Lower Back Pain — A Complete Guide
Whether your pain came on suddenly or has been building for years, understanding what's happening is the first step to getting better.
Lower back pain is one of the most common reasons people visit an osteopath — and one of the most misunderstood. Whether it came on suddenly after lifting something awkward, or has been building gradually for months, the experience is the same: it affects everything. How you sleep, how you sit, how you move through your day. This guide is written to help you understand what's actually happening, what tends to make it better or worse, and how hands-on osteopathic treatment can help — whether you're in the middle of a flare-up or trying to prevent the next one.
Why I wrote this guide
I've had lower back pain since I was 12 or 13 years old.
As a kid I was relentlessly active — rugby in the morning, football in the afternoon. My back was a constant companion in the wrong way. I saw physios, chiropractors and osteopaths throughout my teens, found most benefit from osteopathy even if I now suspect my diagnosis wasn't quite right, and learned to manage around it rather than through it.
It's only through years of clinical training and obsessive personal research that I've come to understand what was probably happening all along — a disc injury that was never properly identified, influencing everything from how I moved to how much pain I was in on any given day.
I've had the bone-deep, gnawing pain of sciatica radiating down my leg. I've had facet joint episodes so acute I couldn't stand straight for two days. I know what it feels like when back pain stops you doing the things you love.
I'm not pain free now — but I'm winning. And everything in this guide is the result of years of clinical experience combined with the kind of motivated personal research you only do when you're desperate to fix yourself.
I wrote it because I wish someone had handed it to me at 14.
Understanding lower back pain
Lower back pain is rarely one thing. The lower back is a complex structure — vertebrae, discs, joints, muscles, ligaments and nerves all working together to keep you upright, mobile and absorbing load. When something goes wrong, it's often a combination of factors rather than a single dramatic cause.
Most lower back pain falls into two broad categories. Specific pain — where there's an identifiable structural cause such as a disc herniation, facet joint irritation or nerve compression. And non-specific pain — which accounts for the majority of cases, where no single structure is clearly to blame but the pain is very real regardless.
The good news is that most lower back pain, even when severe, responds well to hands-on treatment. Understanding what type of pain you have is the first step — and that's exactly what a thorough osteopathic assessment is designed to establish.
What's actually causing your lower back pain?
Most people arrive at this section with the same question — what's wrong with me? The honest answer is that without a proper assessment it's impossible to say. Lower back pain rarely announces itself with a clear label. You just know it hurts, and you want it to stop.
What I can tell you is that most lower back pain comes from a relatively small number of causes. Some of them I've experienced personally. All of them respond well to the right treatment approach. Here's what's most likely going on
Disc injuries — herniation, prolapse or bulge
The disc sits between each vertebra acting as a shock absorber. When the outer casing is compromised, the inner material can bulge or push outward, irritating surrounding structures and sometimes compressing nearby nerves. This is what I now believe has been at the root of my own back pain since my early teens — and it's far more common than most people realise. A disc injury doesn't always mean surgery or a lifetime of pain. Most respond well to hands-on treatment, movement and load management. [Read more about disc injuries here.]
Facet joint irritation
The facet joints run down either side of the spine and guide how your vertebrae move relative to each other. When they become irritated or inflamed — through sudden movement, sustained posture or gradual wear — the pain can be sharp, localised and severe. I've had episodes where I couldn't stand straight for two days. It feels alarming but it typically settles well with the right treatment. [Read more about facet joint pain here.]
Sciatica and nerve pain
When a disc bulge or joint inflammation irritates the sciatic nerve, pain can travel from the lower back down through the buttock and into the leg — sometimes as far as the foot. The quality of the pain is distinctive — gnawing, burning, sometimes electric. I've been there. It's one of the most distressing presentations I treat, and one of the most satisfying to resolve. [Read more about sciatica here.]
Muscle and ligament strain
Often dismissed as "just a muscle strain" — but anyone who's had one knows it's anything but just. Acute muscle and ligament injuries can be severely painful and debilitating. They're usually the result of a sudden overload — an awkward lift, a twist, a fall — and while they tend to resolve relatively quickly with the right approach, they can linger if not managed properly.
Degenerative disc disease
Despite the name, degenerative disc disease isn't a disease and it isn't necessarily a life sentence. It describes the natural ageing process of the discs — they lose some hydration and height over time, which can cause pain and stiffness. Most people over 40 have some degree of disc degeneration on imaging. What matters is how it's managed, not how it looks on a scan. [Read more about degenerative disc disease here.]
Spondylosis
Spondylosis is arthritis of the spine — age related changes to the vertebrae and joints that can cause stiffness, aching and sometimes nerve irritation. Like degenerative disc disease, the presence of spondylosis on a scan doesn't automatically mean you'll be in pain. Many people have significant changes on imaging and minimal symptoms. Treatment focuses on keeping you moving well and managing flare-ups. [Read more about spondylosis here.]
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