Lower back pain: causes, symptoms and non-surgical treatment

What is lower back pain?

Lower back pain is pain, stiffness or muscle tension between the bottom of your ribs and the top of your legs. It may stay in your back or spread into your buttocks or legs.

Doctors and physiotherapists usually describe it by how long it has lasted:

• Acute: a recent episode, lasting up to around six weeks
• Subacute: lasting between about six and twelve weeks
• Chronic: lasting more than about three months, or coming back again and again

Common symptoms

• A dull ache or stiffness across the lower back
• Sharp pain when you bend, lift, twist or get up from sitting
• Pain that's worse after sitting for long periods, or first thing in the morning
• Muscle spasm or tightness
• Pain spreading into your buttock or down the back of your leg, sometimes with numbness or tingling. When pain travels below the knee, it's often a sign of an irritated nerve, known as sciatica.

What causes lower back pain?

In most people, lower back pain doesn't come from a single structure that can be pointed to on a scan. This is often called non-specific low back pain. It's usually linked to the muscles, joints and ligaments of the back and how they cope with everyday loads.

Specific causes include:

• Muscle or ligament strain, often after lifting, a sudden movement or an unusual activity
• Disc bulge or slipped (herniated) disc, where a disc presses on nearby nerves
• Degenerative disc disease and lumbar spondylosis: age-related changes in the discs and joints
• Facet joint pain: irritation of the small joints at the back of the spine
• Sacroiliac joint pain, where the spine meets the pelvis
• Lumbar spinal stenosis: narrowing of the spinal canal, often causing leg pain when walking
• Spondylolisthesis: one vertebra slipping forward on the one below

Things that can make back pain more likely or harder to shift include long hours of sitting, long commutes, heavy or repetitive lifting, low physical activity, poor sleep and stress.

When back pain needs urgent medical care

Most back pain isn't dangerous. But go to a hospital emergency department straight away if back pain comes with:

• numbness around your genitals or bottom
• new difficulty controlling your bladder or bowels
• leg weakness that's getting worse
• back pain after a serious fall or accident

See a doctor urgently if you also have fever, unexplained weight loss, a history of cancer, or pain at night that stops you sleeping.

→ Read the full list of red flags

How lower back pain is diagnosed

A good diagnosis starts with a conversation and a physical examination, not a scan. At your Maana Spine assessment, your physiotherapist asks about your symptoms and history, checks how your back moves, and tests your nerves, strength and reflexes.

Scans aren't always needed. An MRI or X-ray can be useful when nerve symptoms, red flags or a lack of progress suggest something specific. Scans also don't always explain pain: changes such as disc bulges are often seen in people who have no pain at all. That's why your scans are always interpreted alongside how your body actually moves. If you need a scan, your physiotherapist will recommend one and explain why.

→ What happens at your spine assessment

What the research and guidelines say

Exercise is the foundation. Clinical guidelines consistently put exercise, staying active and self-management at the centre of care for low back pain. The UK's National Institute for Health and Care Excellence (NICE), for example, recommends exercise programmes and advises that hands-on treatments such as spinal mobilisation or massage should only be used as part of a package that includes exercise. Exercise and rehabilitation make up most of every DTX program.

Spinal decompression: what trials show. A 2022 sham-controlled trial found that decompression reduced leg pain and herniated disc size in people with a recent disc herniation, and other trials have found benefits when decompression is added to physiotherapy. Results are mixed outside disc herniation with leg pain: a 2009 sham-controlled trial in people with chronic low back pain without leg pain found no added benefit.

What this means for you: if your lower back pain is linked to a disc problem with leg pain, decompression may be part of your plan, always combined with rehabilitation. If your pain isn't disc-related, your program will focus on exercise, movement and the other therapies that suit you.

→ Read our full review of the decompression evidence

Looking after your back

These general tips help many people with everyday back pain. They're not a substitute for an assessment if your pain is severe, persistent or worrying.

• Keep moving. Gentle activity and continuing your normal routine as far as you can usually helps more than resting in bed.
• Break up long sitting. Stand up and move regularly if you work at a desk. → Desk job back pain: what helps
• Lift with care. Keep loads close to your body and avoid twisting while lifting.
• Build strength gradually. Regular exercise that you enjoy, such as walking, swimming or a structured programme, helps protect your back over time.

When to book a spine assessment

Book an assessment if your back pain:

• has lasted more than two weeks, or keeps coming back
• is spreading into your buttock or leg
• comes with numbness, tingling or weakness
• stops you working, sleeping or doing everyday activities

Spine assessments are available at all five Maana Spine clinics in Kochi, Kozhikode, Thiruvananthapuram, Aluva and Perinthalmanna. The consultation fee is ₹250, and no doctor's referral is needed.

Book a Spine Assessment · or call +91 99950 09403