lift, sit without aggravating it. “Rest in bed” is usually outdated advice

3. *Strength & stability phase*

Most back pain improves when the spine is better supported.

- *Core stability*: Not just crunches. Think dead bug, bird dog, side planks - exercises that train deep stabilizers

- *Glute & hamstring strengthening*: Weak glutes force the lower back to do more work

- *Hip mobility*: Tight hip flexors and hamstrings pull on the pelvis/lower back

- *Postural training*: Setting up your work station, learning to brace during lifts

4. *Functional & return-to-activity phase*

Once pain is down, you train for what you actually do.

- *Load progression*: Squatting, deadlifting, carrying with proper mechanics

- *Sport/work-specific drills*: Returning to running, desk work, lifting at your job

- *Endurance*: Walking, swimming, cycling to build back tolerance

5. *Common techniques you might see*

- *McKenzie Method*: Uses repeated movements to centralize pain

- *Maitland/Mulligan mobilizations*: Hands-on joint movements to improve mechanics

- *Dry needling*: For trigger points in tight muscles

- *Pilates/Yoga-based rehab*: Focuses on control and alignment

What works best

Evidence points to *active exercise + education* as the core. Passive treatments like massage, ultrasound, and traction help short-term but don’t fix it alone. The goal is to make you independent, not dependent on the physio.

When to get checked urgently

Go to a doctor/ER if you have:

- Loss of control of bladder/bowel

- Numbness in the saddle area

- Progressive weakness in the legs

- Unexplained fever + back pain

If you tell me what your pain feels like - location, what aggravates it, how long you’ve had it - I can give you a more targeted set of exercises and things to avoid. 

What kind of back pain are you dealing with right now?

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