90% of the people with low back pain I see in clinic have this problem

The low back pain I see in physio and osteo consultations

As a physio and osteopath, I frequently see patients suffering from the lower back. Chronic low back pain is therefore very present in my day-to-day practice. I see just as many patients with acute pain, a “lumbago”, as with low back pain that’s been settled in for several weeks or months. The two have different mechanisms, but often share the same underlying causes.

The band-like pain across the lower back

Horizontal, band-like pain across the lower spine is typical of low back pain, whether acute or chronic. It’s a classic sight: a patient arrives at the clinic bent forward, hand on their lower back, unable to fully straighten up. This characteristic pain can be symmetrical or much more marked on one side. In acute forms, simply changing position, getting up from a chair, or turning over in bed can trigger sharp pain. In chronic forms, it’s more of a dull, constant discomfort that intensifies after a long day of work or an unusual effort.

Pain in one buttock only

Sometimes the pain isn’t concentrated in the lower back but travels further down, into the buttock, generally on one side only. This asymmetrical pain reflects a neurological issue this time: the sciatic nerve. It can be irritated at its origin at the last lumbar vertebrae, or along its path, particularly at the piriformis muscle.

The sciatic nerve sometimes passes through this muscle, and a contracture of the piriformis can compress it. This is called piriformis syndrome, a common cause of buttock pain that I see regularly in clinic and that’s often wrongly mistaken for a genuine disc herniation.

The path down the thigh and further

Some patients describe pain over an even wider area: radiating from the lower back, down the buttock, along the thigh and sometimes as far as the foot. This travelling pain can be accompanied by loss of strength, tingling or loss of sensation in part of the lower limb. This is the classic description of sciatica.

Sciatica isn’t a disease in itself, it’s a symptom. It reflects irritation or compression of the sciatic nerve, most often from a disc herniation or a narrowing of the spinal canal. In most cases, it resolves without surgery, provided it’s treated correctly and promptly.

The typical patient in 90% of the low back pain cases I see

The patient profile I see day to day is between 35 and 60 years old. They have band-like pain across the lower back, sometimes radiating into one buttock, and they’re limited in flexion: they can no longer touch their ankles, and getting up from the floor is difficult. The pain is often masked by anti-inflammatories, which gives the illusion of improvement without treating the cause. This patient generally consults me between 2 days and 3 weeks after the first pain started. As an osteopath, I can see them as a first point of contact, without them having gone through their doctor beforehand.

Sedentary, or sitting 80% of their time

In the vast majority of cases, the patients I see with low back pain spend their days sitting at a desk. Even those who exercise regularly are, in reality, motionless 80% of the time. Yet the body isn’t designed to stay static for hours on end. The stabilising muscles of the back switch off, the fascia stiffens, joint mobility decreases. Movement is fuel for the back, and when it’s missing, the structures weaken.

The under-recognised bad position for the lower back

Crossing your legs is a position I see behind many cases of low back pain, and yet it’s rarely identified as such by patients. To be clear: crossing your legs doesn’t automatically mean low back pain. But holding this position for many hours a day, repeated daily, promotes loss of mobility in the lower back and hips, and concentrates strain on a specific area.

What I observe is that crossing the legs is often unintentionally combined with a lateral tilt of the lower back. It’s this tilt that triggers the problem. This posture held over time is maintained by the iliolumbar ligament, which connects the last two lumbar vertebrae to the pelvis. When you stand up and try to move again, this ligament, left frozen in a poor position, becomes irritated by the stretch. This is a typical pattern I see every day behind very painful episodes of low back pain, which wouldn’t have happened if the patient had simply varied their position throughout the day.

Doing sport in a single plane of movement

Playing sport is essential. Movement is the solution to low back pain, as it is to many musculoskeletal problems. But most of the patients I see do sport in a single plane: forward/backward. Yet the body needs rotational movement.

When you run, for example, the shoulders rotate left and right, generating rotation of the upper body relative to the lower body. This type of movement is fundamental to lumbar spine health. Unfortunately, most exercises done at the gym, like plank holds, squats or classic deadlifts, don’t involve rotation. The back gets stronger in one plane, but stays vulnerable as soon as it’s taken outside that pattern.

How I treat 90% of low back pain cases

My answer comes down to a few words: movement, and more movement. But smart, targeted, progressive movement. Here are the three pillars I systematically use in my care.

I restore movement wherever it’s missing

The key lies in mobility. The body needs to move, particularly in rotation, and move in every direction nature intended. If you stop moving, the body freezes up, structures stiffen, and the smallest strain becomes painful. Walking remains the bare minimum. Running is an excellent option when it’s well tolerated. But the more varied the activities, the better.

My favourite exercise for low back pain is the windmill. In a single movement, it mobilises the lower back in flexion, rotation and lateral tilt, works the hips and pelvis, and stretches the hamstrings and adductors. It’s a complete, functional, accessible exercise. 5 reps per side in the morning to unlock the body, 5 in the evening to clear out the bad positions accumulated during the day. Within a few weeks, patients who practise it regularly see a significant improvement.

Understanding the problem is key for the patient to avoid relapse

Something I regularly observe in clinic: when a patient truly understands what’s happening in their back, they become an active participant in their treatment. They stop just enduring their injury and start managing it.

Spontaneously, they start avoiding bad positions, varying their posture throughout the day, and sticking with the exercises they’ve been given without needing reminders. This awareness is, in my view, just as important as the hands-on work done during a session. A back that doesn’t relapse is a patient who has understood why they were in pain and what needs to be done to stay pain-free.

Rotational strengthening is essential

Finally, to avoid any relapse and have a strong back for the long term, you can’t just rely on flexion/extension work or a plank hold. These exercises are useful, but they stay within one plane. Yet real life doesn’t happen in a single plane.

Carrying a child, moving house, gardening, DIY: there will always be rotations combined with load. That’s precisely the back’s job — to allow this type of effort — which is why it needs to be prepared for it. I put rotational strengthening at the heart of my sessions to get a functional, lasting result.

Two tools I particularly like: working with a resistance band and the Pallof press. The Pallof press in particular is remarkable: it creates a rotational resistance the body has to control, deeply activating the spine’s stabilising muscles. Progressive and adaptable to every level, it fits easily into a rehab or maintenance programme.

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FAQ — Low back pain

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Do I need an MRI for low back pain?

In the vast majority of cases, no. Current medical recommendations are clear: an MRI isn’t indicated as a first step for common low back pain, especially in the first few weeks. Imaging can even be counterproductive: many people show abnormalities on MRI (disc degeneration, disc herniation) with no pain at all, and vice versa. What matters is the clinical picture — what the patient feels, how they move, what worsens or relieves the pain. An MRI is useful in the case of neurological signs (loss of strength, sensory disturbance) or if the pain doesn’t respond to treatment. Your doctor will decide.

After sciatica, do I have to permanently stop lifting loads?

No, and that’s an important message. Well-treated sciatica doesn’t mean you’re condemned to avoid effort. On the contrary: a back that’s strengthened, mobile and used to load is a back that resists relapse better. The goal of rehab is precisely to progressively rebuild the spine’s tolerance to effort, including load-bearing. What’s not advisable is going back to heavy loads without preparation, too fast, or with poor compensation patterns. With a suitable programme, the vast majority of patients who’ve had sciatica can return to full physical activity.

How long does it take to treat low back pain?

It depends on the type of low back pain and, above all, on how it’s managed. For an acute lumbago treated quickly with suitable movement and the right advice, significant improvement is possible within 1 to 3 weeks. For chronic low back pain that’s been present for several months, the work takes longer: expect 6 to 12 weeks of active rehab for a stable result. What tends to extend the timeframe in most cases: waiting too long before seeking care, resting excessively, or not addressing the underlying causes (posture, mobility, rotational strengthening). Movement remains the best medicine for the back, provided it’s prescribed correctly.