Managing Back Pain

Managing Lower Back Pain: A Physiotherapist’s Approach

Lower back pain is one of the most frequent complaints in clinical practice, requiring a multifaceted treatment strategy to achieve meaningful recovery. As physiotherapists, our role extends beyond manual therapy—we must educate patients, integrate adjunct therapies, prescribe effective stretches, and guide them through optimal activity modification.

This blog explores evidence-based approaches physiotherapists can implement to support patients dealing with lower back pain.

Physiotherapy Input: The Core of Recovery

A structured physiotherapy plan is critical for managing lower back pain. Treatment should focus on:

🔹 Soft Tissue Release & Manual Therapy – Targeting lumbar erectors, deep glute muscles, and surrounding fascia can significantly reduce tension and improve mobility.

🔹 Movement Re-education – Many patients develop compensatory movement patterns that further strain their lower back. Teaching proper hip hinge mechanics, core engagement, and postural control helps prevent ongoing dysfunction.

🔹 Progressive Strengthening – Rest alone rarely resolves lower back issues. Core stabilizers, glute strength, and hip mobility should be progressively trained to support long-term recovery.

🔹 Pain Modulation Strategies – Patients often need realistic expectations—early intervention should focus on pain control through education, graded exposure, and adjunct therapies.

Adjunct Therapies That Enhance Recovery

Incorporating adjunct therapies can increase patient compliance and promote recovery between clinical sessions:

✔ Heat Therapy Bands – Heat application is a simple but effective way to reduce muscular tightness and improve circulation. Heat wraps or belts can be recommended for chronic tension.

✔ Anti-Inflammatory Creams – Topical applications (NSAIDs, menthol, or capsaicin-based) can help modulate localized pain and inflammation without systemic effects. Encouraging self-massage with creams improves circulation and tissue relaxation.

✔ Foam Rolling & Massage Tools – Patients benefit from self-administered release techniques targeting lumbar, glutes, and hamstrings. Educating them on proper foam rolling methods enhances recovery without excessive reliance on clinical treatment.

✔ Postural Supports & Ergonomic Modifications – For desk workers, recommending lumbar support cushions and adjusted workstation setups prevents further mechanical strain.

Key Stretches Physiotherapists Should Prescribe

Targeted stretching plays an essential role in reducing muscular tension and improving mobility. The most effective stretches include:

🔹 Knee-to-Chest Stretch – Helps relieve lumbar tension and encourages segmental mobility. 🔹 Child’s Pose – A passive stretch that promotes deep lumbar and hip flexion relief. 🔹 Cat-Cow Mobilization – Enhances spinal movement mechanics, reduces stiffness. 🔹 Piriformis Stretch – Addresses glute tightness, often a contributing factor in lower back pain.

Patients should be guided on proper execution and intensity to avoid overloading tissues.

Activity Modification: The Balance Between Rest & Movement

Physiotherapists should emphasize the importance of graded exposure to movement. Over-resting delays recovery, while excessive activity can aggravate symptoms.

🔹 Limit Prolonged Sitting: Encourage micro-movements, standing breaks, and lumbar-supported sitting posture. 🔹 Avoid High-Impact Loading: Heavy lifting, excessive bending, or rapid movement changes should be phased back in gradually. 🔹 Encourage Controlled Strengthening: Core stabilization, glute activation, and hip mobility work should be incrementally introduced to avoid setbacks.

Finding the right balance ensures functional recovery without exacerbation.

Final Thoughts for Clinicians

Physiotherapists must take a structured, progressive approach to lower back pain management. Combining manual therapy, adjunct treatments, effective stretching, and activity modification ensures a well-rounded recovery plan.

Educating patients on realistic expectations, compliance, and self-care techniques fosters long-term success beyond clinical sessions.