Back Pain.
The most common reason people see a physiotherapist
Back pain is the single leading cause of disability worldwide and affects up to 80% of Australians at some point in their lives. At any given moment, approximately 12% of the population is experiencing an episode of back pain — making it by far the most common musculoskeletal complaint seen in physiotherapy practice. Despite its prevalence, back pain is frequently misunderstood, mismanaged and unnecessarily feared. The evidence consistently shows that most back pain — including many severe and debilitating episodes — resolves with appropriate physiotherapy, and that passive approaches like prolonged rest and heavy reliance on imaging and medication produce worse long-term outcomes than active, physiotherapy-led rehabilitation.
Understanding your back
The back is an impressive and complex structure with 26 vertebrae with discs in between making up the bony vertebral column. The vertebrae are held in place with many ligaments, and there are also a large number of muscles that make up our back with a variety of functions — arching, twisting, breathing, moving and stabilising the shoulders and pelvis. Furthermore, there are 31 pairs of nerve roots that extend from the spinal cord out into the body. Given the vast number of structures, when presenting with back pain, it is often difficult to pin-point the exact structure causing the pain.
This complexity is important context for understanding why imaging alone rarely tells the whole story — findings on MRI (disc bulges, arthritis, degeneration) are extremely common in people with no pain at all, and the severity of imaging findings does not reliably correlate with the severity of pain or disability. A comprehensive physiotherapy assessment — combining history, movement analysis, neurological screening and clinical reasoning — is the most accurate and most clinically useful diagnostic process for back pain.
Types of back pain
Back pain is a symptom, not a diagnosis — and the specific structure generating the pain, the mechanism behind it, and the factors maintaining it all influence the most effective management approach. The most common causes and presentations include:
Mechanical lower back pain — the most common type — arises from the muscles, ligaments, facet joints and discs of the lumbar spine without specific serious pathology. It is typically aggravated by movement and loading, eased by rest initially, and responds well to physiotherapy.
Disc-related back pain — herniated discs, disc bulges and degenerative disc disease — produce back pain with or without referred leg pain (radiculopathy). Disc pathology that produces sciatica — radiating leg pain, numbness or weakness — requires specific physiotherapy management distinct from non-specific mechanical back pain.
Facet joint pain — from facet joint syndrome or osteoarthritis of the facet joints — produces localised back pain with referred pain into the buttock or thigh, typically worse with extension and rotation and eased by flexion.
Spinal stenosis — narrowing of the spinal canal — produces the characteristic neurogenic claudication pattern of leg heaviness and pain that develops with walking and standing and is relieved by sitting and forward bending. Most common in older adults.
Sacroiliac joint dysfunction — SIJ pain — produces low back and buttock pain from dysfunction of the joint between the sacrum and ilium, often aggravated by single-leg loading activities.
Spondylolysis and spondylolisthesis — stress fractures or forward slippage of vertebrae — most commonly in adolescent athletes from hyperextension loading, producing centralised lower back pain.
Inflammatory back pain — ankylosing spondylitis and related spondyloarthropathies — produce inflammatory rather than mechanical back pain, characteristically worse with rest and improved with exercise. Requires specific management and medical co-treatment.
Thoracic back pain — mid-back pain from thoracic facet joints, costovertebral joints and thoracic muscle overload — is common in office workers, students and those with forward-sitting postures. Often coexists with cervicogenic headache and is responsive to manual therapy and postural rehabilitation.
Osteoporotic fractures — compression fractures of the vertebrae in patients with osteoporosis — produce sudden severe back pain after minimal or no trauma. Require specific management including vertebral protection strategies and bone health rehabilitation.
Post-surgical back pain — following spinal fusion, discectomy, laminectomy or artificial disc replacement — requires structured rehabilitation to restore function and prevent recurrence.
Chronic back pain — pain persisting beyond three months — involves central sensitisation alongside the structural contributors and requires a modern pain neuroscience approach rather than simply treating the structural findings.
When to seek urgent assessment
Most back pain — even severe, debilitating episodes — is not a medical emergency. However certain features require urgent medical assessment: back pain with bladder or bowel dysfunction (difficulty passing urine, incontinence or loss of rectal tone), progressive bilateral leg weakness, saddle anaesthesia (numbness in the inner thighs and perineum), or back pain with unexplained fever, significant unintentional weight loss or history of cancer. These are the "red flags" of back pain that require exclusion of serious spinal pathology.
How can physiotherapy help?
Exercises prescribed by a physiotherapist may help to strengthen the muscles surrounding the affected joint and improve flexibility, which can help reduce pain and improve function. Manual therapy techniques, such as joint mobilisation and soft tissue mobilisation, may also help to reduce pain and improve joint mobility.
The physiotherapy approach to back pain is always guided by the specific diagnosis, the stage of the presentation (acute, subacute, chronic) and the individual's goals and functional demands. Manual therapy reduces pain and restores movement in the acute and subacute phases. Dry needling addresses the paraspinal muscle tension that compounds back pain of any origin. Real time ultrasound guides retraining of the deep lumbar stabilisers — multifidus and transversus abdominis — that are consistently inhibited by pain. Progressive exercise — core strengthening, hip and gluteal conditioning, and aerobic exercise — builds the physical capacity that reduces recurrence risk. Clinical Pilates provides a structured, supervised environment for progressive spinal rehabilitation.
For chronic back pain, pain neuroscience education — reconceptualising pain as a nervous system output rather than ongoing tissue damage — is the most distinctively modern and most evidence-based component of rehabilitation. See our chronic pain page for more detail.
For workplace-related back pain, WorkCover funded physiotherapy is available. For motor vehicle accident back pain, CTP applies.
Our physiotherapists Mauricio Bara, Yulia Khasyanova, Eliane Machado and Bethany Kippen all have extensive experience in back pain management and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes & Mt Gravatt.
Back pain is the single leading cause of disability worldwide and affects up to 80% of Australians at some point in their lives. At any given moment, approximately 12% of the population is experiencing an episode of back pain — making it by far the most common musculoskeletal complaint seen in physiotherapy practice. Despite its prevalence, back pain is frequently misunderstood, mismanaged and unnecessarily feared. The evidence consistently shows that most back pain — including many severe and debilitating episodes — resolves with appropriate physiotherapy, and that passive approaches like prolonged rest and heavy reliance on imaging and medication produce worse long-term outcomes than active, physiotherapy-led rehabilitation.
Understanding your back
The back is an impressive and complex structure with 26 vertebrae with discs in between making up the bony vertebral column. The vertebrae are held in place with many ligaments, and there are also a large number of muscles that make up our back with a variety of functions — arching, twisting, breathing, moving and stabilising the shoulders and pelvis. Furthermore, there are 31 pairs of nerve roots that extend from the spinal cord out into the body. Given the vast number of structures, when presenting with back pain, it is often difficult to pin-point the exact structure causing the pain.
This complexity is important context for understanding why imaging alone rarely tells the whole story — findings on MRI (disc bulges, arthritis, degeneration) are extremely common in people with no pain at all, and the severity of imaging findings does not reliably correlate with the severity of pain or disability. A comprehensive physiotherapy assessment — combining history, movement analysis, neurological screening and clinical reasoning — is the most accurate and most clinically useful diagnostic process for back pain.
Types of back pain
Back pain is a symptom, not a diagnosis — and the specific structure generating the pain, the mechanism behind it, and the factors maintaining it all influence the most effective management approach. The most common causes and presentations include:
Mechanical lower back pain — the most common type — arises from the muscles, ligaments, facet joints and discs of the lumbar spine without specific serious pathology. It is typically aggravated by movement and loading, eased by rest initially, and responds well to physiotherapy.
Disc-related back pain — herniated discs, disc bulges and degenerative disc disease — produce back pain with or without referred leg pain (radiculopathy). Disc pathology that produces sciatica — radiating leg pain, numbness or weakness — requires specific physiotherapy management distinct from non-specific mechanical back pain.
Facet joint pain — from facet joint syndrome or osteoarthritis of the facet joints — produces localised back pain with referred pain into the buttock or thigh, typically worse with extension and rotation and eased by flexion.
Spinal stenosis — narrowing of the spinal canal — produces the characteristic neurogenic claudication pattern of leg heaviness and pain that develops with walking and standing and is relieved by sitting and forward bending. Most common in older adults.
Sacroiliac joint dysfunction — SIJ pain — produces low back and buttock pain from dysfunction of the joint between the sacrum and ilium, often aggravated by single-leg loading activities.
Spondylolysis and spondylolisthesis — stress fractures or forward slippage of vertebrae — most commonly in adolescent athletes from hyperextension loading, producing centralised lower back pain.
Inflammatory back pain — ankylosing spondylitis and related spondyloarthropathies — produce inflammatory rather than mechanical back pain, characteristically worse with rest and improved with exercise. Requires specific management and medical co-treatment.
Thoracic back pain — mid-back pain from thoracic facet joints, costovertebral joints and thoracic muscle overload — is common in office workers, students and those with forward-sitting postures. Often coexists with cervicogenic headache and is responsive to manual therapy and postural rehabilitation.
Osteoporotic fractures — compression fractures of the vertebrae in patients with osteoporosis — produce sudden severe back pain after minimal or no trauma. Require specific management including vertebral protection strategies and bone health rehabilitation.
Post-surgical back pain — following spinal fusion, discectomy, laminectomy or artificial disc replacement — requires structured rehabilitation to restore function and prevent recurrence.
Chronic back pain — pain persisting beyond three months — involves central sensitisation alongside the structural contributors and requires a modern pain neuroscience approach rather than simply treating the structural findings.
When to seek urgent assessment
Most back pain — even severe, debilitating episodes — is not a medical emergency. However certain features require urgent medical assessment: back pain with bladder or bowel dysfunction (difficulty passing urine, incontinence or loss of rectal tone), progressive bilateral leg weakness, saddle anaesthesia (numbness in the inner thighs and perineum), or back pain with unexplained fever, significant unintentional weight loss or history of cancer. These are the "red flags" of back pain that require exclusion of serious spinal pathology.
How can physiotherapy help?
Exercises prescribed by a physiotherapist may help to strengthen the muscles surrounding the affected joint and improve flexibility, which can help reduce pain and improve function. Manual therapy techniques, such as joint mobilisation and soft tissue mobilisation, may also help to reduce pain and improve joint mobility.
The physiotherapy approach to back pain is always guided by the specific diagnosis, the stage of the presentation (acute, subacute, chronic) and the individual's goals and functional demands. Manual therapy reduces pain and restores movement in the acute and subacute phases. Dry needling addresses the paraspinal muscle tension that compounds back pain of any origin. Real time ultrasound guides retraining of the deep lumbar stabilisers — multifidus and transversus abdominis — that are consistently inhibited by pain. Progressive exercise — core strengthening, hip and gluteal conditioning, and aerobic exercise — builds the physical capacity that reduces recurrence risk. Clinical Pilates provides a structured, supervised environment for progressive spinal rehabilitation.
For chronic back pain, pain neuroscience education — reconceptualising pain as a nervous system output rather than ongoing tissue damage — is the most distinctively modern and most evidence-based component of rehabilitation. See our chronic pain page for more detail.
For workplace-related back pain, WorkCover funded physiotherapy is available. For motor vehicle accident back pain, CTP applies.
Our physiotherapists Mauricio Bara, Yulia Khasyanova, Eliane Machado and Bethany Kippen all have extensive experience in back pain management and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes & Mt Gravatt.
