Lower Back Pain and Sciatica: What Helps, and When to See a Physio

The short answer

Lower back pain is extremely common, and in most cases it is not a sign that something is broken or worn out. The NHS advises staying as active as you can, and NICE guidance on low back pain and sciatica recommends exercise as a core part of treatment, with manual therapy only as part of a package that includes exercise. Rest for more than a day or two tends to make things stiffer and slower to recover.

Back pain or sciatica?

Back pain is felt in the lower back. Sciatica is different: pain, tingling or numbness travelling from the back down the back of the leg, sometimes into the foot, because the sciatic nerve is irritated. Sciatica can feel alarming, especially when the leg pain is worse than the back pain, but it often settles within a few weeks to a few months.

Either way, the same principle applies. Movement that your back tolerates, built up gradually, usually does more than waiting for the pain to go.

What usually helps

• Keep moving. Walking and normal daily activity, at a level you can manage, are better than bed rest.
• Build strength and capacity. A structured exercise plan, progressed over weeks, rebuilds the tolerance your back has lost.
• Adjust, do not stop. If you train or race, modify volume and positions rather than stopping everything.
• Hands-on treatment, as part of a plan. Manual therapy can ease a painful phase and help you move, and works best alongside exercise.

For drivers, long periods in a low, fixed seated position are a common aggravator. That is worth looking at in its own right, from seat position to how you build tolerance to sustained sitting.

Warning signs that need urgent care

Call 999 or go to A&E if back pain comes with any of these:

• Numbness or tingling around your bottom or genitals.
• Loss of control of your bladder or bowel, or difficulty peeing.
• Weakness or numbness in both legs, or worsening weakness in one.
• Back pain after a serious fall, crash or accident.

These can be signs of cauda equina syndrome or another serious problem, which needs treatment quickly. See your GP or call NHS 111 if back pain comes with a fever, unexplained weight loss, a history of cancer, or pain that is severe at night and not eased by changing position.

When to see a physiotherapist

Book an assessment if your back pain or sciatica:

• has not started to improve after a couple of weeks,
• keeps coming back,
• is stopping you working, training or racing, or
• leaves you unsure what you can safely do.

What happens at a Box Box assessment

Your first session with Carly is a full hour. She takes your history, asks what you need to get back to, and examines how your back and hips move and how they cope with load, checking for anything that needs a doctor rather than a physiotherapist. You leave with a working diagnosis explained in plain English and the first steps of a plan.

From there the plan follows the same path as every Box Box programme: assess, plan, build and return, with progress measured so you can see it. If at any point a scan or a medical opinion is the right next step, Carly will tell you and point you to the right person.