Physiotherapy for back pain

Physiotherapy for back pain

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Condition

Back pain – common, usually harmless, very treatable

Almost everyone has back pain at some point. The good news: the vast majority have no dangerous cause, and only a very small proportion need surgery.

For almost all back problems, the combination of physiotherapy, education and targeted training is the treatment of choice. Movement is the best remedy – discs, joints and muscles are nourished and become more resilient mainly through movement.

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Physiotherapy for back pain

Good to know

What an MRI shows – and what it doesn’t

DiscsWear and tear is normalA large analysis of people without back pain found degenerated discs in 37% of 20-year-olds and 96% of 80-year-olds.
BulgesOften without symptomsDisc bulges were found in 30% of pain-free 20-year-olds and 84% of 80-year-olds. They are often part of normal ageing – like wrinkles in the skin.
What this meansInterpreting images correctlyX-ray or MRI findings often do not explain pain. Imaging is only needed if there are warning signs or if it would change the treatment approach.
Examination for back pain

Assessment

Our approach

We assess acute and persistent back complaints using manual therapy methods based on the latest science. We work in a hypothesis-driven way and complement the medical diagnosis with an ICF-based analysis of physical, functional and personal factors.

  • Screening for warning signs (red flags) and nerve involvement
  • Movement, joint and nerve examination
  • Assessment of load, sleep, stress and worries
  • Proven questionnaires: STarT Back, Oswestry, FABQ and HADS

It is important to us that you understand your complaints and can actively do something about them.

Scientific evidence

What works for back pain

GuidelinesActive rather than passiveInternational guidelines recommend education that supports self-management and a return to normal activities as the first step – medication, imaging and surgery only selectively.
TrainingExercise relieves painA Cochrane review of 249 trials shows that exercise reduces persistent back pain by around 15 out of 100 points compared with no treatment.
AcuteManual therapyFor acute back pain, manual techniques improve pain and function for up to six weeks – opening the door to movement and training.

Our conclusion: Most acute back pain improves within weeks. Staying active, understanding what is happening and training in a targeted way lowers the risk of complaints persisting or returning.

Indications

We treat the full spectrum

  • Acute back pain and lumbago
  • Persistent (chronic) back pain
  • Stiff or locked vertebrae and ribs
  • Pain radiating into the leg, e.g. sciatica
  • Disc herniation and nerve compression
  • Rheumatic conditions such as ankylosing spondylitis or Scheuermann’s disease
  • Complaints after surgery or accidents
  • Back pain during pregnancy and in sport

Understanding pain: What is true – and what is not? You can find the most common misconceptions about back pain and persistent pain under Common misconceptions and what research shows.

FAQ

Frequently asked questions about back pain

Should I rest when I have back pain?

No – bed rest delays recovery. Stay as active as your pain allows. Walking, light movement and your usual activities help your back recover.

Do I need an MRI?

Usually not. Imaging is indicated with warning signs such as paralysis, numbness in the genital area, fever or after a serious accident – or if surgery is being considered. Otherwise it often shows normal ageing processes that do not explain the pain.

When should I see a doctor immediately?

With paralysis, numbness in the genital area, problems passing urine or stool, high fever, unintended weight loss or pain after a serious fall. We check for these warning signs at every initial assessment.

Is a disc herniation a reason for surgery?

In most cases, no. Many disc herniations resolve on their own. Surgery is mainly considered for paralysis or persistent severe nerve pain despite good conservative treatment – we discuss this with your doctor.

How long does treatment take?

That varies from person to person. For acute complaints, a few sessions with education, treatment and a home programme are often enough. For persistent pain, we support you for longer and build up a training programme, e.g. in medical training therapy.

Sources: Brinjikji W et al., AJNR 2015 (imaging) · Foster NE et al., Lancet 2018 (guidelines) · Hayden JA et al., Cochrane Review 2021 (exercise) · Paige NM et al., JAMA 2017 (manual therapy) · O’Sullivan PB et al., Br J Sports Med 2020 (facts about back pain) · George SZ et al., JOSPT 2021 (guideline on acute and chronic low back pain)

Back pain?

We find out what is behind it – and what helps you.

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