The All-in-One Guide to Conquering Lower Back Pain: Causes, Treatments, and Prevention

woman doing back bend with no lower back pain because physical therapy gave her relief

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Last Updated: September 19, 2023

The information in this article is a collection of lessons I've learned through physical therapy school, treating patients in the clinic, and passionately participating in athletics.

Hope you find it helpful!

Table of Contents

Overview of Lower Back Pain

The first thing you’ll read about in most articles about back pain is that it happens to just about everyone.

In the study that a lot of these articles refer to, they determined that for adults, up to 84% will experience an episode of lower back pain at some point in their lives. This is called the lifetime prevalence of back pain. 

Another study showed that by 18 years of age, about 50% will have experienced an episode of lower back pain. 

That’s a lot of people, old and young! This may seem alarming, but there is good news.

A couple extensive data sets from Coste et al. (1994) and Gurcay et al. (2009) showed that up to 90% of individuals with back pain will recover within 2 weeks, irrespective of care.  

This means that if you have experienced an episode of lower back pain, there’s a really high chance that it will get better totally on its own.

Recurrence of Lower Back Pain

So then, if back pain usually goes away on its own, should you even care to do anything?

Do you really need to work on pain relief exercises or see a doctor, if the stats show that your back pain will resolve without treatment?

Well, let’s dive a little deeper.

Even though you can expect your lower back pain to go away within about 2 weeks, evidence (Pengel et al, 2003) shows that on average there is a 73% chance that the same pain will return within one year of your initial episode. This is called the recurrence rate of back pain.

In other words, 7 out of 10 people who have an episode of back pain will experience the same painful symptoms within the next year.

7 out of 10 people who get lower back pain will have another episode within 1 year.

You probably don’t want that happening again, so what this means for you is that getting immediate relief is not enough. Really there are two parts to ultimately resolving your back pain:

  • The short-term solution to help reduce the immediate pain
  • The long-term solution to minimize your risk of future recurrence

Dr. Morey Kolber, who taught me most of the information discussed in this article, once told our physical therapy class:

“Remember, there is a difference between feeling better and getting better.”

My interpretation of this is that feeling better is the short-term solution—reducing pain but still carrying the risk of having future episodes, and getting better is the long-term solution necessary to reduce that risk. 

This article suggests ways that may help you reduce your back pain and prevent recurrence, starting with conservative self-care treatments you can do at home. 

Types of Back Pain

Back pain can be split into two categories, acute back pain and chronic back pain. If your injury happened within the last 6 weeks, it is considered acute back pain. If it happened more than 6 weeks ago, it is considered chronic back pain.

You can feel pain anywhere in your back, and lower back pain is the most common condition that physical therapists treat. 

Acute Back Pain (“I Threw My Back Out”)

Acute back pain happens suddenly, and there is usually a mechanism of injury that causes it to happen. Example mechanisms of injury include:

  • Lifting something heavy
  • Falling down
  • Twisting suddenly 
  • Intense session at the gym

Acute back pain will typically heal on its own, as discussed earlier. It can resolve within a few days or a few weeks. However, it’s wise to remember that each recurrent episode puts you at a higher and higher risk of getting it again. 

Another example is noticing your back aches after spending a full day shoveling the driveway. 

When acute back pain happens, people commonly say “I threw my back out.”

Chronic Back Pain (“I Have a Bad Back”)

Chronic back pain develops more gradually, and sometimes it can keep getting worse. You don’t always know what caused it. Some say it must be pain that lasts at least 3 months. Others say it’s anything over 6 weeks. It’s also described as back pain that happens intermittently over 6 months. 

The mechanism of injury is mostly unknown. These are some of the conditions that show up in people with chronic long-term back pain:

  • Osteoarthritis
  • Degenerative disc disease
  • Degenerative joint disease
  • Disc herniation
  • Spinal stenosis
  • Old spinal fracture / compression fracture
  • Instability
  • Facet joint syndrome

This population is likely to have an ongoing history of back pain. This can be a series of acute back pain episodes that recur over a long period of time. It’s common to hear “I have a bad back” from people dealing with chronic back pain. 

What Causes Back Pain

Most people think that back pain is caused by lifting something heavy, an athletic event, or some kind of trauma. These things definitely can cause back pain but together they account for a tiny fraction of all back pain cases.

The #1 way that people injure their back, by far, is no apparent reason. That’s right, most people (up to 67% of cases) don’t recall the mechanism of injury that caused their back pain to flare up. 

For most people, back pain just happens spontaneously. 

Despite the elusive causes of back pain, we do know the common pathologies (conditions) that are present in people with back pain. 

Conditions Responsible for Back Pain

Back pain can be caused by a wide range of conditions, each with their own set of symptoms and causes. Here are some of the most common conditions responsible for back pain.

Herniated Disc

A herniated disc is when the soft tissue inside the spinal disc slips out through a crack in the outer later. A disc herniation can be bulging (A), protruding (B), extruding (C), or sequestered (D) depending on the severity. 

herniated disc variations that can increase lower back pain

The dynamic disc model is used to describe how different types of movements can affect the position of the herniated disc and the symptoms experienced by the individual. 

dynamic disc model explains how spinal discs move

Centralization is a positive sign, indicating that the herniated disc is moving back towards its original position. Peripheralization, where symptoms move to the extremities, is a negative sign indicating worsening symptoms. 

Physical therapists use the dynamic disc model to determine appropriate treatment to centralize symptoms and return the herniated disc to its normal position.

Degenerative Disc Disease, Degenerative Joint Disease, Osteoarthritis, Spinal Stenosis, or Spondylosis

These conditions are all related to the wear and tear of the spinal discs and joints that occurs with age. The gradual breakdown of cartilage and thinning of discs causes the bones to rub against each other, leading to bone spurs, inflammation, and narrowing of the space for your spinal nerves.

This gradual deterioration of the structures that support the spine can eventually lead to stiffness, limited mobility, and pain. 

In severe cases, it can lead to nerve compression causing numbness, tingling, or shooting pain down the leg (peripheralization).

Note: spondylosis is different from spondylolysis or spondylolisthesis, which are more concerning conditions that will be discussed later in this article. 

aging spine pathologies contribute to lower back pain

Facet Joint Syndrome

Facet joints are the joints that connect the vertebrae to one another in the spine. Facet joint syndrome is an arthritic change that occurs when the cartilage inside the joint breaks down and becomes inflamed. This can occur due to age-related wear and tear or an injury. Symptoms can include pain, numbness, stiffness, and limited mobility.

Lumbar Instability

Lumbar instability occurs when the ligaments and muscles that support the lower back become damaged or weakened, leading to the lack of stability in the spine. This can cause the vertebrae to shift out of their normal position, leading to pain, weakness, and either limited mobility or hypermobility. Lumbar instability can lead to other problems like a disc herniation and an increased risk of injury. 

Sacroiliac Joint Disorder

sacroiliac joint is sometimes responsible for lower back pain

The sacroiliac joint is the joint that connects the pelvis to the spine. Sacroiliac joint disorder occurs when this joint becomes inflamed or damaged, usually due to injury or degenerative changes. 

Injuries can lead to inflammation, swelling, and pain in the lower back, buttocks, and legs. Degenerative changes can also affect the sacroiliac joint, causing the cartilage to wear down and the joint to become stiff and less mobile. Symptoms can include pain in the lower back, buttocks, hips and legs.

Muscle Strain / Myofascial Pain

Muscle strain occurs when the back muscles are stretched or torn. Muscle strains as the cause of lower back pain are much less common than most people think. Most of the time, it’s a joint or disc problem like the conditions listed above. In the case of a muscle strain, the pain is typically localized to the injured area, and muscle spasms may occur.

Muscle strains can result from activities that involve lifting, bending, or twisting, particularly when done incorrectly or with excessive force. Repetitive motion, poor posture, and sudden movements can also lead to muscle strains.

Myofascial pain, on the other hand, occurs when the fascia, a connective tissue that surrounds and supports the muscles, becomes irritated or inflamed. This irritation can cause trigger points to develop, which are areas of tightness and tenderness in the muscles. While myofascial pain and muscle strain can cause similar symptoms, they are different conditions. Myofascial pain is related to the fascia surrounding the muscles while a muscle strain is when the muscle is stretched or torn. 

However, the treatment for both conditions is similar. 

How to Treat Back Pain

Start with conservative care. You want to try the safe and simple stuff first to see if it helps, before contemplating aggressive treatments like surgery. In other words, you only should be considering surgery after conservative care fails.

The more you can do for yourself, the better.

In a study by Farin et al, a predictor of better outcomes for people with chronic lower back pain was having an internal locus of control

This means that the people who wanted to know what they could do for themselves got better results than the people who wanted a physician to do something for them. 

I hope this can encourage you to be more involved with your own care. Seek advice from healthcare professionals but take ownership of the work that you can do yourself. Don’t rely on passive modalities like ultrasound, acupuncture, and massage. These types of treatment are not likely to give you the best benefit. 

Let’s start with what you can do on your own.

Active Rest

First thing you might be wondering is if you should “sleep it off” or minimize your movement. 

This is outdated advice. 

In the 1950s, healthcare workers commonly prescribed bed rest for patients in pain. This proved to leave patients worse off than before. Being still in bed resulted in weakness, deconditioning, and it prolonged the recovery time.

bed rest

However, vigorous exercise and movement that causes pain probably isn’t great either, especially if your injury is acute. 

The most appropriate way to start your road to recovery is to initiate active rest. This means to continue with regular activities as tolerated and safely continue working. Do as much as you can without worsening your symptoms. 

Try not to sit still or lie down for too long when you’re awake.

Every 45 minutes or so, stand up and walk around for a bit. Lightly bend, extend, and twist your spine.

You do not need to stretch your body into end-range at this stage. Keep it light, so that you are resting but also staying active.


When you search “back pain relief” on Google, the first ten search results mention medications as a short-term solution. The main ones they list are:

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
    • Ibuprofen (Advil, Motrin)
    • Naproxen (Aleve)
  • Acetaminophen (Tylenol)

Be careful with medications because they can have some serious side effects. You take them by mouth. They don’t magically travel to only the site of your pain. They end up in your bloodstream and circulate throughout your entire body.

This can consequently damage some of your tissues.

For example, ibuprofen, if taken frequently for a long period of time, can damage your stomach lining and create an ulcer, which can be life-threatening. Aleve can increase your chances of having a heart attack and Tylenol can damage your liver. 

Furthermore, don’t expect to eliminate your pain with medication alone. You may or may not feel better and it definitely does nothing to address the risk of recurrent back pain. 

Spinal Injections

Medication through spinal injections is another option for treating back pain that can be effective for some patients. This surgical procedure involves injecting medication directly into the area surrounding the spinal cord. The medication is usually a combination of a steroid and a local anesthetic.

The purpose of spinal injections is to reduce inflammation, swelling, and pain around the nerves of the spine. They are mostly used for patients with spinal stenosis, disc herniations or osteoarthritis.

Although spinal injections can be a useful tool for pain relief, they are not a great long-term solution. They typically only provide relief for a few weeks to months.

There are also risks associated with the procedure. These include bleeding, infection, nerve damage, allergic reactions to the medication, and sometimes, more pain than before. Prolonged use of corticosteroid injections can start to deteriorate your tissue, including your muscles, tendons, and bones. 

Similar to oral medications, injections alone are not likely to solve your problem because they fail to address the root cause of the problem. 

If meds or injections are used, they should be part of a broader treatment plan that includes posture awareness, improving the way that you use your muscles and bones to move your body, physical therapy and lifestyle modifications.

Better Posture

Pay attention to movements and positions that make your symptoms better, and ones that make your symptoms worse. 

A good rule to follow is whatever activity provokes your pain, try to avoid it while you recover. 

There isn’t a universal position that is best for everyone in the recovery phase. Someone with a herniated disc may find relief standing up or with a slightly arched back, whereas someone with spinal stenosis may find that position to aggravate their symptoms and may instead prefer sitting with a forward bend. 

Identifying a position that feels better, in other words having a directional preference, is one of the best predictors for a faster recovery with back pain. 

Think about how your back feels lying in bed, sitting, standing, and while lifting. Is it better bending forward (flexion), or bending backwards (extension)?

If at any moment you feel pain, numbness or tingling traveling down your thigh or below the knee, get out of that position. This means that your symptoms are peripheralizing.

centralization vs peripheralization symptoms of lower back pain

Peripheralization is when symptoms spread further from your spine. Centralization is the opposite, when your symptoms retreat back toward the spine. Peripheralization is bad. Centralization is good.

Corrective Exercises

Many studies have affirmed that whenever you experience an episode of lower back pain, your stabilization muscles that connect to your spine are likely to get weaker, become smaller, and lose coordination. These deficits are a recipe for future recurrence of lower back pain. 

In other words, the muscles that support your back become somewhat deactivated when you injure your back. 

Hence, corrective exercises to improve activation and stabilization of those muscles can help you overcome those deficits.

Muscles to Target

The primary stabilization muscles for your spine are the transverse abdominis, the multifidus, and the erector spinae, so your exercises should target them.

transverse abdominis, multifidus, and erector spinae
Left: Transverse Abdominis, Middle: Multifidus, Right: Erector Spinae
Transverse Abdominis

The transverse abdominis (TrA) is the deepest abdominal muscle. It connects from the ribs to the pelvis, wrapping around the abdomen from the back to the front. The muscle fibers run horizontally, like a belt around your waist.

This muscle helps contain your organs and create stability for your trunk by providing tension to the front (anterior) body wall. Inadequate activation of the transverse abdominis, can contribute to lower back pain.

transverse abdominis is a stabilizing muscle for the core, and can help reduce lower back pain

The multifidus is arguably the most important stabilization muscle to target when addressing back pain. It is the deepest muscle in your back, connected directly to the spine’s vertebrae. 

The multifidus is an anticipatory muscle, which means it activates in anticipation of movement. 

Say for example you want to raise your arm. Before any of the muscles in your shoulder or arm activate, the multifidus activates first. The reason it does this is to provide stability in your spine while you lift your arm. 

What researchers have discovered is that when you injure your back, the multifidus in that region loses some of its ability to activate. What happens after, is other muscles like the erector spinae compensate to try to provide the stability for your trunk. 

If this goes on long enough, the multifidus can become “dormant” and can have trouble waking back up. After years of inactivity, fat starts to infiltrate the multifidus as seen in the images below.

fat infiltration of multifidus leads to degeneration of the spine and can result in lower back pain
Fat infiltration of the multifidus, progressively from left to right.
Erector Spinae

The erector spinae muscle group lies superficial to the multifidus. It is a collection of three back muscles; the spinalis, longissimus, and the iliocostalis. These muscles run vertically from the pelvis to the upper back with some fibers running all the way up to the base of the skull. 

If the multifidus does not adequately activate, the erector spinae will compensate in order to help create stability in your spine. This can cause the erector spinae to become overactive, which can cause an unbalanced load to the vertebral column further contributing to back pain and an increased risk of reinjury

superficial strength vs deep weakness leading to lower back and lumbar instability
A. Balanced tension representing a stable structure and B. Unbalanced tension representing structural instability of the deep core (overactive erector spinae and underactive multifidus)
Extensor/Flexor Ratio

Another risk factor for developing lower back pain is an imbalance of core muscle strength.

You have muscles on the front side of your body, which can be categorized as the flexors of your trunk, and on the back side of your body, the extensors of your trunk. 

What research shows is that when your extensors are weaker than your flexors, you are more likely to experience lower back pain. In a study by Lee et al, a group of volunteers were followed around for 5 years to see who developed lower back pain and who did not. 

They looked at the ratio of strength of the extensors to the flexors. This was called the extensor/flexor ratio.

A ratio of 1 means that the extensors are equally as strong as the flexors. A ratio greater than 1 means that the extensors are stronger and a ratio less than 1 means that the extensors are weaker relative to the flexors. 

At the end of the study, what they discovered was that men who did not develop back pain over the 5 year period had on average a 1.23 extensor/flexor ratio (extensors were 1.23x stronger than flexors). Men who did develop lower back pain had a ratio of 0.96 (extensor strength was 96% of flexor strength). For women, the ratio was 1 for negative back pain and 0.77 for positive back pain.

What is special about this risk factor is that it is modifiable, meaning you can do something about it! Increasing your extensor/flexor ratio by building up your multifidus and erector spinae strength can be a major boost in the overall reduction of existing and recurrent lower back pain.

Another interesting observation is that in the gym or the clinic, there is traditionally a big emphasis on strengthening the abdominal muscles for core stability. What this study suggests is that strengthening the back side of the body, the extensors, is equally as important (or perhaps even more important than strengthening the abs) to stabilize your core and reduce the risk of lower back pain. 

There is a physical therapy test called the Biering-Sorensen test where a person holds a static position off the edge of a bed for as long as they can. This tests the muscular endurance of the extensors.

extensor endurance test is used in patients with lower back pain
Biering-Sorensen testing position

Evidence suggests that if you cannot hold the position for at least 58 seconds, you are three times more likely to develop lower back pain.

The purpose of the exercises described below is to reactivate the multifidus so that it can provide the stability for your spine like it is designed to, and to develop endurance strength in your extensors to reduce your risk of developing back pain again

Keep in mind there are thousands of exercises that can be performed to target the multifidus, transverse abdominis, and erector spinae. The following exercises are a few of many that can help you get the desired result of reduced lower back pain.

Abdominal Draw

10 reps x 10 second holds

The purpose of this exercise is to train yourself how to simultaneously activate the transverse abdominis and multifidus muscles. Perform this one on your back with your knees bent and your feet flat on the floor. Maintain a neutral spine, which means having a slight arch in your lower back. Keeping the slight arch will help activate the multifidus during this exercise. Take a deep breath in and then exhale completely. As you exhale, gently pull your belly button toward your spine without flattening your spine against the ground. Maintain this new position as you continue breathing in and out for 10 seconds. Release the contraction and repeat 10 times.

Anterior Pelvic Tilt / Posterior Pelvic Tilt

15 reps

In a seated position, straighten up your posture and draw in your abdomen as described in the previous exercise. Work on controlling the rotation of your pelvis forward and backward, which moves your lower back from arched to rounded. This may feel awkward or difficult at first if you have never done it before. This movement specifically targets the multifidus, transverse abdominis, and erector spinae.

Cat Cow

15 reps

Starting in a tabletop position on your hands and knees, alternate from full flexion to full extension of your spine, from your tailbone to your head. 


3 sets x 10 reps

In tabletop position, start by extending one arm in front of you. Then try the other arm. Then try one leg, then the other. Once you have that down without any trunk rotation, try alternating arms and legs (right arm with left leg, left arm with right leg).

Prone Cobra

10 reps x 10 second hold

Start lying down on your belly. With your arms out behind you, squeeze your shoulder blades together and lift your chest off the ground until you feel the activation in the back muscles to the right and left of your spine. These are your erector spinae at work. Hold for 10 seconds and bring yourself back down.

Swimmers (Alternating Arm & Leg Lifts)

3 sets x 1 minute duration

Starting lying face down and holding an abdominal draw, bring your arms out in front of you. Begin by lifting one arm and the opposite leg a few inches off the ground. Bring the arm and leg back down and switch to the other arm and leg. Pause for 2 to 3 seconds at the top for each rep. 

Plank / Side Plank

10 reps x 10 second hold

Position yourself on the ground on your forearms and toes. Keep your spine neutral. Your heels, hips and shoulders should be in a straight line (or close to it). Keep your abs tight and maintain a neutral neck. Hold for 10 seconds and rest.

To do a side plank, turn to the side so now you are down on one forearm and your feet are placed one in front of the other. Your body should be facing the side, as if your back is against a wall. One shoulder should be over the top of the other shoulder. Remember to keep your neck neutral. Hold for 10 seconds and rest. Do both sides. 

For the planks, a regression would be to do them on your knees instead of your toes. 

If you want more mobility exercises for your back and core, read this blog article.

Physical Therapy

Physical therapists are human movement experts trained at a doctorate level. They are skilled in understanding your objectives, evaluating your clinical presentation and using their knowledge of evidence-based research to identify a solution that is most beneficial for you.

In a pivotal study (Di Fabio and Boissonnault, 1998) for the physical therapy discipline, the researchers looked at 10,000 people from 272 clinics with an average age of 43.5. It was discovered that the 4 most common regions symptomatic with pain were lower back, neck, shoulder, and knee.

Out of these top 4 regions, the lower back was the most commonly reported (50%). This was followed by neck (24.1%), shoulder (15.3%), and knee (10.3%). 

In short, lower back pain is the #1 condition that physical therapists treat. 

For back pain recovery, a good physical therapist should ask a thorough history, attempt to identify a directional preference, and develop a plan of care that should include reactivation of the stability muscles surrounding your spine. 

He or she will likely also perform manual therapy to reduce the pain you feel and improve mobility if your spine and surrounding tissues are stiff. 

The physical therapist should also empower you to do more on your own, as discussed earlier about internal locus of control. Active therapy (where you move your own body) typically works best to get you back to normal. 

If they insist on primarily performing passive therapies like ultrasound, ice, heat, or electrical stimulation, they may be missing the mark on giving you the best benefit. These treatments may help you feel some relief if your back pain is acute, but they are usually not long-term solutions. 

Evidence also shows that among patients who received physical therapy for acute low back pain, those receiving physical therapy within 3 days of their episode were consistently associated with decreased medical expenses and decreased followup health care utilization.

Take Control of Your Sleep

One of the simplest and most effective solutions might surprise you… good sleep. Getting a good night’s rest can do wonders for reducing back pain and improving overall health.

First of all, it’s important to understand the connection between sleep and back pain. Research has shown that lack of sleep can increase pain sensitivity, which can make back pain feel worse. 

So, how can you get better sleep?

Getting good sleep can help improve back pain

Here are some tips:

  • Stick to a regular sleep schedule. Try to go to bed and wake up at the same time each day (even on weekends).
  • Come up with a bedtime routine. Find a few things to wind down with, like reading, stretching, and/or meditating.
  • Make sure your sleep environment is comfortable. Similar to a cave (which is where people slept way back in the day), try making your sleep environment dark, quiet, and cool.
  • Limit caffeine and alcohol intake. Try to avoid consuming caffeine or alcohol in the second half of the day, as these can interfere with sleep quality.

By adding some of these tips into your daily routine, you can improve your sleep quality and potentially reduce back pain. Good sleep can also improve your mood, immune system function, and overall physical and mental well-being.

Make sleep a priority, and you may be surprised at how much it can improve your overall quality of life.

Take Control of Your Diet

Currently there isn’t strong evidence that obesity is a direct predictor for lower back pain, however we do know that obesity increases your risk of developing a host of health issues, one of which is early onset of osteoarthritis. We also know that osteoarthritis is a common condition seen in people with lower back pain.

In light of these findings, it can be inferred that obesity may indirectly contribute to lower back pain through its association with degenerative changes like osteoarthritis. 

Therefore, it’s recommended for those with obesity and chronic lower back pain to shed excess weight. This approach is unlikely to make things worse, and it may potentially alleviate back pain symptoms.

And it’s not just your spine that is at risk if you are overweight. You’re also at risk of developing early onset osteoarthritis in your knees and hips from the excess pressure on these joints. 

But it’s not just about weight. The foods you eat can also impact back pain. 

Processed foods, sugary drinks, and high-fat meals can lead to inflammation in the body, which is associated with pain and stiffness. On the other hand, a diet rich in anti-inflammatory foods like fruits, vegetables, whole grains, and lean proteins can help reduce inflammation and ease back pain.

Mediterranean diet

For example, a 2020 study by Kaushik et al concluded that a Mediterranean-style diet, which emphasizes fruits, vegetables, whole grains, and lean proteins like fish, was associated with a reduction in chronic pain. The study suggests that the anti-inflammatory properties of the diet may have played a role in reducing pain.

Vitamin D is a nutrient worth mentioning when it comes to bone health and muscle function, both of which can positively impact back pain. Some research has suggested that vitamin D deficiency may be linked to an increased risk of chronic low back pain. 

Sources of vitamin D include fatty fish like salmon (which is still overall low in fat), eggs, and fortified foods like milk and cereal (try to avoid the processed and surgery cereals).

You can get a blood test to see your levels of vitamin D. The reality is that most individuals are deficient in vitamin D. If that’s you, taking a 5000 IU supplement daily can take care of that.

Overall, improving your diet can be an effective way to reduce back pain. Eating a balanced diet with a variety of nutrient-rich foods, limiting processed and high-fat meals, and incorporating anti-inflammatory foods can all play a role in managing back pain. Schedule a consultation with a registered dietician (RD) to discuss any major dietary changes.

Manage Your Stress Levels

Stress is a common factor in many health conditions, including back pain.

When your body is under stress, your sympathetic nervous system activates the “fight or flight” response, which increases heart rate and blood pressure. This can also cause muscles to tense up, which can increase the pressure on the spine and contribute to back pain.

In addition to stress, Ferguson et al determined that psychosocial measures including anxiety, depression, and low job satisfaction are risk factors of developing back pain. 

In 2022, Lin et al reviewed the literature and concluded that the use of meditation-based therapies present an efficient alternative method of managing chronic low back pain. 

Managing stress through techniques such as deep breathing and meditation can help to reduce muscle tension and inflammation, ultimately leading to reduced back pain. In addition, stress management techniques can help to improve sleep quality, which we know from the previous section is an important element of back pain relief.


Deep breathing involves taking slow, deep breaths in through the nose and out through the mouth. This can help to activate the parasympathetic nervous system, which promotes relaxation and can reduce muscle tension.

Meditation and mindfulness involves focusing on the breath or a mantra to help clear the mind to reduce stress. Studies have shown that regular meditation practice can help to reduce pain and improve overall well-being.

Regardless of the method you use, it’s important to keep in mind that keeping your stress levels to a minimum can contribute to a reduction in back pain.


Yoga is a popular mind-body therapy that has been gaining attention as an effective alternative treatment for low back pain. 

You may not want to jump into a yoga class if you just had an acute episode of back pain, however a systematic review of randomized controlled trials published in the American Journal of Lifestyle Medicine in 2013 found that yoga can be an effective intervention for reducing chronic low back pain.

The study reviewed 10 randomized controlled trials involving close to 1000 participants with chronic low back pain who practiced yoga. The results showed that yoga was associated with significant improvements in pain intensity, disability, and quality of life.

Yoga seems to address both physical and psychological factors that contribute to chronic low back pain. 

yoga childs pose

Deep breathing involves taking slow, deep breaths in through the nose and out through the mouth. This can help to activate the parasympathetic nervous system, which promotes relaxation and can reduce muscle tension.

Physical benefits of yoga include improved flexibility, strength, and balance, and psychological benefits include stress reduction and improved mood.

Some of the yoga poses that have been found to be effective for chronic low back pain include the downward-facing dog, cat-cow stretch, and child’s pose. It’s best to practice yoga under the guidance of a trained instructor, especially if you have chronic low back pain.

When Back Pain Becomes an Emergency

Back pain is a common ailment that many people experience at some point in their lives. In most cases, back pain can be managed with the information described above. However, there are times when back pain can be a sign of a more serious underlying condition. In these cases, prompt medical attention is crucial.

Sinister Symptoms

Be on a lookout for symptoms that may indicate a more serious problem. These include:

  • bowel and bladder dysfunction
  • sensory disturbance near the anus, genitals and buttock region (saddle anesthesia)
  • numbness and tingling in the legs
  • muscle weakness or weakness in the legs
  • unexplained weight loss
  • sudden loss of balance

These symptoms may indicate a problem with the nerves or spinal cord and require urgent medical attention.

Spinal Surgery

In some cases, back pain may require surgical intervention. Conditions such as spondylolysis (C), spondylolisthesis (D), or compression fracture may be treated with surgery. Sometimes, a herniated disc can be so extruded that a discectomy is performed. However, it’s important to keep in mind that getting surgery also comes with added risks and complications.

lower back pain from spondylolysis or spondylolisthesis
C. Spondylolysis (pars interarticularis fracture) and D. Spondylolisthesis (pars interarticularis fracture with displacement of the vertebral body)

One potential complication is something called adjacent segment disease, which refers to degeneration or instability of the vertebrae above or below the site of a surgery. Studies have shown that the incidence of adjacent segment disease is relatively high, occurring in up to 25% of patients within 10 years after surgery.

Furthermore, surgery may not always completely alleviate back pain and can lead to other problems. In some cases, patients may experience nerve damage, infection, fusion failure, or excessive bleeding. It’s important to discuss the risks and benefits of surgery with a qualified healthcare professional.

Post-Operative Management

Proper post-operative management is essential for a successful recovery after spinal surgery.

Physical therapy plays a vital role in regaining mobility, strength, and flexibility, making it an integral part of post-operative care. Early physical therapy can prevent complications and improve outcomes, reducing the need for additional medical intervention.

Patients are usually in a lot of pain after surgery, and medications may be prescribed to manage the discomfort and swelling in the recovery process as well.

Patients should consult with their surgeon to determine the best course of action after surgery, and early physical therapy should be emphasized to ensure a faster, more effective recovery, and minimize the risk of complications.


As a physical therapist, my goal is to help you get better, not just feel better. Part of that is to empower you to manage your back pain on your own.

Through this article, you’ve learned about the different types and causes of back pain, as well as short-term and long-term treatment options. You learned about the muscular structures that protect your back and corrective exercises that help activate those muscles. You also learned that back pain can be reduced by making lifestyle modifications like taking control of your sleep, diet, and stress. 

Another appropriate option you learned about is seeing a physical therapist, which is a human movement expert who specializes in recovery for back pain. They can set you up with a plan of care to not only alleviate the back pain, but to also recondition your body so that you minimize your risk of having a future episode. A physical therapist can also identify any sinister symptoms you may be having and will know if urgent medical attention is required. 

In rare instances, surgical interventions may be appropriate. Just make sure to try conservative care first.

If you want to learn more about how physical therapy can help you overcome your back pain, click here to book your free consultation today with Physical Therapy Doc.

Get started today by booking your free consultation:

If any of the exercises or treatment options have worked for you, I would love to hear about your experiences. 

Please leave a comment below and share what has helped you manage your back pain. Your feedback can help others who are dealing with similar issues. Let’s work together to find the most effective solutions for managing back pain and improving overall quality of life.


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Legal Note: This blog article is not professional medical advice. Although the article was written by a doctor of physical therapy, there are many variables that come with patient healthcare. We recommend you consult your primary doctor if you want medical advice for your particular situation. No patient-doctor or confidential relationship exists simply by watching, reading, and applying the information presented in this article.

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