Lower back pain

Medically reviewed by Dr. K. G. Gopalakrishna, Consultant Orthopaedic Surgeon · Last reviewed: August 2026

Lower back pain is one of the most common reasons people see any kind of doctor, and the reassuring truth is that the overwhelming majority of cases are muscular or mechanical, not a sign of serious spine damage. Understanding what's actually causing it - rather than assuming the worst - is the first step toward the right treatment.

What's actually there

The lower back (lumbar spine) is made up of 5 vertebrae carrying most of the body's weight, cushioned by discs between each one that act as shock absorbers. The erector spinae muscles run alongside the spine supporting posture and movement, while deeper core muscles help stabilize the whole area. Nerves exit between the vertebrae and travel down into the legs, which is why a genuine disc or nerve problem can cause pain, numbness, or weakness that radiates well beyond the back itself.

Common causes

• Wear-related: Degenerative disc changes and osteoarthritis of the small spinal joints are extremely common with age and are often found on scans even in people with no pain at all - meaning a scan finding alone doesn't necessarily explain your pain.
• Injury-related: A sudden awkward lift, twist, or fall can strain the muscles or, less commonly, cause a disc to bulge or herniate, sometimes pressing on a nearby nerve.
• Inflammatory or overuse: Prolonged poor posture, especially sitting for long periods, contributes to muscle tension and stiffness. Weak core muscles relative to the demands placed on the back is a very common underlying contributor.
• Referred pain: Hip problems can occasionally refer pain into the lower back and buttock, and true sciatica - nerve pain radiating down the leg - originates from the lower back even though it's felt much further away.
• Gym and training-related: Deadlifts and squats are the two most common gym movements linked to lower back strain, almost always from rounding the back under load, lifting too heavy before technique is solid, or increasing weight too quickly.

What it tends to feel like

A dull ache or stiffness that's worse after sitting or first thing in the morning, easing with gentle movement, points toward muscular or postural causes. Pain that radiates down one leg, especially past the knee, with numbness or tingling, suggests a nerve is being irritated - this is sciatica. Sudden, sharp pain during or right after a specific lift or twist points toward a muscle strain, and occasionally a disc issue if it comes with leg symptoms.

When to seek care urgently

• Numbness around the groin or difficulty controlling bladder or bowel function - this needs emergency care immediately
• Progressive weakness in one or both legs, rather than just pain
• Severe pain following significant trauma, like a fall from height or an accident
• Back pain with fever, unexplained weight loss, or a history of cancer

What's usually tried first

• Staying as active as pain allows - complete bed rest is now known to slow recovery rather than help it
• Physiotherapy focused on core strengthening and correcting movement patterns, which addresses the most common underlying cause
• Heat for muscle tension, alongside gentle movement and stretching
• Anti-inflammatory medication for short-term flare-ups
• For sciatica that isn't settling, a guided injection can meaningfully reduce nerve-related pain and support physiotherapy progress

Myths vs facts

• Myth: A scan showing a disc bulge means that's definitely causing your pain and needs fixing.
  Fact: Disc bulges are extremely common in people with no pain at all - a scan finding has to be matched against your actual symptoms, not treated as the automatic explanation.
• Myth: You should rest completely in bed until lower back pain fully resolves.
  Fact: Staying gently active, within a pain-tolerable range, leads to faster recovery than bed rest in the large majority of cases.

When surgery enters the conversation

The vast majority of lower back pain, including most sciatica, improves substantially with physiotherapy, activity, and time - typically within 6-12 weeks. Surgery is considered for a confirmed disc herniation causing significant, persistent nerve compression that hasn't responded to at least several weeks of proper non-surgical treatment, or urgently for any of the red-flag symptoms above.

Recovery from a disc-related sciatica episode, broadly:

• Weeks 1-2: managing pain while staying as active as tolerable, avoiding complete rest.
• Weeks 2-6: physiotherapy-guided core strengthening and movement correction as pain allows.
• Weeks 6-12: most people see substantial improvement; ongoing core work helps prevent recurrence.

Looking after your lower back

• Build core strength consistently, even without existing pain - this is the single most protective factor for the lower back
• Use proper lifting technique in daily life, bending at the knees and hips rather than rounding the back
• Avoid sitting for very long unbroken periods; take regular breaks to stand and move
• Keep the back braced and neutral on deadlifts and squats, and increase weight gradually rather than chasing personal records too soon
• Don't ignore pain radiating down a leg - early attention to sciatica generally leads to a faster, smoother recovery

FAQs: questions worth asking your doctor