Low back pain: understanding your back pain and getting back to activity

What is low back pain?

The anatomy of the lower back

The lower back is made up of five lumbar vertebrae, separated by intervertebral discs that absorb strain and linked together by spinal ligaments, the whole surrounded by a powerful network of back muscles (spinal erectors, quadratus lumborum, deep abdominals) that stabilises the trunk with every movement. Low back pain refers to any pain felt in this region, from the lower back down to the top of the buttocks. In more than 90% of cases in athletes, it’s described as “common” or “non-specific”: it isn’t linked to a serious structural injury, but to mechanical overload of this region.[1]

Why does this area become painful?

Pain most often appears when the lower back is subjected to a repeated or sudden load beyond its capacity to adapt at a given moment: a flexion-rotation movement under load, a training volume increased too quickly, lack of sleep, stress or a period of general fatigue can all temporarily lower this tolerance threshold, without any structural “malfunction” of the back.

Acute, subacute, chronic low back pain: definitions

• Acute: less than 6 weeks, the most common case
• Subacute: between 6 and 12 weeks
• Chronic: more than 12 weeks, which applies to a minority of cases but calls for more comprehensive care

In everyday language, the term “lumbago” refers to a sudden episode of acute low back pain, often following a flexion-rotation movement.

Symptoms and diagnosis of low back pain

Typical pain and what triggers it

The pain is located in the lower back, sometimes radiating to the buttock or upper thigh, without going further down into the legs for common low back pain. A reflex muscle contraction (spasm) often accompanies the episode, particularly at the start. The pain is typically triggered by flexion-rotation under load, prolonged postures (sitting, bending forward), or waking up with stiffness that eases with movement.

How symptoms progress without treatment

Contrary to popular belief, the main risk isn’t the worsening of a structural injury, but the onset of fear of movement, which leads to avoiding certain movements, which in turn maintains muscular deconditioning and prolongs the pain well beyond the natural recovery time.[3]

Differential diagnosis

Certain signs should point towards a diagnosis other than common low back pain:

• True sciatica: pain that clearly extends below the knee along the path of the sciatic nerve, from nerve compression linked to a symptomatic herniated disc
• Spondylolysis or spondylolisthesis: a bone stress fracture of the vertebra, to consider in young athletes practising sports with repeated hyperextension (gymnastics, throwing sports, dance)
• Facet joint arthritis: wear of the posterior spinal joints, with pain more often triggered by spinal extension and rotation, more common with age

Causes and risk factors

Low back pain rarely results from a single cause: it’s most often a combination of mechanical and non-mechanical factors that lowers the spine’s tolerance at a given moment. A direct trauma (fall, impact), on the other hand, is a rarer cause in athletes than progressive overload.

Biomechanical and personal factors

• A deficit in deep core strength (transverse abdominis, multifidus)
• A lack of hip mobility, often compensated for by excess movement in the lower back
• Too rapid an increase in training volume or load
• Repeated asymmetric loading (unilateral sports)
• Age-related disc degeneration signs, present in many athletes with no associated pain: their presence on imaging doesn’t automatically mean they’re the cause of the pain

Non-mechanical factors, often underestimated

Insufficient sleep, stress and periods of general fatigue lower the back’s tolerance to load, independently of any specific movement. This is one of the particularities of low back pain: it’s rarely purely “mechanical”.

Which sports contribute to low back pain?

All sports that place heavy load or repeated rotation on the trunk carry a particular risk:

• Strength training and weightlifting (deadlift, squat)
• Golf and other trunk-rotation sports
• Rowing
• High-volume running
• Combat and contact sports
• CrossFit with heavy loads

Why does low back pain sometimes appear with no clear trigger?

This is the most common scenario: no sudden movement, and yet pain appears. It’s almost always the result of a build-up of small overloads (repeated movements, fatigue, stress) that gradually exceeds the back’s tolerance, without any single identifiable event.

Treating low back pain in rehab with a sports physio

The goal of treatment is to help you stay active despite the pain, by progressively strengthening the lower back and correcting overload factors, rather than waiting for the pain to disappear completely before moving.

1. 1Understanding your pain and reassurance
2. 2Staying appropriately active from the start
3. 3Mobility of the lumbar spine and pelvis
4. 4Deep core strengthening
5. 5Strengthening the spinal erectors
6. 6Overall posterior chain strengthening
7. 7Correcting the at-risk sporting movement
8. 8Strengthening under sport-specific load
9. 9Progressive return to your sport
10. 10Return to competition

“The back isn’t fragile: it’s built to move, bend and carry load, even when it hurts.”

Strengthening and movement, the cornerstones of treatment

Strengthening the deep core and spinal erectors, combined with staying regularly active rather than immobilisation, is currently the most scientifically documented treatment for common low back pain.[2] Staying active, even with moderate pain, speeds up recovery compared with strict rest.

In brief

• Staying appropriately active from the start
• Deep core strengthening
• Strengthening the spinal erectors
• Gradual return: mobility, then load, then sport

Should you rest or keep playing sport?

Strict rest is now discouraged in the vast majority of cases of common low back pain: it delays recovery and can reinforce fear of movement.[2] It’s better to temporarily adjust the intensity of your activities while staying active, and start progressive strengthening as soon as possible.

When should you see a specialist for low back pain?

A prompt medical consultation is recommended in the case of unusually intense night pain, loss of strength or numbness in a leg, loss of bladder or bowel control (a possible sign of spinal cord or nerve root compression), or accompanying fever. Outside of these rare signs, low back pain that persists beyond four to six weeks despite active care also warrants a further opinion.

Recovery time for low back pain

The vast majority of acute low back pain improves significantly within 2 to 6 weeks by staying active. The risk of it becoming chronic (beyond 12 weeks) is more closely linked to fear of movement and deconditioning than to the initial severity of the pain.[3]

Factors that speed up or slow down recovery

Preventing re-injury

Low back pain often recurs, but a back that’s regularly strengthened and kept moving is a better-protected back.

The 10% progression rule

Not increasing training volume or load by more than 10% per week limits the risk of a new lower-back overload.

Regular deep core maintenance

Regular deep core work (transverse abdominis, multifidus), combined with maintaining hip mobility, remains the best-documented measure for reducing the risk of recurrence. Gentle stretches for the back and lower limbs can complement this work for comfort, without being its cornerstone. This kind of maintenance work, even brief but regular, matters more than intense but occasional sessions.

The HOPP care programmes to treat your low back pain and get back to sport

Low back pain requires active support that combines progressive strengthening with staying in motion. HOPP offers you a precise exercise programme, allowing you to get back to your activities as quickly as possible.

The programme runs from 3 to 9 weeks depending on the injury and ends with a reconditioning phase allowing a return to competition in the best possible conditions. Each programme is designed by the HOPP team, made up of two sports physiotherapists who are experts in assessing and treating athletes. You’ll also find theoretical content throughout your progression, so you master every aspect of your recovery and can adjust your treatment independently. If needed, our team of physiotherapists is on hand to support you.

A programme that adapts to you every day

Every day, how you feel (RPE) is factored in to automatically adjust the rest of your programme: more load if all is well, a bit less if your back is complaining. This daily personalisation is what makes the difference compared to a fixed, paper-based programme.

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