Lower back pain is the most common reason people see a kinesitherapist (physiotherapist). It is pain low in the back, between the last ribs and the buttocks. In most cases it comes from the muscles and joints of the spine, not from a serious illness. Sudden severe pain that makes it hard to stand up straight is what people call lumbago.
Symptoms
- Dull, constant pain in the lower back that gets worse when you sit or bend.
- Sharp pain with a particular movement, for example when you get up from a chair or pick something up from the floor.
- Stiffness in the morning that eases once you get moving.
- Tight muscles on both sides of the spine that are tender to the touch.
- Pain that reaches the buttock or the upper thigh but doesn’t go below the knee.
- Difficulty finding a comfortable position to sleep.
An acute attack is usually at its worst in the first 2–3 days and then gradually eases. If it comes back several times a year, easing each attack isn’t enough: exercises that strengthen the back between attacks help most.
If the pain goes down the leg below the knee, or the leg goes numb, an irritated nerve is more likely. In that case, read the pages on sciatica and herniated disc.
Why it happens
- Sitting for a long time at a computer or in a car, without breaks.
- Lifting heavy things while bent over or twisting.
- Weak abdominal and buttock muscles that don’t support the lower back.
- Sudden strain after a long period without activity: home renovation, moving house, the first day in the garden in spring.
- Wear of the discs and joints over the years (disc degeneration, spondylosis).
- Stress and poor sleep, which keep the muscles tense.
How we treat it
Kaloyan starts with a conversation and an examination. Bring your scans and test results if you have them, and wear comfortable clothes. He asks when the pain started and which movements make it worse, and watches how you bend and straighten up. He checks the strength and sensation in your legs to rule out a trapped nerve. For muscular pain he most often starts with therapeutic massage, which relaxes the tight muscles around the lower back and buttocks. If the pain is stubborn or the joints are stiff, he adds TECAR therapy: deep heat that reduces pain and prepares the tissues for movement.
For painful knots in the muscle (trigger points) that massage doesn’t release, Kaloyan uses dry needling. Most people come 1–2 times a week and feel a difference after the first few visits. From the start Kaloyan shows you a few exercises to do at home, and makes them harder as the pain eases.
What you can do yourself
- Keep moving as far as the pain allows. Short walks help more than lying in bed.
- If you sit for long, get up for a moment every half hour.
- Heat usually relaxes the muscles: a warm shower or a heating pad. In the first days after a sudden strain, some people prefer cold.
- Lift heavy things with your knees bent and close to your body, without twisting.
- Sleep in the position where the pain is least: on your side with your knees bent and a pillow between them, or on your back with a pillow under your knees.
When to see a doctor first
Most lower back pain isn’t dangerous. See a doctor first if:
- your leg is getting weaker or your foot drags when you walk;
- you have numbness in the groin or around the anus;
- you have trouble urinating or with bowel movements (you need an urgent examination by a neurologist and an MRI, CT scan or X-ray);
- the pain started after a fall, a blow or a car accident;
- you have a fever or are losing weight and don’t know why;
- the pain is severe at night too and doesn’t ease in any position.
