Back Pain and Staying Active

Knowing when to seek help
Daniel Smit | Physiotherapist | Strides Health Group

Back pain can make work, sleep and everyday movement difficult. For many adults, the most useful starting point is an assessment when needed, clear advice and a gradual return to activities that matter. Prolonged bed rest is usually unhelpful.

This guide focuses on low back pain in adults. It explains practical steps, the role of physiotherapy and symptoms that need urgent care. Advice for a new episode can differ from support for pain that has persisted for months.

Understanding low back pain

Low back pain is felt in the lower part of the back and may occur with leg symptoms. Many episodes are described as non-specific: assessment does not identify a single disease or injury that explains the pain. This does not make the pain less real.

Pain intensity does not reliably measure the amount of tissue damage. Many new episodes improve over the following weeks, although recovery varies and recurrences are common. An assessment helps check for conditions that need a different approach. [1]

Keep moving with sensible adjustments

During a new episode, try to continue manageable everyday activities. You might shorten a walk, reduce a load or change how long you spend on a task. Brief rest can be useful, but spending extended periods in bed generally does not support recovery.

A 2025 Cochrane overview found that advice to stay active probably reduces short-term pain compared with advice to rest in bed for acute or subacute low back pain. This supports adapting activity rather than waiting for every symptom to disappear. [2]

For example, several short walks may feel more manageable than one long walk. Choose a starting point suited to your symptoms and health, then increase gradually. Seek advice if activity causes a substantial ongoing worsening or new leg symptoms.

Do you need a scan

An X-ray or MRI is not routinely needed for uncomplicated low back pain. Imaging is considered when the history or examination suggests serious disease, or when it is likely to change treatment decisions. Common age-related changes on scans may also be present in people without pain, so findings need to be interpreted alongside your symptoms. [1]

Exercise when pain persists

When pain lasts more than three months, a structured exercise programme can be part of care. Research supports exercise for persistent non-specific low back pain, but benefits vary and improvements are often modest. A programme should fit your abilities, preferences and goals. [2, 3]

Walking, strengthening, water-based activity or other exercise may be appropriate. The useful question is which activities you can practise consistently and progress, rather than searching for a single exercise that will fix every back problem.

A new painful episode does not automatically require a demanding strengthening programme. Start with an appropriate level of movement and review the plan as symptoms and function change.

Walking after recovery may reduce recurrence

The Australian WalkBack trial, published in The Lancet in 2024, studied adults who had recently recovered from non-specific low back pain. An individualised, progressive walking programme combined with education and physiotherapist support delayed the return of activity-limiting back pain compared with no intervention. [4]

The result supports building a sustainable activity routine after recovery. It does not show that walking alone has the same effect, or that everyone should immediately walk for a fixed duration during a painful flare-up. The programme was tailored, and some participants experienced lower-limb problems, reinforcing the value of gradual progression. [4]

What about hands on treatment

Hands-on treatment may help some people manage symptoms and feel more comfortable moving. For persistent primary low back pain, WHO recommends considering a personalised combination of education, exercise and selected other treatments, rather than relying on one intervention in isolation. [3]

Treatment should be reviewed against practical outcomes: walking further, sleeping more comfortably, returning to work or lifting with confidence. Discuss the likely benefits, costs and alternatives with your treating professional.

Consider the whole picture

Sleep, stress, mood, other health conditions and worries about movement can influence the experience of persistent pain. Addressing these factors alongside physical activity is part of care; it does not mean the pain is imagined. Some people benefit from coordinated input from a GP, physiotherapist or psychologist. [3]

If you are considering pain medicines, ask your GP or pharmacist about the potential benefits, risks and suitability for you. Medicines should support a broader management plan. [1]

 When to seek assessment

Arrange a review if pain is worsening, repeatedly returning, not improving or limiting work, sleep and daily activities. Leg pain, numbness or weakness also warrant assessment. You do not need to wait three months to seek help.

Seek emergency medical care for new symptoms with back pain such as:

• Difficulty passing urine or loss of bladder or bowel control.
• Numbness around the genitals, buttocks or inner thighs, sometimes called saddle numbness.
• Severe or rapidly worsening leg weakness.

Seek prompt medical review for back pain with fever or feeling significantly unwell, following a significant injury, or with unexplained weight loss or a history of cancer. Mention osteoporosis or prolonged steroid use, particularly if pain followed a fall or minor injury. These features do not establish a diagnosis, but need clinical assessment. [1]

How physiotherapy can help

At Strides Health Group, assessment considers your symptoms, health history, movement and the activities you want to return to. Where needed, this includes checking strength, sensation and other signs of nerve involvement, and arranging medical review.

Care may include education, exercise, hands-on treatment and a gradual plan for everyday activity. We review your response and adjust the plan with you, focusing on meaningful progress and confidence with movement.

If back pain is affecting your daily life, book an adult physiotherapy appointment at our Narre Warren clinic or contact us to discuss your needs.

This resource provides general information and does not replace individual assessment or medical advice. It is not a guide for managing fractures, infection, cancer or other specific spinal conditions.

Free Resource: Back Pain Practical Guide

A helpful guide with practical advice on managing back pain, staying active and understanding when to seek professional support.

Download the Back Pain Practical Guide (PDF)

References and further reading

Related resources and physiotherapy support

Explore Adult Physiotherapy in Narre Warren. Selected appointments are available in Nunawading. View appointment and booking information or ask us about your needs.

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