Lower back pain is one of the most common reasons people see a health professional, and one of the most common reasons people book a massage. It can be painful and worrying, but for most people it is not caused by serious damage, and it tends to improve. Knowing what the evidence supports can help you spend your time and money on what is most likely to help.

This article is general information, not a diagnosis. If your pain is severe, keeps coming back, or you are unsure what is causing it, see your GP.

Understanding Lower Back Pain

For most people with lower back pain, no single structure can be pinpointed as the cause. Doctors call this "non-specific" lower back pain, and it is the most common type [1]. It is still real pain; it simply means there is no sign of a serious underlying problem such as a fracture, infection or disease.

Pain that has started recently is often called acute, and pain that lasts for months is called chronic or persistent. Many people have episodes that settle and then return from time to time [1].

Common situations in which people notice their back include:

  • Lifting, bending or twisting, especially with something heavy or awkward, or when you are tired.
  • Long periods in one position, such as a day at a desk, a long drive or a long flight.
  • A sudden change in activity, such as a weekend of gardening, moving house or returning to sport.
  • Stress, poor sleep and low mood, which can make pain feel worse and last longer [1].

Muscle tension and tender spots in the lower back and buttock muscles often come with lower back pain, and many people describe them as the part that hurts most. Whether they are a cause or a response to pain is not clear, so they are one piece of the picture rather than the whole story.

Why Staying Active Matters

Rest feels like the sensible thing to do when your back hurts, but the evidence points the other way. International guidelines consistently recommend reassurance, advice to stay active and continuing usual activities as much as you can, including work, rather than bed rest [2][3].

That does not mean pushing through severe pain. It means keeping moving within what you can manage, and building up gradually. Short walks, changing position often and gentle movement are usually better for your back than lying still.

What the Research Supports

Time and reassurance. Research following people with a new episode of lower back pain found that pain and disability improve markedly in the first six weeks. Some people still have low levels of pain a year later, so ongoing care can matter [4].

Exercise. For back pain that lasts or keeps coming back, exercise has the best support. A 2021 Cochrane review found moderate-certainty evidence that exercise probably reduces pain compared with no treatment or usual care, although the size of the benefit varies from person to person [5]. A practical starting point is a type of exercise you enjoy and will keep doing.

Massage and hands-on treatment. We want to be honest about this. A Cochrane review of massage for lower back pain found improvements in pain only in the short term, and the authors had very little confidence in the evidence because most studies were small or of low quality [6]. A clinical practice guideline lists massage, along with heat, among options for recent-onset back pain, based on low-quality evidence for massage [7].

That is why treatment here combines hands-on work with movement. Many people find hands-on treatment eases tension and discomfort in the short term, which can make it easier to stay active and keep up the exercises that help over time.

  • Remedial massage starts with an assessment of how you move, then uses targeted soft tissue techniques on the areas contributing to your symptoms.
  • Deep tissue massage uses firmer pressure for tension that has built up over a long time.
  • Trigger point therapy applies focused pressure to tender knots in the back and buttock muscles that may be referring discomfort elsewhere.
  • Exercise and movement advice. Our therapist's background in exercise science means you leave with simple, practical exercises and a plan to build your activity back up. You can read more about her qualifications.

Simple Things That Often Help Day to Day

  • Keep moving. Walking and gentle movement within a comfortable range usually help more than resting in bed [2].
  • Break up long sitting. Stand up, walk and change position regularly when working at a desk or driving.
  • Build up gradually. Return to lifting, sport and heavier tasks step by step rather than all at once.
  • Try warmth if it helps you. Heat is low risk and is listed as an option for recent back pain [7]. Stop if it makes symptoms worse.
  • Look after sleep and stress. Both can affect how much pain you feel and how quickly it settles [1].

How Long Does It Take to Feel Better?

Many people notice a clear improvement within the first few weeks, but recovery is not always a straight line and flare-ups are common [4]. Pain that has built up over months usually takes longer to settle than a recent strain. Your therapist can give you an honest idea of what to expect after your first assessment.

When to See a Doctor First

Serious causes of back pain are uncommon, but some symptoms need medical assessment before massage [8]. See your GP promptly, or call 000 in an emergency, if your back pain comes with:

  • numbness or altered feeling around your genitals, buttocks or inner thighs (the "saddle" area);
  • new difficulty passing urine, loss of bladder or bowel control, or other new changes in bladder or bowel function;
  • weakness or numbness in one or both legs that is getting worse;
  • a significant fall, accident or other injury;
  • fever or feeling generally unwell;
  • unexplained weight loss, or a past history of cancer;
  • severe pain at night or pain that does not ease with rest or a change of position.

If you have seen a doctor and been cleared for hands-on treatment, let us know at your appointment so we can work with any advice you have been given.

What to Expect at Your First Appointment

Your first session starts with a conversation about your symptoms, health history and daily routine, followed by a check of how your back and hips move. Treatment is tailored to what we find, and you will leave knowing what may help between sessions and whether follow-up visits are worthwhile.

Remedial massage may be claimable through your private health fund extras cover, and we offer on-the-spot claiming with HICAPS. When you are ready, you can book online.

References

  1. Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. The Lancet. 2018;391(10137):2356–2367. doi:10.1016/S0140-6736(18)30480-X
  2. Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet. 2018;391(10137):2368–2383. doi:10.1016/S0140-6736(18)30489-6
  3. Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. European Spine Journal. 2018;27(11):2791–2803. doi:10.1007/s00586-018-5673-2
  4. Menezes Costa LC, Maher CG, Hancock MJ, et al. The prognosis of acute and persistent low-back pain: a meta-analysis. Canadian Medical Association Journal. 2012;184(11):E613–E624. doi:10.1503/cmaj.111271
  5. Hayden JA, Ellis J, Ogilvie R, et al. Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews. 2021; CD009790. doi:10.1002/14651858.CD009790.pub2
  6. Furlan AD, Giraldo M, Baskwill A, et al. Massage for low-back pain. Cochrane Database of Systematic Reviews. 2015; CD001929. doi:10.1002/14651858.CD001929.pub3
  7. Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2017;166(7):514–530. doi:10.7326/M16-2367
  8. Finucane LM, Downie A, Mercer C, et al. International framework for red flags for potential serious spinal pathologies. Journal of Orthopaedic & Sports Physical Therapy. 2020;50(7):350–372. doi:10.2519/jospt.2020.9971