Chronic low back pain: what the latest evidence says and how physiotherapy can help

Chronic low back pain affects millions of people and is one of the leading causes of disability worldwide. If you’ve been told your back is “worn out” or that your MRI explains all your pain, current research suggests the story is often much more complex. In this article, we explain the modern evidence on chronic low back pain and how physiotherapy can help you regain confidence and function.

Quick answer

Chronic low back pain is influenced by biological, psychological and social factors. The best evidence supports education, staying active, individualised exercise, self-management and addressing lifestyle factors, with manual therapy used as an adjunct rather than a standalone treatment.

What is chronic low back pain?

Chronic low back pain is pain lasting longer than three months. In most people it cannot be explained by a single structure seen on a scan. Instead, pain reflects an interaction between tissue health, the nervous system, movement, sleep, stress, beliefs and daily life.

Causes of chronic low back pain

• Reduced physical conditioning
• Nervous system sensitisation
• Poor sleep
• Fear of movement
• Stress, anxiety or low mood
• Occupational and lifestyle factors

Symptoms to watch for

• Persistent back pain
• Stiffness
• Reduced confidence with bending or lifting
• Avoidance of activity
• Reduced function at work, sport or home

How to manage chronic low back pain

At home

• Stay active
• Gradually increase activity
• Prioritise sleep and healthy habits
• Continue an exercise program

With physiotherapy

• Education about pain
• Individualised exercise and strength training
• Graded exposure to feared movements
• Manual therapy when appropriate
• Self-management strategies

Exercises that help

1. A walking program
2. Sit-to-stand
3. Hip hinge, progressing to deadlift or functional lifting under guidance

When should you see a physiotherapist?

If pain persists beyond a few weeks, you are avoiding activities, your function is declining, or you are unsure how to exercise safely.

If you’re dealing with chronic low back pain in Wollongong, our physiotherapy team can help you build confidence, improve strength and return to the activities that matter most. Book an appointment.

Frequently asked questions

Should I get an MRI?

Usually not, unless there are red flags or neurological concerns.

Is my spine damaged?

Not necessarily. Imaging changes are common even in people without pain.

What’s the best exercise?

The one you enjoy, can perform safely and will continue long term.

About the author

Blake Lindsay, Doctor of Physiotherapy. Blake is a sporty, energetic and passionate physio with an extensive background in sport, including experience at the Wests Tigers and Canberra Raiders. He plays rugby league and enjoys an afternoon surf. A strong advocate for his patients, he is committed to ongoing learning so he can provide up-to-date, evidence-based treatment. He holds dry needling qualifications and has covered rugby, hockey and the National Swimming Championships, and he loves a laugh while getting the best out of his patients.

If chronic low back pain is stopping you from living the life you want, book an appointment with our physiotherapy team. We’ll help you understand your pain, build strength and confidence, and develop a personalised recovery plan.