Back Pain: Symptoms, Causes, and Physiotherapy Treatment in London
Back pain affects 8 in 10 people at some point in their lives, making it the leading cause of disability in the UK. Whether you're experiencing acute lower back pain after lifting something heavy, chronic thoracic discomfort from desk work, or radiating sciatic symptoms, physiotherapy offers effective evidence-based treatment. London has over 200 specialist back pain physiotherapists who can assess your condition, identify underlying causes, and create personalised rehabilitation programmes to reduce pain and restore function.
What is back pain?
Back pain is discomfort, ache, or sharp pain anywhere along the spine from the neck to the tailbone, most commonly affecting the lower back (lumbar region). It ranges from mild, temporary discomfort to severe, chronic pain that limits daily activities. Back pain is classified as acute (lasting less than 6 weeks), subacute (6-12 weeks), or chronic (lasting more than 12 weeks). Approximately 2.5 million people in the UK consult their GP about back pain each year.
The back comprises 33 vertebrae separated by intervertebral discs, supported by ligaments, muscles, and tendons. Pain arises from various structures including muscle strain, ligament sprain, disc problems, facet joint irritation, or nerve compression. Understanding the pain source guides effective treatment.
Back pain rarely indicates serious disease. Most episodes result from mechanical problems such as muscle strain or poor posture. Red flag symptoms suggesting serious pathology (cancer, infection, fracture) occur in fewer than 1% of cases. However, persistent or severe pain warrants professional assessment to rule out serious conditions.
What are the symptoms of back pain?
The main symptoms of back pain include localised ache, muscle spasm, stiffness, reduced range of motion, and pain that worsens with certain movements or positions. Symptoms typically worsen with prolonged sitting, bending, lifting, or first thing in the morning. Severity varies from mild discomfort to significant functional limitation preventing work or daily activities.
Common symptoms:
Localised Pain - Ache or sharp pain in a specific area of the back, often the lower back. Pain may be constant or intermittent, varying in intensity throughout the day.
Muscle Spasm - Involuntary muscle contractions causing visible twitching or severe cramping. Spasms force the spine into unusual positions and limit movement significantly.
Stiffness - Reduced flexibility making it difficult to bend, twist, or move freely. Stiffness typically worsens with prolonged static positions such as sitting at a desk or sleeping.
Radiating Pain - Pain spreading into the buttocks, thighs, or legs suggests nerve involvement. Sciatica causes pain radiating down the leg following the sciatic nerve pathway.
Numbness or Tingling - Altered sensation in the legs or feet indicates nerve compression. Pins and needles sensations or areas of numbness require prompt assessment.
Weakness - Difficulty performing movements such as standing on tiptoes or lifting the foot suggests nerve compression affecting muscle control.
When to seek urgent medical attention:
Seek immediate medical help if experiencing:
Inability to control bladder or bowels (cauda equina syndrome)
Progressive leg weakness or numbness in both legs
Severe pain unrelieved by rest or medication
Back pain following significant trauma
Fever combined with back pain
Unexplained weight loss with back pain
History of cancer with new back pain
These red flags suggest serious conditions requiring emergency investigation. Most back pain doesn't involve these symptoms and responds well to physiotherapy.
What causes back pain?
Back pain is caused by mechanical dysfunction (muscle strain, ligament sprain, disc injury), postural stress, age-related degeneration, or less commonly nerve compression or inflammatory conditions. Risk factors include poor posture, sedentary lifestyle, weak core muscles, heavy lifting, obesity, smoking, and psychological stress. In many cases, multiple factors combine to trigger symptoms.
Primary causes:
Muscle Strain - Overstretching or tearing of back muscles from sudden movements, heavy lifting, or unusual physical activity. Muscle strains account for 70% of acute back pain episodes. Recovery typically occurs within 2-6 weeks with appropriate treatment.
Ligament Sprain - Stretching or tearing of ligaments supporting the spine. Sprains result from twisting movements, falls, or excessive bending. The lower back is particularly vulnerable due to its mobility and load-bearing function.
Disc Problems - The intervertebral discs act as shock absorbers between vertebrae. Disc bulging or herniation occurs when the outer layer weakens, allowing inner material to protrude. This can compress nearby nerves causing radiating pain and numbness.
Facet Joint Dysfunction - The small joints linking each vertebra can become irritated or arthritic, causing localised pain and stiffness. Facet joint pain typically worsens with extension (arching backwards) and rotation.
Degenerative Changes - Age-related wear and tear causes disc dehydration, bone spurs, and arthritis. Degenerative changes are normal as we age and don't always cause pain. Many people with significant degeneration on scans have no symptoms.
Poor Posture - Prolonged sitting, particularly with slouched posture, stresses spinal structures. Office workers commonly develop postural back pain from sustained positions and inadequate workstation setup.
Nerve Compression - Pressure on spinal nerves from disc herniation, bone spurs, or spinal stenosis causes radiating pain, numbness, or weakness. Sciatica is the most common nerve compression syndrome affecting the back.
Risk factors:
Sedentary lifestyle and weak core muscles
Obesity increasing spinal load
Smoking reducing disc nutrition
Repetitive heavy lifting or awkward postures at work
Psychological stress and poor sleep quality
Previous back injury increasing re-injury risk
Pregnancy causing postural changes and ligament laxity
How does physiotherapy help back pain?
Physiotherapy treats back pain through comprehensive assessment, manual therapy techniques, specific exercise prescription, education about pain mechanisms, and ergonomic advice. Research shows physiotherapy is as effective as surgery for many back conditions, with the advantage of no surgical risks or recovery period. Treatment reduces pain, improves function, and helps prevent recurrence.
Assessment:
Back pain physiotherapy begins with detailed assessment identifying pain location, movement patterns triggering symptoms, postural habits, muscle imbalances, and contributing lifestyle factors. Your physiotherapist performs specific tests to differentiate muscle, disc, facet joint, or nerve problems. Understanding the pain source guides targeted treatment.
Assessment includes observation of your standing posture, walking pattern, and how you move from sitting to standing. Your physiotherapist tests spinal mobility in all directions, palpates to identify tender areas and muscle tension, and assesses core muscle control. Strength testing reveals muscular weaknesses contributing to pain.
Treatment techniques:
Manual Therapy - Hands-on techniques including soft tissue massage, joint mobilisation, and manipulation reduce pain and stiffness. Manual therapy addresses tight muscles, restricted joints, and trigger points. Evidence supports manual therapy combined with exercise for optimal outcomes.
Exercise Prescription - Specific exercises targeting core stability, flexibility, and strength form the cornerstone of physiotherapy. Initial exercises focus on gentle movement and motor control. As pain settles, exercises progress to strengthen muscles supporting the spine and improve movement patterns.
Core stability exercises activate deep abdominal and back muscles providing spinal support. These muscles often become inhibited with back pain, requiring specific retraining. Strengthening larger muscles such as the glutes and back extensors improves overall spinal stability.
Flexibility exercises address tight hip flexors, hamstrings, and thoracic spine mobility. Improved flexibility reduces strain on the lower back. Your physiotherapist prescribes exercises matched to your specific restrictions.
Pain Education - Understanding pain mechanisms reduces fear and anxiety. Modern pain science shows pain doesn't always indicate tissue damage. Chronic pain involves sensitised nervous systems requiring different management approaches. Education empowers you to self-manage effectively.
Ergonomic Advice - Workplace setup significantly affects back pain. Physiotherapists assess your workstation and provide recommendations for optimal positioning. Simple changes such as adjusting chair height, screen position, and introducing movement breaks reduce postural stress.
Lifestyle Modification - Guidance on lifting technique, sleeping position, and daily activities protects your back. Physiotherapists teach correct bending and lifting mechanics, recommend appropriate mattresses and pillows, and suggest activity pacing strategies.
Additional treatments include dry needling for muscle trigger points, shockwave therapy for chronic pain, and taping techniques for acute episodes.
What is the recovery timeline for back pain?
Recovery from back pain typically takes 4-12 weeks with appropriate treatment, though individual timelines vary considerably. Acute back pain (sudden onset) often improves within 4-6 weeks. Chronic back pain (lasting over 3 months) requires 8-16 weeks of consistent physiotherapy. Individual factors including pain severity, duration before seeking treatment, age, overall fitness, and adherence to exercise programmes influence recovery speed.
Typical recovery phases:
Acute Phase (Week 1-2)
Focus: Pain reduction and inflammation control
Activities: Gentle movement, avoiding bed rest, modified daily activities
Treatment: Manual therapy, heat/ice application, simple exercises
Goals: Reduce pain intensity, restore basic movement, understand condition
Subacute Phase (Week 3-6)
Focus: Restoring normal movement and building core stability
Activities: Gradual return to regular activities, specific exercise programme
Treatment: Progressive exercise, manual therapy, ergonomic modifications
Goals: Pain-free daily activities, improved strength and flexibility, reduced pain frequency
Rehabilitation Phase (Week 7-12)
Focus: Strengthening, preventing recurrence, returning to full activity
Activities: Gym-based exercises, sport-specific training, unrestricted activities
Treatment: Advanced strengthening, movement pattern correction, education
Goals: Return to pre-injury activity level, prevent future episodes, independent management
Chronic Pain Management (Ongoing)
For persistent pain beyond 12 weeks, treatment shifts to function optimisation
Focus on improving quality of life despite pain
Emphasis on self-management strategies, pacing, and psychological approaches
Regular physiotherapy maintaining gains and preventing deterioration
Factors affecting recovery:
Pain duration before treatment - earlier intervention produces faster outcomes
Severity of initial injury - severe disc herniation recovers more slowly than muscle strain
Age - younger people typically recover faster than older adults
Physical fitness - better baseline fitness supports quicker recovery
Adherence to exercise - consistent home exercise significantly improves outcomes
Psychological factors - fear avoidance and catastrophising delay recovery
Work demands - heavy manual jobs require longer recovery than sedentary roles
Most people experience significant improvement within 6-8 weeks of starting physiotherapy. If progress plateaus or pain persists beyond 12 weeks, your physiotherapist may recommend specialist referral for imaging or consultant opinion.
How to prevent back pain
Prevent back pain by maintaining strong core muscles through regular exercise, practising good posture throughout the day, using correct lifting technique, managing healthy body weight, and taking regular movement breaks from prolonged sitting. Those with previous back pain episodes should continue strengthening exercises indefinitely to prevent recurrence.
Prevention strategies:
1. Core Strengthening - Regular exercise targeting deep abdominal muscles, back extensors, and glutes protects the spine. Exercises such as planks, bridges, and bird dogs build core endurance. Aim for core training 3 times weekly, even when pain-free.
2. Posture Awareness - Maintain neutral spine alignment throughout daily activities. When sitting, use lumbar support and keep feet flat on the floor. Stand with weight evenly distributed and shoulders relaxed. Avoid slouching or prolonged forward-leaning positions.
3. Correct Lifting Technique - Lift with your legs, not your back. Bend at the knees, keep the load close to your body, and avoid twisting while lifting. For heavy items, ask for help or use mechanical aids. Never lift with a rounded back.
4. Regular Movement - Break up prolonged sitting with movement every 30-45 minutes. Stand, walk, or perform simple stretches. Sustained positions load spinal structures causing stiffness and pain. Frequent position changes distribute loads across different tissues.
5. Appropriate Exercise - Activities such as swimming, walking, yoga, and Pilates maintain spinal health. Avoid high-impact activities if you're prone to back pain. Start new exercises gradually to allow adaptation.
6. Weight Management - Maintain healthy body weight to reduce spinal load. Every kilogram of excess weight multiplies forces through the lower back. Weight loss reduces pain in overweight individuals with back problems.
7. Ergonomic Workspace - Adjust your desk, chair, and computer to support neutral posture. Screen at eye level, feet flat, and arms at 90 degrees. Use ergonomic chairs with lumbar support. Consider standing desk options for variety.
8. Stress Management - Psychological stress increases muscle tension and pain perception. Incorporate stress reduction techniques such as mindfulness, adequate sleep, and relaxation practices. Chronic stress correlates with increased back pain risk.
When should I see a physiotherapist for back pain?
See a physiotherapist for back pain when symptoms persist beyond 2 weeks, significantly limit daily activities, recur frequently, or cause concern. Early physiotherapy intervention produces better outcomes than delayed treatment. You do not need a GP referral to book a private physiotherapy appointment for back pain assessment and treatment.
Seek physiotherapy when:
Pain persists beyond 2 weeks despite rest and over-the-counter medication
Pain significantly limits work, exercise, or daily activities
Symptoms recur frequently (3+ episodes per year)
You want to prevent future episodes after recovering from acute pain
Pain radiates into your leg suggesting possible nerve involvement
Morning stiffness lasts more than 30 minutes
You're concerned about what's causing your pain
Previous back pain episodes became chronic
Early intervention prevents acute pain becoming chronic. Research shows physiotherapy within 2 weeks of symptom onset reduces the risk of developing chronic back pain by 50% compared to waiting 4+ weeks for treatment.
Most London physiotherapists can see you within 3-5 days of initial contact. Many offer same-day or next-day appointments for acute pain. Areas like City of London, Canary Wharf, and Westminster have numerous clinics with flexible appointment availability.
Find a Back Pain Specialist in London
Ready to start treatment? Find specialist physiotherapists in London experienced in treating back pain. Our directory includes practitioners across all London areas, from specialist back pain physiotherapists to general MSK specialists who treat spinal conditions regularly.
Specialist clinics:
Back Pain Physiotherapy London - Specialist back pain physiotherapists
Central London Physiotherapists - Convenient city locations
Islington Physiotherapy - Community-based back pain treatment
Kensington Physio Clinics - Premium back pain specialists
Related conditions:
Lower Back Pain - Specific lower back pain information
Sciatica Treatment - Leg pain from nerve compression
Neck Pain - Upper spine and neck problems
Frequently Asked Questions
Is bed rest good for back pain?
No, bed rest is not recommended for back pain. Research shows prolonged bed rest delays recovery and weakens muscles. Stay active within pain tolerance, continuing normal activities as much as possible. Gentle movement helps healing by maintaining muscle strength and joint mobility.
Should I use heat or ice for back pain?
Use ice for acute injuries (first 48-72 hours) to reduce inflammation. Apply for 15-20 minutes every 2-3 hours. After the acute phase, heat relieves muscle tension and stiffness. Apply heat for 15-20 minutes before activity or exercise. Neither ice nor heat addresses underlying causes, but both provide temporary symptom relief.
Will I need an MRI scan?
Most back pain doesn't require MRI scanning. Your physiotherapist can diagnose the problem through clinical assessment. MRI becomes necessary only when symptoms suggest serious pathology, nerve compression causes progressive weakness, or conservative treatment fails after 8-12 weeks. Scans often show age-related changes that don't correlate with symptoms.
Can physiotherapy cure my back pain?
Physiotherapy effectively treats most back pain, but "cure" implies complete elimination of symptoms forever. More realistically, physiotherapy reduces pain significantly, restores function, teaches self-management strategies, and prevents recurrence. Some chronic conditions require ongoing management rather than cure.
How many physiotherapy sessions will I need for back pain?
Most acute back pain requires 4-6 physiotherapy sessions over 4-6 weeks. Chronic back pain typically needs 8-12 sessions over 8-16 weeks. Your physiotherapist provides a specific timeline after initial assessment. Adherence to home exercise programmes significantly influences session numbers needed.
Does back pain always come back?
Back pain recurs in approximately 60-80% of people who've had an episode. However, recurrences are typically less severe and shorter duration than initial episodes. Continuing core strengthening exercises, maintaining good posture, and managing risk factors significantly reduces recurrence rates.
Should I see a physiotherapist or chiropractor for back pain?
Both physiotherapists and chiropractors treat back pain, but physiotherapy emphasises active rehabilitation through exercise, while chiropractic focuses on spinal manipulation. Research shows physiotherapy produces equivalent or superior outcomes for most back conditions. Physiotherapists are regulated by the HCPC, ensuring consistent training standards.
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