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Lower back pain is common, but it can be frustrating when you are unsure whether to rest, stretch, strengthen, get a scan or keep moving.
In many cases, lower back pain improves with the right advice, movement, load management, hands-on treatment where appropriate, and a clear rehabilitation plan. At Acland Street Physiotherapy in St Kilda, we help people with lower back pain from sitting, lifting, running, gym training, tennis, parenting, work and everyday life. Our goal is simple: Help you understand what may be driving your back pain and give you a practical plan to move with confidence again. Why does lower back pain happen? Lower back pain can come from many factors. It is not always caused by one “tight muscle”, one “weak core” or one scan finding. Common contributors include:
The goal of physiotherapy is to work out what is relevant for you, not give everyone the same generic back pain exercises. Do I need an MRI or scan for lower back pain? Not always. Australian guidance states that diagnostic imaging is not indicated for the vast majority of people with acute low back pain and may cause more harm than benefit when used unnecessarily. Imaging is generally considered when there is strong clinical suspicion of a serious underlying cause, significant neurological symptoms, or severe symptoms that are not improving. This does not mean scans are never useful. It means they should be used at the right time, for the right reasons. A physiotherapist can help screen for concerning signs and advise whether further medical review may be needed. When should I see a physiotherapist for lower back pain? You may benefit from a physiotherapy assessment if you have:
The Australian Low Back Pain Clinical Care Standard focuses on early assessment, appropriate management, review and referral, while also reducing unnecessary investigations and treatments. What are red flags for lower back pain? Most lower back pain is not dangerous, but some symptoms need urgent medical review. Seek medical advice urgently if you have:
Red flags do not mean something serious is definitely present, but they do mean further medical assessment may be needed. Should I rest or keep moving? For most lower back pain, complete bed rest is usually not the answer. Many people benefit from staying active within tolerable limits, gradually returning to normal activity, and rebuilding confidence with movement. The Low Back Pain Clinical Care Standard aims to improve early management and reduce unnecessary or ineffective care. The key is choosing the right level of movement. For some people, that means walking and gentle mobility. For others, it means modified gym training, running changes, hands-on treatment, strength work or a staged return-to-sport plan. What is the best treatment for lower back pain? The best treatment depends on the person. Many people benefit from a combination of:
Treatment may also include:
The goal is not to rely only on passive treatment. Hands-on treatment can be useful to reduce pain, improve movement and help you get started, but long-term recovery usually also needs active rehabilitation, confidence building and a plan that fits your life. How can physiotherapy help lower back pain? At Acland Street Physiotherapy, your treatment may include:
Our goal is not just short-term pain relief. Our goal is to help you understand your back, move with confidence and get back to the things that matter. How are we different from other local physio clinics? At Acland Street Physiotherapy, we do not treat lower back pain as a one-size-fits-all problem. Many people with back pain have already tried rest, stretches, massage, generic exercises, YouTube routines, Google advice or AI-generated exercise lists. Some have been told to “just strengthen your core” without a clear explanation of what is actually going on. Our approach is different. We combine:
We are also comfortable working with patients who have already used ChatGPT, Google, YouTube or scan reports to understand their back pain. That information can be useful, but it needs to be interpreted in the context of your actual body, symptoms, goals and movement. Our focus is not just “fixing your back”. It is helping you feel clearer, safer and more confident about what to do next. You should leave your appointment understanding what is likely contributing to your back pain, what to avoid for now, what to keep doing, and what the plan is to get you moving again. Lower back pain from sitting, work or parenting Back pain often affects busy adults who sit for long periods, lift children, work at a desk, train inconsistently or juggle stress and poor sleep. You may not need a complicated plan. You may need a practical one. That might include simple changes to your workday, movement breaks, progressive strengthening, lifting advice, hands-on treatment and a plan to rebuild confidence with normal activity. Lower back pain from running, gym or sportActive people often do not want to be told to simply stop everything. If your back pain is related to running, gym, tennis, football, cycling or sport, we can help identify what you can keep doing, what should be modified, and how to rebuild safely. This may include reviewing:
The aim is to keep you moving where possible, while reducing the things that are aggravating your symptoms. Lower back pain physio in St Kilda If lower back pain is stopping you from working, training, sleeping, lifting, running or enjoying life, a physiotherapy assessment can help you get clarity. At Acland Street Physiotherapy in St Kilda, we help people from St Kilda, Elwood, Balaclava, Windsor, Albert Park, Port Melbourne and surrounding suburbs manage lower back pain and return to normal activity. Book a lower back pain physiotherapy assessment with Acland Street Physiotherapy in St Kilda. FAQs 1. What is the best treatment for lower back pain? The best treatment depends on the person. Many people benefit from a combination of education, movement, progressive exercise, load management and physiotherapy guidance. Treatment may also include hands-on techniques such as manual therapy, soft tissue treatment, dry needling, taping, joint mobilisation and, where appropriate, joint manipulation. The goal is not to rely only on passive treatment, but to reduce pain, improve movement and help you return to normal activity with a clear plan. 2. Do I need an MRI for lower back pain? Not usually. Most acute lower back pain does not need imaging unless there are red flags, significant neurological symptoms, or symptoms that are severe and not improving. 3. Should I stop exercising with lower back pain? Not always. Many people can continue modified activity. A physiotherapist can help you work out what to continue, what to reduce and how to rebuild safely. 4. Can sitting cause lower back pain? Sitting can contribute to lower back pain for some people, especially when combined with low movement variety, stress, poor sleep, low strength or sudden increases in activity. 5. Can physiotherapy help sciatica? Physiotherapy may help assess and manage symptoms that travel into the buttock or leg. If there is progressive weakness, numbness, bladder or bowel changes, or severe symptoms, medical review may be required. 7. Can dry needling help lower back pain? Dry needling may help some people with short-term pain relief or muscle sensitivity. It is usually most helpful when combined with movement advice, exercise rehabilitation and load management. 8. Can manual therapy help lower back pain? Manual therapy, soft tissue treatment, joint mobilisation and occasional joint manipulation may help reduce pain and improve movement for some people. These treatments are usually combined with education and exercise rather than used alone. 9. How long does lower back pain take to improve? Many episodes improve over days to weeks, but recurrent or persistent pain may need a more structured plan. Early assessment can help guide recovery and reduce uncertainty. Key message Lower back pain needs a plan, not panic.
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Why many people try physio but don’t fully recover
Most people who come to see us have already seen a physio. They’ve had massage, dry needling, and a sheet of exercises. They felt better for a few days. Then the pain returned. So they booked another appointment. And another. At some point, they start to wonder whether this is just how it is now. It usually isn’t. What’s missing is a diagnosis. Treatment without diagnosis is guesswork Massage, dry needling and shockwave therapy are tools. Used well, they are valuable. Used without a clear understanding of what is causing your pain, they are simply managing symptoms. The real work of physiotherapy is identifying the root cause of your injury, understanding why it has not improved, and mapping a clear path to recovery. Without that, you are not fixing the problem. You are temporarily suppressing it. A simple test is this: can your physio clearly explain what is wrong and why? If not, you do not have a treatment plan. You have a series of appointments. Equipment does not fix injuries. Clinical thinking does Many clinics promote shockwave therapy, laser treatment and advanced equipment. Some of these tools can help. None of them are the reason people get better. Two clinics can use the same technology and get completely different outcomes. The difference is always clinical. It comes down to reasoning, timing, progression and the ability to adapt when something is not working. Technology supports good physiotherapy. It cannot replace it. You need a plan, not just appointments Effective rehabilitation has a beginning, a middle and an end. You should know what is wrong, what you are doing about it, and roughly how long recovery will take. If you do not know these after your first appointment, ask. If you still do not get a clear answer, find someone who can give you one. Feeling better after a session is not the same as recovering. The most common reason pain keeps returning is that there is no structured progression. Hands-on treatment and exercise — both matter Manual therapy helps reduce pain and restore movement. Exercise rebuilds strength and reduces the likelihood of the problem returning. Neither works as well without the other. Clinics that rely only on passive treatment often create short-term relief but leave underlying issues unaddressed. Clinics that move too quickly to exercise without managing pain can struggle to get patients engaged early. The key is balance, and knowing when to shift from one to the other. The goal is to not need physio A good physio’s job is to make themselves redundant. You should leave with a clear understanding of your condition, the tools to manage it, and the confidence to move without fear. Not a standing appointment every two weeks with no clear endpoint. The goal is to return you to work, sport and daily life without ongoing treatment. Clarity speeds up recovery Pain is not purely physical. It is influenced by uncertainty, fear and lack of understanding. When you understand what is happening and what is safe, you move with more confidence. You follow your rehabilitation more effectively. Recovery improves. Clarity is not just reassuring. It is part of the treatment. Our approach at Acland Street Physiotherapy At Acland Street Physiotherapy, we focus on what actually drives outcomes. We start with an accurate diagnosis. From there, we build a structured, progressive plan. We combine hands-on treatment with exercise-based rehabilitation throughout recovery. We use technology when it adds value, not as a default. We treat back and neck pain, sports and running injuries, workplace and postural conditions, and chronic pain. We see many patients who have tried physiotherapy elsewhere without lasting results. Our role is to understand why, and to provide a clearer path forward. Book a physio in St Kilda If your pain keeps coming back despite treatment, there is usually a reason. Book an appointment at Acland Street Physiotherapy and start your recovery with a clear, structured plan. Low back pain is a common condition affecting millions globally, significantly impacting daily activities and quality of life. However, with the right strategies, it's possible to prevent or minimise its occurrence. Acland Street Physiotherapy is dedicated to providing you with evidence-based information to guide you in preventing low back pain effectively. Understanding Prevention Levels Prevention of low back pain can be categorised into three main types: primary, secondary, and tertiary. 1. Primary prevention aims at stopping the disease before it occurs, focusing on health promotion and environmental regulation. 2. Secondary prevention targets the prevention of recurrences or exacerbations of already diagnosed conditions. 3. Lastly, tertiary prevention focuses on minimising morbidity through supportive and rehabilitative services after a disease or injury has occurred. Key Strategies for Low Back Pain Prevention
1. Core Strengthening Exercises Strengthening your core is vital for supporting your spine. Try exercises like planks and the bird dog to build core strength and stability. 2. Flexibility and Stretching Incorporate the cat-cow stretch and hamstring stretches into your routine to improve flexibility and reduce tension in the lower back. 3. Aerobic Exercise Engage in walking, swimming, or cycling to improve cardiovascular health and support back health. ** Please see YouTube clips below this blog post for demonstrations of these exercises recommended above! What to Avoid Certain interventions like lumbar supports, back belts, and shoe insoles are not recommended for preventing low back pain due to their potential negative effects on back pain beliefs. Personalised Approach to Prevention A one-size-fits-all approach does not apply to preventing low back pain. Consulting with a physiotherapist at Acland Street Physiotherapy can help create a personalised prevention plan that suits your specific needs. Preventing low back pain requires a multifaceted approach, combining physical activity, manual therapy techniques, ergonomic adjustments, and educational programs. By adopting these strategies, individuals can significantly reduce their risk of experiencing low back pain and improve their overall health and well-being. Remember, an ounce of prevention is worth a pound of cure. Stay active, stay informed, and let's work together towards a pain-free back. Tendinopathy is a generic term used to describe injuries to the tendon associated with inflammation and degeneration. It can be either characterised as a painful or pathological condition associated with overuse. Usually pain is associated with increased loads and a recognition that there has been a relative increase in inactivity. Pain is often reported as sharp early on and then becomes a dull ache weeks later. Pain may be present at the beginning of the activity then disappear during it, then returns on subsequent attempts of the activity. Tendinopathies are common as they have a poor blood or nutrient supply compared to skeletal muscles. In fact, the oxygen consumption of tendons is about 7.5 times lower than skeletal muscles. A relatively low metabolic rate results in generally slow healing after injury. Common tendinopathies seen at Acland Street Physiotherapy include:
Tendinopathies generally respond well to physiotherapy treatment. This could include treatment techniques such as manual therapy, extracorporeal shockwave and eccentric strengthening exercises to improve the load capabilities of the tendon.  One of the most common lower back complaints at Acland Street Physiotherapy is symptoms of a pinched nerve. This is a condition where lower back pain occurs as a result of a nerve in the lower spine is being compressed by a nearby bone or soft tissue structure. The pressure from the pinch may causes pain, numbness, burning or tingling in the lower back, legs or feet. Some people may also call this condition "sciatica". The common causes of this condition are:
Often such conditions do not need further x-rays, CT scans or MRIs and respond extremely well to physiotherapy treatment, which may include manual therapy, heat therapy, dry needling, postural taping, pain and postural education and a specific exercise program. It is important to note that you should seek emergency medical attention or see your doctor if:
 Subacromial pain syndrome is a non-traumatic one sided condition of the shoulder. This common condition is two thirds of all shoulder complaints at Acland Street Physiotherapy. This condition is more prevalent as you age. It usually causes pain localised around the acromion (bony process of the shoulder) when lifting the arm. Usually one or structures are injured within the subacromial space. Common conditions that cause subacromial pain syndrome include:
The above conditions often respond very well to physiotherapy treatment which includes manual therapy, dry needling, extracorporeal shockwave therapy, exercise programs involving stretching, strengthening the rotator cuff and stabilising the scapula (shoulder blades).  Supraspinatus tendinopathy or supraspinatus "tendinitis" is a common source of reported shoulder pain in patients that perform repetitive overhead activities, overloading the tendon. Examples of this include painting, hairdressing or sports requiring overhead actions such as tennis and volleyball. This is commonly clinically diagnosed by experienced physiotherapists and formally confirmed on shoulder ultrasound scans. The supraspinatus tendon is part of the rotator cuff muscle group in the shoulder, involved in stabilising, "externally rotating" and "abducting" the shoulder (side raise). The tendon often experiences impingement as it passes in between the humeral head ("ball and socket" joint) and acromion (the bony process on the shoulder blade). Friction between the tendon and acromion is reduced by the subacromial bursa which can also get inflamed causing "subacromial bursitis". Supraspinatus tendinopathy can cause significant reduced shoulder function, pain, strength and range of motion, particularly with overhead activites. Physiotherapy treatment is often the first line of treatment before a cortisone injection is considered. Manual therapy, extracorporeal shockwave therapy, dry needling and a rotator cuff strengthening and shoulder stabilisation exercise program often can help resolve the problem quickly.   "Uneven shoulders" are often noticed when you look in the mirror as you get dressed after a shower. This can be a cause of various symptoms such as tension headaches, pain, tightness, pins and needles and a lack of general mobility in the neck and shoulders. Most of the time, it is not a major health concern. Common causes include:
If you are worried about having "uneven shoulders", please do not hesitate to get it professionally assessed by an appropriately trained physiotherapist or your GP.  Subacromial pain syndrome is usually non-traumatic, one sided shoulder problems which cause pain, localised around the acromion (bony process of the shoulder blade). This painful condition makes up over two thirds of the shoulder presentations at Acland Street Physiotherapy. Patients often report the pain to be worse with lifting of the arm. From an anatomical point of view, pain associated with this syndrome suggests that there is a lesion or injury associated with one or more structures within the subacromial space. Common conditions associated with subacromial structures include:
These clinical conditions often respond very well to physiotherapy treatment and modified rest. Physiotherapy treatment may involve manual therapy, extracorporeal shockwave therapy, dry needling and rotator cuff strengthening, shoulder stretching and stabilisation exercises.  Low back pain (LBP) and associated sciatica (leg symptoms originating from the lower back) is the leading reason why the local residents of St Kilda visit Acland Street Physiotherapy.
Low back pain affects 60-80% of the population (see reference) throughout their lifetime. According to multiple recent studies, about 10% of the population are physically disabled by low back pain. Low back pain is usually characterised into 3 types: 1. Acute - Symptoms experienced for less than 6 weeks. 2. Sub-acute - Symptoms experienced between 6-12 weeks. 3. Chronic - Symptoms experienced for greater than 6 weeks. At Acland Street Physiotherapy, we commonly see patients in all 3 categories with both the acute and chronic categories being the most functionally debilitating for our patients. Non-specific or mechanical lower back pain accounts for approximately 90% of the cases of low back pain presentations in primary care, that is seen by physiotherapists. 10% are generally more serious medical conditions that need urgent medical intervention. Very occasionally at Acland Street Physiotherapy are we presented with more serious medical conditions associated with low back pain symptoms. In such cases, we generally refer these patients directly for further diagnostic imaging or back to their primary GP for further investigations. Through taking the patients history and physical testing, physiotherapy assessments aim to rule out the unlikely chances of a more serious medical condition or emergency. In addition, it aims to identify the impairments and likely causes that may have contributed to the pain and the likelihood of the lower back condition becoming persistent. From our many years of experience, non specific low back pain is commonly caused by disorders of the neural or musculoskeletal structures of the lumbar spine, which often responds well to physiotherapy treatment and advice. Diagnostic imaging (ie. x-ray, CT scan or MRI of the lumbar spine) are generally not recommended in the first month of lower back pain and only when more serious medical conditions are suspected. Sciatic or leg pain originating from the lower back condition is a common presentation. Like low back pain, it is often due to disorders of neural or musculoskeletal structures of the lumbar spine assessed by a physiotherapist. In addition, low back pain is generally caused by the result of such structures. International clinical guidelines recommend non-pharmacological management of non-specific low back pain which is commonly physiotherapy treatment. Physiotherapy treatment often involves manual therapy to alleviate the symptoms and encourage movement, therapeutic exercises, personalised education and supportive taping. Prevention of lower back pain recurrence involves the physiotherapist to devising an individualised exercise program for you to target the specific issues assessed, as well as to improve general health and wellbeing. This could involve a home exercise program, supervised gym program, recommending pilates or yoga classes, or a gym and swimming program. Learn about some self help exercises for your low back here. |
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