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Back pain

Low back pain: less frightening than it feels, but worth taking seriously

By Milan Subošić, physiotherapist  ·  October 1, 2026

You bent down to pick something up and felt a sharp pain in your lower back. Or it crept in slowly after a week of strain and long hours of sitting. Most people have the same first thought: “What is wrong with my spine?”

Let's calm things down first. In the vast majority of cases, pain in the lower back without numbness, weakness or pain running down the leg is not a sign of serious injury. Experts call it non-specific, which does not mean it is imaginary. The pain is real and can be strong. It only means that there is usually no dangerous damage behind it that a scan could show.

Your spine is not made of glass

Many people get scared when a report says “degeneration” or “protrusion.” Here is a fact that helps. A review of 33 studies covering more than 3,000 people with no pain at all found signs of disc degeneration in 37% of 20-year-olds and in 96% of 80-year-olds. The authors conclude that these are mostly ordinary changes with age, a bit like wrinkles on the skin.

That is why guidelines do not recommend routine imaging for this kind of pain when there are no signs of a serious cause. A finding on a scan is not a verdict and it is not the same thing as pain.

The good news about recovery, and one important caveat

Within the first weeks most people notice clear improvement. That is real and important good news. But the picture is not entirely rosy. In a review of studies that followed people who sought help for back pain, only about a third had recovered within three months, and after a year about two thirds still reported some pain. Pain also comes back: depending on how it is counted, it returns within a year in roughly a third to two thirds of people. That is why the authors conclude that we should not lightly rely on everything passing by itself.

Why it helps to know which group you are in

Two people with the same pain can have very different courses. Among the factors that best predict whether pain will last are fear of movement and psychological distress, while evidence for purely physical factors is weaker. That is why the British guidelines (NICE) recommend working out at the first visit who is likely to recover quickly and who needs more support.

For the first group it is often enough to hear that all is well, to stay active, and to know a few safe exercises. The second group needs a plan: exercise, explanation and, when appropriate, manual therapy as part of a programme.

To wait or not to wait?

It is not a mistake to wait the first few days, stay active and see how the pain responds. But waiting blindly for weeks and months is not the best plan, for three reasons:

• an assessment rules out rare serious causes and gives you peace of mind;
• what keeps pain going can be caught early: fear of movement, avoiding activity, and habits that load the back, such as too much sitting or a sudden jump in effort;
• analyses of studies suggest that exercise, especially combined with education, may reduce the risk of the pain coming back. The evidence is not perfect, but it is the best we have for now.

What an assessment looks like

It starts with a conversation, because you know your pain best: when it started, what makes it worse, what eases it, what you have already tried. Then comes an examination of movement and, when needed, neighbouring areas such as the hips and the upper back. We also look for positions and movements that ease your pain, so you can use them yourself at home.

At the end you get a clear answer: what the likely cause is, what to expect and what the next steps are. The plan usually consists of exercise and explanation, with manual therapy when appropriate, as part of a programme and not instead of exercise. We wrote about one of the techniques we use, fascial manipulation, in our previous article.

What you can do today

• Stay active as far as the pain allows. This is exactly what the guidelines advise.
• Change positions instead of sitting or standing in the same place for a long time.
• Notice which movement or position eases the pain. It is valuable information for the assessment.

When not to wait and see a doctor right away

See a doctor as soon as any of these appear: numbness around the groin or inner thighs, trouble holding urine or stool, leg weakness that is getting worse, severe pain after a fall or blow, fever with pain, unexplained weight loss, or pain that does not ease even at rest, especially at night. In those cases a medical examination comes before any therapy.