Part 1 of our Move Better, Feel Better: Pain & Movement Explained series
Written by Jessica Brown, Osteopath and Owner of One Health Osteopathy Clinic, Tunbridge Wells
Lower back pain is one of the most common musculoskeletal problems we see in clinic. It can come on suddenly after lifting, exercise or an awkward movement, build gradually after long periods of sitting, or sometimes appear without one obvious cause.
For some people it feels like a dull ache or stiffness. For others, it can be sharp, intense or make everyday things such as getting out of bed, driving, walking, exercising or putting on shoes surprisingly difficult.
When your back hurts, it is natural to wonder what has happened and whether you should be worried.
The reassuring news is that most episodes of lower back pain are not caused by serious damage. The spine is a strong, adaptable structure, and pain does not automatically mean that something significant has gone wrong.
There are, however, times when back pain should be assessed, particularly if it is persistent, severe, keeps returning, affects your normal activities or is accompanied by other symptoms.
At One Health Osteopathy Clinic in Tunbridge Wells, we regularly assess people with acute and persistent lower back pain, back stiffness, sciatica and other musculoskeletal problems.
In this guide, I explain what can contribute to back pain, what current evidence tells us about recovery, and when it is sensible to seek professional help.
Lower back pain at a glance
For most people with uncomplicated lower back pain, the following principles are helpful:
Movement is usually beneficial. Prolonged bed rest is generally not recommended, but that does not mean you should push through activities that are clearly aggravating your symptoms. Temporarily doing a little less, modifying painful activities and allowing more rest than usual can be helpful, particularly in the early stages. The key is finding the right balance between rest and movement, and knowing how to keep moving in a way that feels manageable and supports recovery.
Pain does not always mean damage. A painful back can still be a strong and healthy back.
You will not usually need an MRI or X-ray. Imaging is generally most useful when the result is likely to change how your condition is managed.
Recovery varies from person to person. Many episodes improve within a few weeks, but the time it takes can depend on a number of factors, including which tissues are contributing, how irritable the symptoms are, whether there have been previous episodes, your general health, activity levels, sleep, stress, work demands and how confident you feel moving again.
Some people recover quickly, while others need a more gradual return to normal activity. Back pain can also recur, particularly if the factors contributing to it have not changed or if activity levels increase suddenly.
Treatment is usually most effective when it takes the whole picture into account. This may include hands-on care, movement, exercise, rehabilitation and advice tailored to the individual.
Most importantly, back pain needs to be considered in context. Your symptoms, health, work, activity levels, sleep, stress, previous episodes and goals can all influence how your back feels and how best to manage it.
What causes lower back pain?
People often expect back pain to have one clear structural cause, perhaps a particular muscle, joint or disc.
Sometimes there is an identifiable source. Often, several factors may be contributing at the same time.
Back pain can involve irritation or sensitivity in joints, muscles, ligaments, nerves, discs or fascia, alongside other influences such as changes in activity, movement, strength, sleep, stress, general health and previous experiences of pain.
In other words, there may be a genuine local musculoskeletal source of pain, but how that pain is experienced and how quickly it settles can also be influenced by the wider picture.
That is why a good assessment should look at both the painful area itself and the factors around it.
Non-specific lower back pain
Most lower back pain is classified as non-specific lower back pain.
This does not mean that the pain is imaginary or unimportant. It means that it cannot reliably be attributed to one specific disease or anatomical structure.
The lower back contains vertebrae, joints, discs, muscles, ligaments, nerves and connective tissues that all work together. Pain may reflect a combination of tissue sensitivity, changes in movement or activity, reduced physical capacity and how the nervous system is responding.
Sleep, stress, general health and previous experiences of pain can also influence symptoms.
This is why a good assessment should look beyond the painful spot. Understanding what has changed in your life, activity, work or movement can often be just as important as examining the back itself.
Muscle and soft-tissue irritation
Back pain sometimes starts after an unfamiliar or demanding activity, such as gardening, lifting furniture, returning to the gym, playing sport or simply doing much more than your body has recently been used to.
Muscles and other soft tissues can become sore or sensitive when the demands placed on them temporarily exceed their current capacity.
That does not necessarily mean you have seriously injured your back. In many cases, reducing aggravating activities briefly and then gradually rebuilding normal movement is an important part of recovery.
Disc-related back pain
The discs between the vertebrae help distribute load and allow the spine to move.
Discs change naturally throughout life. Findings such as disc degeneration and disc bulges are common on MRI scans, including in people who have no back pain at all.
A disc can sometimes contribute to symptoms, and in some cases disc material may irritate a spinal nerve and produce pain, tingling, numbness or weakness into the leg.
However, finding a disc bulge on a scan does not automatically explain someone’s pain, and it certainly does not mean their back is permanently damaged.
This is one reason scans must always be interpreted alongside the person’s symptoms and clinical examination.
What is the difference between lower back pain and sciatica?
Back pain and sciatica are often used interchangeably, but they are not the same thing.
Sciatica refers to symptoms caused by irritation or compression of a nerve that supplies the leg.
Rather than feeling pain only in the lower back, you may experience pain travelling into the buttock and down the leg. Some people also notice tingling, numbness, altered sensation or weakness.
Not every pain in the buttock or leg is sciatica. Problems involving the hip, muscles, tendons or other structures can produce pain in similar areas.
A clinical assessment can help distinguish between these possibilities.
We look at this in more detail in the next article in the series, Sciatica: What Does It Feel Like and When Should You Get Help?
Why can back pain feel so severe if nothing serious is wrong?
This is one of the most important things I explain to patients.
The intensity of pain does not always reflect the amount of tissue damage.
A sudden back spasm can feel dramatic. You may temporarily struggle to stand upright, turn over in bed or walk normally.
That can understandably feel alarming. However, severe pain does not automatically mean that you have seriously injured your spine.
Pain is a protective response produced by the nervous system. It takes information from many sources into account, including tissue irritation, previous experiences, sensitivity of the nervous system, sleep, stress, illness, worry and how safe or confident you feel when you move.
This becomes particularly relevant when pain lasts for longer than expected. Persistent back pain does not necessarily mean that your tissues have failed to heal.
Sometimes the nervous system becomes more protective and movement becomes guarded. Understandably, people can then start avoiding activities because they are worried about making the problem worse.
Helping someone recover may therefore involve improving movement, strength and physical capacity, but also helping them regain confidence in what their body can do.
Should you rest if you have lower back pain?
Usually, complete rest is not the best approach. If your back is particularly painful, it can be sensible to modify activities for a short time. You do not have to push through severe pain.
However, prolonged bed rest is generally discouraged.
For uncomplicated lower back pain, it is usually helpful to remain active and continue normal activities where possible.
Early movement might be as simple as:
- walking little and often;
- changing position regularly;
- continuing comfortable everyday activities;
- gradually returning to your usual exercise;
- rebuilding strength and confidence over time.
There is no single “best” back exercise that works for everybody.
What is appropriate for you depends on your symptoms, current ability, preferences and what you want your body to be able to do.
For one person, the goal may be returning to running or the gym. For someone else it may be sitting comfortably through the working day, gardening, lifting a child or walking without worrying about their back.
Do you need an MRI for lower back pain?
Often, no.
It is understandable to think that a painful back needs a scan to identify what has gone wrong. In reality, scans frequently identify changes that are also seen in people without pain.
Disc degeneration, disc bulges and changes in the small joints of the spine become more common with age and do not necessarily explain someone’s symptoms. For this reason, imaging is not routinely needed for most straightforward episodes of lower back pain or sciatica.
An MRI or other investigation may be appropriate when the history or examination suggests a condition requiring further assessment, or when the result is likely to change how the problem is managed.
A good clinical assessment therefore includes knowing when imaging is useful and when it is unlikely to add anything helpful.
When should you get lower back pain assessed?
It can be useful to have your back assessed if:
- the pain is significantly affecting work, sleep or everyday life;
- you are struggling to move normally;
- symptoms are not starting to improve;
- the problem keeps returning;
- pain travels into your buttock or leg;
- you have numbness, tingling or weakness;
- you are unsure what exercise or activity is safe;
- you have stopped doing things because you are afraid of making your back worse;
- or you simply want to understand what may be contributing to your symptoms.
You do not need to wait until back pain becomes unbearable before asking for help.
When is back pain more urgent?
Most back pain is not caused by serious disease, but certain symptoms do need prompt medical attention.
Contact NHS 111 or seek urgent medical assessment if your back pain is severe and started suddenly, is worsening rapidly, or you feel generally unwell, feverish or shivery.
Seek immediate emergency medical attention if back pain is accompanied by:
- new numbness or loss of sensation around the genitals, anus or saddle area;
- new loss of bladder or bowel control;
- significant weakness, numbness or altered sensation affecting both legs;
- chest pain;
- or back pain following a serious accident.
These symptoms are uncommon, but they should not be ignored.
Other symptoms such as unexplained weight loss, significant unexplained night pain, a history of cancer, recent significant trauma or new and unusual symptoms should also be discussed with an appropriate healthcare professional.
Can an osteopath help with lower back pain?
Osteopaths are regulated healthcare professionals trained to assess, diagnose and manage musculoskeletal problems, including lower back pain and sciatica.
An osteopathic approach should involve more than simply treating the area that hurts.
At One Health, your first appointment begins with a detailed history and clinical assessment. We want to understand when your symptoms started, how they behave, what makes them better or worse, your medical history, your lifestyle and what the problem is stopping you from doing.
Your osteopath may assess movement, strength, joints, muscles and the nervous system, alongside any relevant clinical tests.
An important part of our role is also identifying when symptoms require investigation or referral to your GP or another healthcare professional.
Our osteopathic approach to lower back pain
Osteopathy is based on the understanding that the body functions as an interconnected whole. Muscles, joints, fascia, ligaments, nerves and other body systems do not work independently of one another. How one area moves and functions can influence another.
Another important principle is that the body has its own self-regulating and healing mechanisms. Healing is not something a practitioner simply “does” to the body. Our role is to try to create the most favourable conditions for recovery.
That can mean addressing areas of stiffness or excessive muscle tension, improving comfortable movement and function, gradually rebuilding strength and capacity, and considering other factors that may influence recovery such as sleep, stress, workload, activity levels and general health.
Movement and manual treatment may also support normal circulation, nerve function and fluid exchange through the tissues, including the movement of lymph. Healthy tissues rely on appropriate blood supply, movement and normal physiological processes to deliver oxygen and nutrients, remove metabolic waste and support repair.
This whole-person approach is one of the reasons we may look beyond the exact site of your pain. Your lower back does not work in isolation. The hips, pelvis, thoracic spine, rib cage and surrounding muscles and fascia may all be relevant depending on your individual presentation.
The aim is to help the body function as efficiently and comfortably as possible, addressing the factors that appear relevant to you rather than following the same treatment formula for everyone.
How do we treat lower back pain at One Health?
Treatment is always individual and based on what we find during your assessment.
Where appropriate, osteopathic treatment may include a combination of techniques such as:
- joint mobilisation and articulation, using controlled movements to improve comfortable joint mobility and function;
- soft-tissue treatment and massage techniques for muscles and surrounding tissues;
- myofascial techniques, aimed at areas of tension or restriction within the soft tissues and fascia;
- stretching and mobility techniques where reduced movement may be contributing;
- muscle energy techniques, where you actively contract particular muscles against gentle resistance to help influence muscle tension and joint movement;
- joint manipulation, where clinically appropriate and with your consent;
- neuromuscular techniques and movement retraining, helping improve coordination, control and confidence in movement;
- strength and progressive rehabilitation, gradually rebuilding the capacity of your back and the rest of your body;
- postural and ergonomic advice where work or sustained positions are contributing to symptoms;
- breathing and relaxation strategies where muscle guarding, stress or persistent pain are relevant;
- gentle fascial or visceral approaches where these are considered clinically appropriate as part of the wider treatment plan.
Not everyone needs every technique. Some people benefit more from hands-on treatment initially, while for others exercise, strengthening, load management and reassurance become the most important parts of their recovery.
We may also look at other areas of the body that could be influencing how your back is functioning, such as your hips, pelvis or upper back.
The aim is to support better movement and more balanced function throughout the body, rather than focusing only on the painful spot.
Most importantly, treatment should help you move towards independence. Our aim is not simply for your back to feel better in the treatment room. We want you to understand what may be contributing to your symptoms, know what you can do yourself, feel confident moving again and return to the activities that matter to you.
What if you’ve had back pain for months or years?
Persistent back pain deserves a thoughtful, individual approach.
If you have experienced pain for months or years, it can be easy to assume that something must still be damaged or that your back has become fragile.
That is not necessarily the case.
Persistent lower back pain can be influenced by a combination of physical, neurological, psychological and lifestyle factors. That does not make the pain any less real.
It simply means there may be more opportunities to help than focusing on one painful structure.
A good rehabilitation programme may look at strength, movement, activity levels, sleep, work demands, confidence and how your nervous system has adapted to persistent pain.
For people who have gradually stopped exercising or doing things they enjoy because of pain, rebuilding confidence can be an important part of recovery.
What is the best treatment for lower back pain?
There is no single treatment that is best for every person. Good back-pain care starts with understanding what you need. If you have a recent episode that is already improving, reassurance and advice about staying active may be enough.
Someone else may benefit from hands-on treatment combined with exercise and rehabilitation. A person with persistent pain may need a broader approach that considers movement, strength, sleep, work, activity levels and confidence.
Occasionally, the assessment tells us that someone would be better served by their GP, further investigation or another healthcare professional.
The right treatment plan should therefore be based on your clinical presentation, your goals and how you respond, rather than on a predetermined number of appointments.
Lower back pain treatment in Tunbridge Wells
If lower back pain is affecting your work, exercise, sleep or everyday life, an assessment can help you understand what may be contributing to your symptoms and what to do next.
One Health Osteopathy Clinic is based in central Tunbridge Wells and welcomes patients from Tunbridge Wells, Tonbridge, Sevenoaks and the surrounding areas of Kent.
Our registered osteopaths assess and treat a wide range of musculoskeletal problems, including:
- acute lower back pain;
- persistent and recurring back pain;
- back stiffness;
- sciatica and leg symptoms;
- desk and work-related back pain;
- exercise and sports-related back pain;
- difficulty returning to normal activity following pain or injury;
- Pregnancy or postnatal related back pain or pelvic girdle pain.
Our approach combines thorough clinical assessment with hands-on treatment where appropriate, together with movement, education and tailored rehabilitation.
We want you to understand your body, feel confident in how you move and have a clear plan for getting back to the things that are important to you.
Ready to get your back moving again?
If you are looking for help with lower back pain in Tunbridge Wells, sciatica, recurring stiffness or persistent back pain, you can book an assessment with one of our registered osteopaths at One Health Osteopathy Clinic.
We will listen carefully to what has been happening, assess your symptoms and explain our findings and your options clearly.
If osteopathic care is appropriate, we will create a treatment and rehabilitation plan based on you, your symptoms and what you want to get back to doing.
Book online with One Health Osteopathy Clinic in Tunbridge Wells.
Move better. Feel better. Feel more confident in your body.
Frequently asked questions about lower back pain
Is walking good for lower back pain?
For many people with uncomplicated lower back pain, walking is a useful way to stay active. Start with an amount that feels manageable and build up gradually. You do not usually need to be completely pain-free before you move.
Should I see an osteopath for lower back pain?
An osteopath can assess musculoskeletal causes of lower back pain, screen for symptoms that may need medical investigation and, where appropriate, provide treatment, exercise and rehabilitation advice. If your symptoms suggest that osteopathic treatment is not appropriate, you should be referred to the relevant healthcare professional.
How long does lower back pain take to improve?
Many episodes improve within a few weeks, although recovery varies. Some people experience recurrent episodes or longer-lasting symptoms. Pain that persists does not necessarily mean that your back is continuing to be damaged.
Is lower back pain always caused by a slipped disc?
No. Most lower back pain cannot be reliably attributed to one specific structure. Disc changes are also common in people who do not have pain. Your symptoms and clinical assessment are therefore more informative than a scan finding in isolation.
Do I need an MRI for back pain?
Usually not. Imaging is not routinely needed for most episodes of lower back pain or sciatica. It may be considered if there is a clinical reason for it or if the result is likely to change how your condition is managed.
Should I rest or exercise with back pain?
For most uncomplicated lower back pain, prolonged bed rest is discouraged. Remaining active and gradually returning to normal activity is generally helpful, although your exercise may need to be adapted to your symptoms and individual circumstances.
Can sitting all day cause lower back pain?
Long periods in one position can aggravate back pain for some people, but there is no single perfect sitting posture that prevents pain. Changing position regularly, moving throughout the day and maintaining your overall strength and activity are generally more useful than trying to sit in one supposedly ideal position for hours.
We explore this further later in the series in Is Sitting Really Bad for Your Back?
Coming next
Sciatica: What Does It Feel Like and When Should You Get Help?
Part 2 of our Move Better, Feel Better: Pain & Movement Explained series.
The Move Better, Feel Better: Pain & Movement Explained series
- Lower Back Pain: What Causes It and When Should You Get It Checked? (you are here)
- Sciatica: What Does It Feel Like and When Should You Get Help?
- Is Sitting Really Bad for Your Back?
- Neck and Shoulder Pain: What Could Be Causing It and What Actually Helps?
- Knee Pain: Common Causes and When Should You Get It Assessed?
- Hip Pain: Is It Coming From Your Hip, Back or Somewhere Else?
About the author
Jessica Brown is a registered osteopath and owner of One Health Osteopathy Clinic in Tunbridge Wells.
Jessica holds a Master’s degree in Osteopathy from the University College of Osteopathy, where she received awards for academic achievement and her dissertation. She also has postgraduate training in women’s health osteopathy.
Her clinical approach combines careful assessment, hands-on osteopathic treatment where appropriate, movement, rehabilitation and clear, evidence-informed advice. She is particularly interested in helping people understand their symptoms, regain confidence in their bodies and return to the activities that matter to them.
Evidence and further reading
This article is informed by current UK health information and contemporary evidence relating to lower back pain, including NHS guidance on back pain, self-management and when to seek medical help. Clinical evidence continues to evolve, and this article should be reviewed periodically as new research becomes available.
One Health Osteopathy Clinic
Oxford House, 15–17 Mount Ephraim Road
Tunbridge Wells, Kent TN1 1EN
This article provides general health information and does not replace an individual medical assessment.
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