Why does my Lower Back Hurt?: Understanding Lower Back Pain: Causes, Treatments, and How to Identify the Problem

1. Muscle Strain or Ligament Sprain

Often triggered by sudden movements, lifting, or overdoing it at the gym or garden. Even sleeping in an awkward position can cause it.

• What it feels like: A sudden sharp or pulling pain, possibly after an identifiable event.

• Treatment: Early management focuses on reducing pain and keeping you moving gently. Over time, strengthening exercises help prevent recurrence.

2. Poor Posture or Sedentary Lifestyle

Sitting for hours on end, especially slouched at a desk or sofa, can overload certain structures in your back.

• What it feels like: A gradual, nagging ache, especially in the afternoon or after prolonged sitting.

• Treatment: Education about posture, active breaks during your day, ergonomic changes, and exercises to support your spine.
  
  

4. Facet Joint Irritation

These small joints in the spine help guide movement. They can become irritated by stiff movement, poor posture, or wear and tear.

• What it feels like: Local back pain, sometimes worse when leaning backward or twisting.

• Treatment: Mobilisation, movement retraining, and improving core and hip strength.
  
  

5. Degenerative Disc Disease and Osteoarthritis (OA)

These age-related changes are a normal part of life, like wrinkles on the inside, but can contribute to stiffness and flare-ups in some people.

• What it feels like: Morning stiffness that eases with movement, or aching after prolonged activity.

• Treatment: Regular exercise, movement variety, and a healthy lifestyle can make a big difference. Pain doesn't always equal damage.
  
  

How Physiotherapists Reason Through Your Pain

We don't jump to conclusions or rely only on scans. Instead, we look at the whole picture. Here's what you can expect:

Your Story

• When did the pain start?

• What makes it worse or better?

• How is it affecting your life?

• Have you had pain before?

This helps us understand why your back might be sensitive, and which tissues or patterns are involved.

Movement Assessment

• We look at how you bend, twist, and move.

• We check muscle strength, joint mobility, and posture.

• We look at your whole body, not just your back.

When Is Imaging (like MRI) Needed?

Most people don't need a scan. In fact, imaging can sometimes cause unnecessary worry.

A scan might be needed if:

• You have significant leg weakness

• There's a loss of bowel or bladder control

• You have unexplained weight loss or a history of cancer

• Your pain isn't improving despite good rehabilitation

What Are the Treatment Options?

Your treatment will depend on your specific presentation. No two people are the same. But here are the core tools we use in physiotherapy:

• Education – Understanding your pain reduces fear and confusion

• Exercise therapy – Builds strength, mobility, and confidence

• Manual therapy – Hands-on techniques for relief and movement

• Posture and ergonomics – Especially helpful if you sit a lot

• Lifestyle coaching – Sleep, stress, and pacing your activity

• Return to activity – We help you safely return to the things you love