Treating Lower Back Pain (2)

Part 2 of the lower back pain (LBP) series. Read about the causes of LBP (part 1) here.

Here’s a quick recap about the causes of LBP…

Approximately 80% of adults will experience at least one episode of LBP during their lifetime.

5-10% of cases result from tissue specific damage, while 90% have no identifiable cause (“non-specific” LBP).

There are many factors, such as stress, that can influence the sensitivity of the nervous system and LBP.

This article focuses on the treatment of non-specific LBP.

What should I do if I get a sudden bout of back pain?

A sudden and severe attack of lower back pain can be quite a scary thing to deal with, especially because it can stop you from working and participating in the activities that you love.

Your healthcare professional should perform a thorough physical examination. More importantly, they should also take a detailed history that establishes:

  • Your current and previous experiences of back pain
  • Levels of stress and coping strategies
  • Work and family life
  • Your levels of physical activity and the presence of other health conditions

What is the best way to treat LBP and reduce the risk of it happening again?

There are several risk factors that researchers have consistently found an association with the development of LBP.

PANA Wellness

It follows that the most effective methods of treating LBP should address those risk factors that are modifiable.

Research has repeatedly shown that the most effective way to treat LBP is a personalised exercise programme combined with cognitive therapy.

Personalised exercise programme

A personalised exercise programme should not only address any specific movement deficits but also include whole-body strength and conditioning and cardiovascular fitness.

The key to any rehabilitation exercise programme is that it should be gradual and progressively expose the individual to the activities that they specifically want to get back to, essentially reducing fear of movement whilst building robustness and resilience.

Cognitive behavioural therapy

The cognitive therapy aspect of rehabilitation involves addressing erroneous and negative beliefs about the nature of LBP, providing coping and pacing strategies and options to change lifestyle factors such as smoking that are known risk factors for LBP.

What about treatments like massage, manipulation and acupuncture?

These are passive treatments that can be useful adjuncts to manage pain levels in the short-term. However, they have little long-term effectiveness and may perpetuate the cycle of disability by creating dependence on therapy.

If your health professional is treating you with passive therapies and not provided you with a graded exercise programme and self-management strategies, then it may be time to seek a second opinion.

What is the best type of exercise for LBP?

An exercise programme that is tailored to the individual.

Studies investigating the effectiveness of specific “core stability” exercise programmes versus more generalised gym exercise programmes show that both are effective at reducing LBP and improving day to day function, but there are no clear advantages between the two.

A simple brisk walking exercise regime has also been shown to be effective at reducing disability from LBP.

So the choice should be based on the individual’s goals, levels of energy, time constraints, access to facilities and enjoyment.

At the end of the day, movement and physical activity is key. As long as the exercise programme is tailored, gradual and progressive then it doesn’t matter what type of exercise you do as long as you move more and enjoy it!

Some practical tips to manage LBP and reduce risk of recurrence.

Practice a form of meditation or mindfulness.

Mental stress is a significant factor in LBP flare-ups.

Stress is an unavoidable fact of life. It is, in fact, sometimes a good thing as it primes us into action. However, too much stress over a prolonged period in the absence of appropriate coping strategies can have a negative physiological effect on the body.

Making time to practice meditation or mindfulness or simply to take some “down time” for yourself can make a real difference in how you cope with your stress levels and continue to function on your day to day life.

Move More

Here are some easy ways to increase your activity levels:

Moving in the work place:

This is particularly important if you have a sedentary job.

Take a movement break for a few minutes every hour. Get up out of your chair and do some squats, march on the spot, go for a short walk. It doesn’t matter what you do so long as you provide a change in position from prolonged sitting frequently. 

If your workplace can provide you with a stand-up desk, then request one. Having the option to stand for a proportion of the time during your work day adds varietyto your posture and movement which is key. In addition, you will burn more calories whilst you work.


Written by Herbert Trabanino MSc

Editted and designed by Rebekah Jade BSc


Hart, P.D. and Buck, D.J. (2019). The effect of resistance training on health-related quality of-life in older adults: systematic review and meta-analysis. Health Promotion Perspectives, 9 (1), 1-12.

Hartvigsen, J., Hancock, M.J., Kongsted, A., Louw, Q., Ferreira, M.L., Genevay, S., Hoy, D., Karpinnen, J., Pransky, G., Sieper, J., Smeets, R.J and Underwood, M. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356-2367.

Maher, C., Underwood, M. and Buchbinder, R. (2016). Non-specific low back pain. The Lancet, 389(10070), 736-747.

8Stamakis, E., Lee, I-M., Bennie, J., Freeston, J., Hamer, M., O’Donovan, G., Ding, D., Bauman, A. and Mavros, Y. (2017). Does strength promoting exercise confer unique health benefits? a pooled analysis of eleven population cohorts with all-cause, cancer, and cardiovascular endpoints.American Journal of Epidemiology, 187(5), 1102-1112.

About the author

Herbert Trabanino MSc, MCSP.

Herbert is a chartered specialist musculoskeletal Physiotherapist, personal trainer and strength and conditioning coach. He qualified as a Physiotherapist in Australia, and obtained a Masters in Neuromusculoskeletal Physiotherapy from the University of Hertfordshire in 2016. He practices out of Spire Bushey Hospital and Harley Street Physiotherapy and specialises in the rehabilitation of musculoskeletal injuries with a special interest in low back pain and lower limb conditions. Herbert is a firm believer that exercise should be an integral part of a healthy lifestyle rather than a short-term intervention and as such promotes the integration of physical activity in all of his patients.

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