How to Treat and Manage Low Back Pain
If you read the first article in this series, you'll know that most low back pain isn't a sign of serious damage — it's more like a sensitive alarm system responding to a mix of physical and lifestyle factors. So what do you actually do about it?
Do you need to rest?
Short answer: not for long. A day or two of relative rest during a really acute flare is fine and normal, but staying in bed or avoiding all activity for an extended period tends to make things worse, not better — it can lead to stiffness, deconditioning, and can actually prolong recovery. Current guidelines consistently recommend staying as active as symptoms reasonably allow, rather than waiting to move until pain is completely gone.
What does treatment usually involve?
Modern, guideline-based care for low back pain is built around a few key pillars:
Education and reassurance — understanding what's going on (and what isn't) reduces fear and helps people move more confidently
Staying active — continuing normal activities as much as possible, modified where needed
Exercise and movement-based rehabilitation — tailored to you, not a generic sheet of stretches
Manual therapy — hands-on techniques like joint mobilisation can help some people, generally used alongside exercise and education rather than as a standalone fix
Clinical practice guidelines are clear that this active, education-led approach outperforms passive treatments used in isolation.
What can physiotherapy help with?
A physio's role isn't just "give you exercises." It's about working out what's driving your particular presentation — whether that's a recent spike in activity, prolonged sitting, deconditioning, or nervous system sensitivity — and building a plan around that. This might include hands-on treatment for comfort in the early stages, graded exercise, movement retraining, and practical advice about your specific work or lifestyle demands.
Activity modification and load management
Rather than avoiding movement altogether, the goal is usually to modify how much and how you're doing things temporarily, while gradually building back up. This might mean:
Breaking up long periods of sitting or standing
Adjusting how you lift for a short period, without avoiding lifting altogether
Pacing activities rather than pushing through until pain forces you to stop, or avoiding them completely out of fear
This is often called "load management" — matching what you ask your back to do with what it can currently tolerate, then progressively building that tolerance back up.
What exercises can help?
Here's something that often surprises people: there isn't one single "best" exercise for low back pain. Research comparing different exercise types generally hasn't found one approach that's clearly superior to another for most people. What seems to matter more is finding movement you can do consistently, that's appropriately dosed for you, and ideally something you don't dread doing.
For chronic or persistent low back pain specifically, exercise therapy has consistently been shown to reduce pain and improve function compared to minimal or no treatment, even though the average effect size is modest — meaning it helps, but it's rarely a complete fix on its own, and often works best as part of a broader plan.
Depending on your presentation, this might include general strengthening, walking or aerobic activity, motor control exercises, or movement retraining — which is why an individual assessment matters more than a generic exercise sheet.
How do you get back to normal?
Recovery is rarely a straight line. A sensible approach usually looks like:
Managing the acute flare with modified activity and appropriate pain relief strategies if needed
Gradually reintroducing normal movements and activities
Building strength and capacity through structured exercise
Progressively returning to work, exercise, or sport-specific demands
Addressing any contributing factors — like sleep, stress, or a sudden jump in activity — so it's less likely to flare again
Return to work
Most people don't need to be pain-free before returning to work. Guidelines generally support staying at work or returning early with temporary modifications where needed, rather than waiting for complete resolution — prolonged time off tends to be associated with worse outcomes, not better ones.
Return to exercise or sport
The same principle applies here: a graded return, guided by how your back responds, generally works better than either pushing straight back to full training or avoiding activity altogether out of fear of re-injury.
What might aggravate symptoms?
This varies person to person, but common patterns include prolonged static positions (sitting or standing without breaks), sudden unaccustomed heavy loads, and poor sleep or high stress periods. Notice your own patterns rather than assuming a universal list of things to avoid forever.
Common treatment mistakes
A few things I see regularly that tend to slow recovery down:
Complete rest for extended periods "just to be safe"
Chasing a scan or a single diagnosis before trying appropriate conservative care
Passive treatments (like massage alone) used long-term without an active rehab component
Avoiding movements indefinitely out of fear, rather than gradually reloading them
Stopping exercise the moment symptoms flare, instead of adjusting and continuing appropriately
What can you do yourself?
Keep moving within a tolerable range — walking is a great, low-cost starting point
Avoid prolonged bed rest
Apply heat if it helps you feel more comfortable moving
Prioritise sleep and manage stress where you can
Gradually reintroduce activities you've been avoiding, rather than waiting for zero pain
When should you see a physiotherapist?
If your back pain is limiting what you want to do, isn't settling with a few days of sensible self-management, or you're unsure how to safely get back into activity or exercise, that's a good time for an assessment. Earlier input often means a faster, clearer path back to normal activity.
When might further investigation be needed?
If red flag symptoms are present (see Article 1), if there's significant nerve-related pain or weakness down a leg that isn't improving, or if pain isn't responding to appropriate conservative care over several weeks, further medical review or investigation may be appropriate. Your physiotherapist can help guide this and refer where needed.
What can you generally expect?
Most people see meaningful improvement within the first few weeks with appropriate active management. Recurrence is common — low back pain often comes and goes over a lifetime — but understanding your triggers and having a plan you trust tends to make each episode feel far less overwhelming than the last.
If you're dealing with ongoing low back pain or you're not sure how to safely get moving again, a physiotherapy assessment can help identify what's contributing to your symptoms and build a clear, personalised plan to get you back to doing what you enjoy.
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