Pain in your lower back is one of the most common reasons people visit a physiotherapist. It’s also one of the most common reasons people miss work, skip workouts, or struggle to sleep. The good news is that most lower back pain isn’t caused by anything serious. The majority of episodes improve within a few weeks with the right mix of movement, self-care, and guidance.
In this guide, our physiotherapists cover four things: practical tips to alleviate lower back pain at home, simple physiotherapy exercises for lower back pain you can start today, what physiotherapy treatment involves, and the warning signs that mean you should get checked sooner rather than later.
Why Does My Lower Back Hurt?
Lower back pain rarely has a single cause. For most people, several factors build up over time, sometimes with one awkward movement on top. Common contributors include:
- Muscle or ligament strain from lifting, twisting, or a sudden movement
- Prolonged sitting or static postures, especially at a desk or behind the wheel
- Stiffness and weakness in the hips, core, and glutes
- Disc-related irritation, which can sometimes send pain into the buttock or leg
- Mechanical problems such as posterior lumbar derangement, where certain positions reliably make pain better or worse
- Car accidents, falls, and sports injuries
Sometimes pain in the lower back comes with tingling, numbness, or pain travelling down the leg. That can signal nerve involvement, and it’s a good reason to have a physiotherapist assess you. For a broader look at what we treat, see our overview of the types of conditions physiotherapy can treat.
6 Tips to Alleviate Lower Back Pain at Home
1. Stay active and avoid bed rest
It’s tempting to lie down until the pain passes. However, extended bed rest tends to make the back stiffer and slower to recover. Gentle walking, light household tasks, and short movement breaks keep blood flowing to the tissues and help your back heal. Stay as active as your pain allows, and ease back into heavier activities gradually.
2. Use heat or ice
For a fresh strain, some people find ice soothing in the first day or two. For ongoing stiffness and muscle tension, heat usually works better. There’s no strict rule, so use whichever gives you more relief. Apply it for 15 to 20 minutes at a time, with a cloth between your skin and the pack.
3. Change positions often
Whether you sit or stand, staying in one position for too long is usually what aggravates the back. Set a reminder to change position every 30 minutes or so. You could stand up, walk to refill your water, or do a few gentle back extensions. If you work at a desk, choose a chair that supports the curve of your lower back and set your screen at eye level.
4. Find a back-friendly sleeping position
If you sleep on your side, place a pillow between your knees to keep your hips and spine aligned. If you sleep on your back, a pillow under your knees can take pressure off your lower back. A medium-firm mattress suits most people, but comfort matters more than any rule.
5. Lift with your legs and keep loads close
Bend at your hips and knees rather than rounding through your lower back. Keep the object close to your body, and turn your feet instead of twisting your spine. While you’re sore, break heavy loads into smaller trips.
6. Be patient, but don’t wait too long
Most acute lower back pain settles over a few weeks. That said, a physiotherapy assessment can pinpoint what’s driving the pain and speed up recovery if any of the following apply:
- You haven’t seen steady improvement after a week or two.
- The pain keeps coming back.
- The pain is interfering with work or sleep.
Physiotherapy Exercises for Lower Back Pain
The right exercises are one of the most effective tools for lower back pain relief. The gentle movements below are commonly used in physiotherapy for lower back pain to restore mobility and build support around the spine. HealthLinkBC recommends similar exercise programs as part of self-care for low back pain.
Before you start: Move slowly and stay within a comfortable range. Mild stretching discomfort is fine, but sharp or worsening pain is not. Stop any exercise that sends pain, tingling, or numbness down your leg. These are general exercises. If your pain is severe or you have a diagnosed back condition, check with a physiotherapist first.
Knee-to-chest stretch
Lie on your back with your knees bent and feet flat. Gently pull one knee toward your chest with both hands and hold for 20 to 30 seconds. Then lower it and switch sides. Repeat 2 to 3 times per side. This stretch eases tension through the lower back and glutes.
Pelvic tilts
Lie on your back with your knees bent. Tighten your stomach muscles and gently flatten your lower back into the floor, tilting your pelvis slightly upward. Hold for 5 seconds, then relax. Repeat 10 times. Pelvic tilts activate the deep core muscles without straining the spine.
Cat-cow
Start on your hands and knees. Slowly round your back toward the ceiling while tucking your chin (cat). Then let your stomach lower as you lift your chest and tailbone (cow). Move smoothly between the two positions 10 times to gently mobilize each segment of your spine.
Glute bridge
Lie on your back with your knees bent and feet hip-width apart. Squeeze your glutes and lift your hips until your body forms a straight line from shoulders to knees. Hold for 3 to 5 seconds, lower slowly, and repeat 10 times. Strong glutes take load off the lower back during everyday movement.
Bird dog
Start on your hands and knees with your back flat. Slowly extend your right arm forward and your left leg back, keeping your hips level. Hold for 5 seconds, return to the start, and switch sides. Repeat 8 to 10 times per side. This exercise builds the coordinated core stability your back relies on.
A note on direction: For some people, flexion-based stretches like these aren’t the best fit. This is especially true if your pain eases when you arch backward. For them, extension exercises such as prone press-ups often help more. This approach is the foundation of the McKenzie Method, which we explain in our guide for people with posterior lumbar derangement. A physiotherapist can help you identify which direction of movement suits your back.
What Does Physiotherapy for Lower Back Pain Involve?
When self-care isn’t enough, physiotherapy aims to find the root cause of your pain and give you the tools to manage it long term, not just short-term relief. At Oakridge Physiotherapy, physiotherapy for lower back pain typically includes the following.
A thorough assessment
Your physiotherapist will start with your history: how the pain started and what makes it better or worse. They’ll then assess your posture, movement, strength, flexibility, and nerve function. This helps distinguish muscular, joint, disc, and nerve-related pain, and it screens for anything that needs medical follow-up.
Hands-on treatment
Manual therapy techniques such as joint mobilization and soft tissue work can reduce pain and stiffness. That makes it easier to move and exercise.
A personalized exercise program
Exercise is at the heart of most back pain treatment plans. Your physiotherapist will progress you from gentle mobility work to strengthening exercises tailored to your body, job, and activities. For longer-term conditioning, our kinesiology team can help you build strength and confidence in movement.
Education and prevention
Understanding your pain is a big part of recovering from it. We’ll cover activity pacing, posture habits, workstation setup, and lifting strategies to reduce the chance of future flare-ups.
Depending on your needs, your plan may also include massage therapy to ease muscle tension, acupuncture, or electrotherapy. If your back pain started after a car accident, our team can also support your recovery through ICBC-covered treatment.
When to See a Physiotherapist, and When to Seek Urgent Care
Book a physiotherapy assessment if:
- Your pain hasn’t improved after one to two weeks of self-care
- Your back pain keeps returning
- Pain, tingling, or numbness spreads into your buttock or leg
- You’re having trouble sitting, working, or sleeping
- Your pain started after a car accident, fall, or sports injury
In BC, you can book directly with a physiotherapist without a doctor’s referral. Some extended health plans do require one for reimbursement, so check your coverage.
Seek urgent medical care if you have:
- Loss of bladder or bowel control, or difficulty urinating
- Numbness in the groin, inner thighs, or “saddle” area
- Leg weakness or numbness that is getting worse
- Fever, unexplained weight loss, or a history of cancer along with new back pain
- Back pain after a significant fall or accident
- Severe, constant pain that doesn’t change with position or rest, including at night
Do I need an X-ray or MRI?
Many people expect imaging to reveal the cause of their back pain. For most lower back pain without red flags, though, X-rays and MRIs rarely change treatment. They also often show normal age-related changes that aren’t actually causing the pain. According to Choosing Wisely Canada, most people with lower back pain feel better in about a month whether or not they have imaging. If your assessment suggests imaging is needed, your physiotherapist will refer you back to your doctor.
Watch: Lower Back Pain Advice and Exercises
This video offers additional information, advice, and exercises for people dealing with lower back pain.
Frequently Asked Questions
What can a physiotherapist do for lower back pain?
A physiotherapist assesses your movement, strength, and posture to identify what’s causing your pain. They then treat it with hands-on therapy, a personalized exercise program, and education on posture, lifting, and activity pacing. The goal is to relieve pain, restore movement, and reduce the chance of the pain coming back.
Should I go to physio for lower back pain?
Physiotherapy is a good choice if your pain hasn’t improved after a week or two, keeps coming back, spreads into your leg, or limits your daily activities. Exercise-based care is one of the most recommended approaches for lower back pain, and in BC you can book a physiotherapist directly.
Is it better to sit or stand with lower back pain?
Neither is better on its own. Staying in any one position for too long is usually what aggravates lower back pain. Alternate between sitting, standing, and walking every 30 minutes or so, and use a chair that supports your lower back when you do sit.
I pulled my lower back. What should I do?
Stay gently active rather than resting in bed. Use heat or ice for comfort, and avoid heavy lifting for a few days. Gentle movements like pelvic tilts and knee-to-chest stretches can help. If the pain isn’t improving within a week or two, or if it spreads down your leg, book a physiotherapy assessment.
How long does lower back pain take to heal?
Most acute lower back pain improves significantly within a few weeks, and many people feel better within about a month. Pain lasting longer than 12 weeks is considered chronic. Chronic pain often responds well to a structured physiotherapy and exercise program.
What are the red flags for lower back pain?
Seek urgent care for any of the following: loss of bladder or bowel control, numbness in the groin or saddle area, worsening leg weakness, fever, unexplained weight loss, a history of cancer, back pain after a significant fall or accident, or severe pain that doesn’t ease with rest or position changes.
Get Back to Moving Comfortably
You don’t have to put up with lower back pain or guess your way through recovery. Our experienced team at our Cambie Street clinic in Vancouver can assess your back, build a plan around your goals, and help you return to the activities you enjoy.
Book an appointment online or contact us with any questions.