Low Back Pain
Most low back pain is mechanical and resolves with the right movement, exercise prescription and a clear return-to-activity plan — not bed rest.
Common symptoms
- Localised lower-back ache
- Stiffness on rising or after sitting
- Pain that eases with movement
- Difficulty bending, lifting or twisting
Common causes
- Lumbar muscle or ligament strain
- Disc bulge or prolapse
- Facet joint irritation
- Poor lifting mechanics or sustained postures
When to seek help
Most back pain is mechanical, settles within four to six weeks, and doesn’t need imaging. That said, book in if any of the following are true:
- the pain has been there for more than a couple of weeks without easing
- it’s waking you at night for reasons other than rolling over
- you can’t sit, stand or walk for as long as you used to
- numbness, pins and needles, or weakness is travelling down a leg
- you’re losing weight without trying, or you’ve had a recent fever
The last two are uncommon but worth flagging. Most people we see come in because the pain has outstayed its welcome and is starting to affect work, sleep, or being able to pick up a toddler without bracing.
How we treat low back pain
The first visit is about working out what’s driving the pain rather than naming the bulging disc. We look at how your back moves, how your hips and pelvis sit, how you brace under load, and what makes things worse over a day.
From there, treatment usually mixes a bit of hands-on work to settle the immediate pain with movement and strength work that gives you something to do at home. People often expect more passive treatment than they get. Hands-on therapy is useful in the early weeks, but it’s exercise that does the heavy lifting on outcomes.
Imaging? Useful sometimes, often not. We’ll tell you if and when a scan would actually change the plan.
What the research actually says about back pain
The Australian guidelines for managing low back pain haven’t changed dramatically in twenty years. Stay active. Avoid extended bed rest. Use simple pain relief if you need to. Get back to normal activity as soon as your body lets you. Most people are noticeably better at six weeks and largely recovered by twelve.
About one in five people will have a recurrence in the year after their first episode. That isn’t a sign something is wrong — it’s how this kind of pain behaves. The job of physio is twofold: settle the current flare, and build enough buffer that the next one is smaller and shorter.
When imaging is actually useful
Most MRIs in the first six weeks of a new back pain episode show findings that exist in people without pain too. Disc bulges, mild degeneration, the occasional protrusion — these are normal on scans of pain-free adults in their thirties. Imaging changes the plan when symptoms suggest a specific structure (severe nerve-root pain that isn’t settling, suspicion of fracture, red-flag features) or when surgical decisions are on the table. Otherwise, a scan is more likely to scare you than help you.
What you’ll actually do between sessions
Most treatment plans involve four to six exercises that take 10–15 minutes a day. Not the gym, not yoga, not Pilates — a short list of specific things matched to what your back is doing. We send them by email after the appointment with photos or short video clips so you don’t have to remember from memory. Sticking with the program is the single biggest predictor of how quickly things settle.
Common questions about low back pain
Should I rest my back or keep moving?
Keep moving, gently. Bed rest beyond a day or two makes most back pain worse, not better. Walk, change position regularly, and avoid the things that flare you up — but don’t curl up on the couch for a week.
Do I need an MRI before I see a physio?
No. A good physio assessment in the first few weeks tells you more about how your back is functioning than an MRI does. If we think a scan would change the plan, we’ll write the referral and tell you why.
I’ve been told I have a disc bulge. Is that bad?
Probably not, on its own. Disc bulges are common findings on the scans of people with no back pain at all. What matters is whether the bulge is actually irritating a nerve and how your symptoms are behaving over time. We’ll talk through what your scan means in plain English.
How long until I can lift again?
Most people are lifting light loads within a couple of weeks and back to their normal lifting within six to eight, depending on what "normal" looks like for them. Tradies, parents of toddlers, and people who lift at the gym all need slightly different return-to-load plans, so we build the right one with you.
Is surgery on the table?
For most low back pain, no. Spinal surgery is generally reserved for cases where there’s a clear structural problem causing nerve compression that isn’t settling with conservative care, or where bladder, bowel or major motor function is affected. Even most people with disc problems get better without surgery.
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