Muscular lower back pain is any pain in the lumbar spine caused by damage to the muscles in this area. Physiotherapy is a successful treatment for muscular lower back pain.

Each person’s case is unique and we want to address your specific needs. If you would like us to investigate or provide some insight, we invite you to contact us by clicking the link below.

How does muscular lower back pain happen?

Muscular lower back pain is commonly caused by poor sitting postures, repetitive bending and twisting movements or wear and tear of the joints in the lumbar spine. All of these place extra strain on the muscles supporting the lumbar spine which can then become damaged and weakened. Pregnancy, osteoporosis and being overweight also predispose the body to muscular lower back pain. Muscular lower back pain often builds up over time and you may not notice any symptoms until the condition becomes more severe. Therefore it is important to maintain a good posture and remain active to try and prevent symptoms of muscular lower back pain.

Symptoms of muscular lower back pain

Symptoms of muscular lower back pain include pain and aching of muscles around the lumbar spine. Muscle spasm and tenderness are also common symptoms which makes it more difficult and painful to move. In more severe cases, nearby nerves may be irritated or pinched causing various neurological symptoms including numbness, pins and needles and weakness.Other symptoms include:

  • gait problems
  • spasm
  • balance problems
  • reduced range of movement

What should I do

You should seek professional help as soon as you start to notice symptoms of lower back pain. Your GP may prescribe you with painkillers or anti-inflammatory drugs to help reduce your pain or any inflammation in the area. Muscle relaxants may also be prescribed to reduce muscle spasm. Physiotherapy should begin as soon as possible to optimise your recovery and prevent any long term complications.

What shouldn’t I do

Do not ignore symptoms of muscular lower back pain as this will make the condition worse and more difficult to manage in the future. You should avoid taking too many painkillers to completely mask the pain as this may allow you to carry out activities which put too much strain on the lower back without realising it. Bed rest is the worst treatment for muscular lower back pain as this will increase the stiffness and weaken the muscles around the lumbar spine.

Physiotherapy treatment for muscular lower back pain.

Your physiotherapy programme will include stretching and strengthening exercises of the affected muscles to try and keep the back strong and support the lumbar spine. Cardiovascular activities such as swimming, hydrotherapy and cycling are important to remain active and keep the lumbar spine mobile. Cold and hot therapy are useful to relieve pain and can be used before and after your exercise programme.

Further treatment includes:

  • Soft Tissue Treatment
  • Manipulation / Mobilisation
  • Taping
  • Ergonomic Assessment

Could there be any long-term effects from muscular lower back pain?

Muscular lower back pain is usually cleared up in 6-8 weeks with physiotherapy and prescribed medication. However, if there is nerve involvement recovery may be considerably longer. Physiotherapy is also an effective way of managing neurological symptoms.

This is the introduction to your article topic

  • Use your key phrase in the first paragraph
  • Bold your message take-away
  • Capture your audience attentionrtbgt5yhnb with a stats or interesting fact

The Anatomy of your

What is the structure

Relevant anatomy you’d like the person to understand, that you may refer to in your article.

What does it do?

This is function of the structure your article is about

  • How it normally should work if everything is ok.
  • Good place to underpin the relationship working in harmony with surrounding structures to produce, stabilize, absorb, generate force.

Stability, Protective, Move, Hold, Static Stability, Mobilizer

Isolated function

I have a … How did it happen?

What was the even, or buildup that lead to this __________ (condition) what were the mechanisms of injury?

  • The circumstances that lead up to the point of pathology
  • The condition of the tissue
  • Why the tissue damage takes place – Rotational force, Pressure force, sudden twisting, e.g. sideways pressure along the length of the bone is like stomping on a toothpick, the bone will break.
  • Pathophysiology
    EXPLAIN on a cellular level what goes wrong – Friction, Pressure, Bleeding, Forces, Tension
  • Explain defect & bring back to function
    • Backwards, regression of a chemical irritant, nociception leading into chaos, damage, destruction, loss of function, loss of _____

    This is not a bullet section, this is the explanation part – the “causes section is for list the bullet points”

Causes of

This is the causes that progress into this type of problem,

meaning the activities, movements, positions that directly flares-up, worsens and keeps on causing the problem

Symptoms of

Symptoms are the words your patient will use – in a subjective assessment.

Try to resonate the exact words used by your patients to describe it to you. Then Read your symptoms again and imagine a patient reading it to you… (Does it fit into the Title Diagnosis) can you describe it even better (signs they haven’t even noticed yet)

Tests that you can do to see if you have a …

Self- test your … at home with these modified tests and see if you might have a ….

Remember to use your key phrases abundantly here, if you need a few more.

Try to describe at least:

  • Weight bearing
  • Loaded
  • Unloaded
  • Stretch/ End of Range
  • Sit upright on a chair
  • Slowly lean forward as if to reach down to put on your shoes
  • Come back up into an upright seated position
  • Pain and tension in your lower back at any point during these movements may indicate that you have muscle pain and spasms in your lower back
  • Stand comfortably with your feet slightly apart and arms hanging next to your sides
  • Bend sideways to one side
  • Slowly bend as far as you can go and come back up
  • Repeat this movement to the other side
  • Pain or tension in your lower back at any point during this movement may indicate a muscle pain and spasms in your lower back
  • Stand comfortably with your feet slightly apart and your arms next to your sides
  • Turn your upper body to one side as far as you can go (almost like you want to reach the back of your leg with your hand)
  • Repeat this movement to the other side
  • Pain or tension in your lower back may indicate muscle pain and spasms in your lower back
  • Stand comfortably with your feet slightly apart
  • Try to tilt your pelvis back, flattening your lower back
  • Keep your lower back and the rest of your back as flat and straight as possible while slowly bending forward
  • Bend as far as you can and come back up, while keeping your back as flat and as straight as possible
  • If you feel pain or tension in your lower back or even an inability to control the movement, you could have muscle pain and spasms in your lower back

How severe is the muscle spasm in my lower back?

This is painting a picture of a person with that condition. Color in the story using some of these details (

  • Frequency – Intemittent/Constant
  • Intensity – bearable, pain doesn’t stop you
  • Duration – Days, Weeks, Sudden, Short burst, change position of your … eases the pain.
  • Size – Radiate – Shoulder, Upper back, Head…
  • Colour: Bruising
  • Loading: Contraction
  • ROM: Limitation?
  • Stifness
  • Swelling
  • Instensity: Discomfort – Painful – Sharp sting
  • Movement or static positions flare pain.

WHY is it a serious type of injury?

On a scale from 0-10 describe a picture of Regression.

  • Ligament tear Gr 1 – 3
  • Muscle strain, micro tear – complete separation split in fibers
  • Tendon phase of degeneration
  • Cartilage erosion, plugging, tears


Physiotherapy diagnosis

Describe a sentence to give the patient confidence that we’re the equipped/best at diagnosing this problem.
“We can handle it”

Our physiotherapists are

  • experts in anatomy
  • experience to know
  • We understand the
  • guidance and structure
  • Confidently identify the root cause

Why is it crucial to get/understand a diagnosis? Does it mean anything? Or is it a death sentence?

We will also test other structures like joints, discs and nerves in the area.
That’s why our physiotherapists are the best at diagnosing this type of problem.


Muscles cannot be seen on an x-ray, so it will not be effective to diagnose a muscle spasm. X-rays will however show the integrity and alignment of joints in your spine. This will enable us to see if something is wrong with the structure of the bones in your spine or if there is a loss of disc space.

Your physiotherapist can refer you to get x-rays taken if necessary.

Diagnostic ultrasound

Diagnostic ultrasound can be used to show the presence of a muscle tear (muscle strains), inflammation, swelling or simply increased contraction of a muscle (muscle spasms).

If you need an ultrasound, your physio will refer you.


An MRI scan can image all of the structures in your lower back, including soft tissue, discs, nerves and bones. However, for a muscle spasm an image like this is unnecessary and very expensive. If your physiotherapist suspects anything more than just a muscle spasm, you will be referred to the right specialist.

Why is the pain not going away?

Discuss why the pain does not improve

You become stuck in a cycle of pain, not knowing if it is safe to move or not.

  • Make sure you are getting the right treatment from the start
  • Without intervention, or treatment why is the tissue state not improving.
  • There is a risk of more critical and possibly irreversible damage if you don’t take the warning signs seriously.

Why will this condition NOT resolve or recover on it’s own

What NOT to do

  • Continuous use of anti-inflammatory medication, as they are thought to delay healing

  • Manage the pain by only taking pain medication or muscle relaxants. You are only masking the symptoms of something more serious

  • Stretch through the pain

  • Walk, run, jog through the pain

  • Do not ignore back pain that gets worse (it could be an sign of a deeper problem)

  • Leave it untreated, if you are uncertain of the diagnosis, rather call us and be safe

What you SHOULD do

  • Rest as needed
  • Avoid activities that is flaring up your pain, like sitting for long hours or bending

  • Make a list of movement or activities that brings on your pain and rank them

  • Make an appointment to confirm the diagnosis and determine how severe the tissue damage is.

  • Finish your treatment and rehabilitation programme for better long-term results

Making it worse

  • Specific movements, positions or even sports that we know will definitely make it worse. Just mention the top culprits.

  • Bending down to tie shoelaces

  • Picking up your child

  • Climbing stairs

  • Walking uphill

  • Running

  • Deadlifts

  • Jumping

  • Wearing high heels

  • Driving

  • Working at your computer

Problems we see when patients come to us with …

One concept per paragraph. Explain What resistance or problems can you encounter during the treatment process. Stay to the core message.

Speak to your patient as if each of these are happening to them.

Explain the WHY it’s a problem, not only state “it’s a problem”, but why…

  • Waiting too long – longer you wait, the bigger your chances of causing permanent damage
  • Not getting a proper diagnosis – Don’t get a proper diagnosis from the start, it wastes time.
  • Trying out, but not completing different forms of treatment
  • ‘stretching” because it feels stiff
  • Medication only mask the pain – not addressing the root of the problem
  • Wearing a brace to ‘support’ – Braces & guards.
  • Resting too much or too little – finding the balance between resting and doing safe movements is key
  • Braces & guards
  • Crutches
  • Too much rest will not solve the problem
  • Pain medication (how long is normal/ acceptable)
  • Misconceptions about treatment

Physiotherapy treatment

Please inspire confidence in your ability to test, identify, diagnose and treat/ deal with this.

Patient asks you:
“So why should I come see you for … ?”
Your answer is…

We can provide the best treatment for

  • provide guidance and answers.
  • Implement a very effective and structured plan of action like

Use the antonyms of the words the patient complains of.
Instibility – stability/stable
Fear – confidence
worried – calm/carefree
anxiety – serenity

And we will also look at

  1. muscle strength,
  2. joint range of motion
  3. flexibility
  4. ligament stability 
  5. nerve control.

Gradual strengthening, control and conditioning.

Phases of rehabilitation

As long as I can see progression & functional expectations changing , Example:

  1. crutches
  2. 20% Weight (limited ROM)
  3. 50% weight (FROM)
  4. 100% weight with concentric & eccentric contractions
  5. Speed & Power (Jump)

Please work the PEACE & LOVE protocol into the Plan of Action (Not all in the first phase)

  1. Balance on one leg
    Perform a lunge
    Squat to 90 degrees
    Balance reactions (stepping out sideways, forwards & backwards)
    Jump & Land from a step
    Do a Single leg jump
    Sit in a crouched position & get up
    Jump over a hurdle

1st Phase: What you want to achieve (Week 0 – 1)

Functional expectation, what we’ll do.

To progress to the next stage you should be able to …

2nd Phase: What you want to achieve in Week 1 – 2

What needs to happen in the tissue/ pathology to fix it

This is the thing you should be able to do by now

3rd Phase: What you want to achieve in Week 2 -3

Treatment elaborated

This is what you need to be able to do with ease so we can progress to the next phase of treatment.

4th Phase: What you want to achieve in Week 3 – 4

Re-inforce, strengthen, guide,

What you should be able to do by this stage is ….

5th Phase: Test return to normal life Week 4 – 6

To makes sure you’re safe to turn to

  • Driving you should be able to
  • Jogging you should be able to
  • Run you should be able to
  • Work

6th Phase: Final medical clearance tests (Week 

By now you should be able to jump, throw, but there’s some specific stress tests that you should be able to do

This allows us to make sure the structure of the tissue (muscle, ligament, tendon) is able to handle stretch stress, max load, compressive forces.

So we can sign off on your recovery, knowing you’re safe.

Healing time

Physio protocol time frame for healing (weeks / months)

  • You will need physiotherapy treatment twice a week for the first two weeks.
  • After this, your treatment sessions can be …
  • How fast you recover will greatly be up to you.
  • Remember: “Non-operative Treatment” or Non- Surgical Not conservative
  • A full recovery and return to sport will take longer and should not be confused with the healing period.

Other forms of treatment

  • Your doctor (GP) will probably
  • Pain meds, injections,
  • Getting your back or neck ‘aligned’ or ‘clicked’ in the hopes of improving the … will not improve the state of the muscle or change your pain. It could even worsen or trigger a muscle spasm. You need to look at the bigger picture.
  • A biokineticist will be able to help you in the final stages of your rehabilitation and get you back to training for your sport.
  • Wearing a back brace won’t be the solution to your problem.
  • Stretching or foam-rolling might ease your pain temporarily, but

Is surgery an option?

Surgery is necessary when …

  • These are the surgical checkboxes that must be ticked before surgery is even considered.
  • Surgery is only Halfway mark for a successful surgery, the rest is the reintegration, strengthening and adapting your body to the change.
  • Types of surgeries that can be done.
  • Why is rehab important after surgery?

What else could it be?

  • Only mention a few (up to 5) differential Diagnosis
    • Describe one symptom or difference between the two that sets them apart

Also known as

  • Synonyms
  • List key phrases (careful – start each bullet with different word)