Low back pain, back pain, lumbar pain, spinal pain, all are names for the troublesome and very common problem which affects many of us at certain times in our lives. Physiotherapists assess and treat large number of back pain patients every day and have various treatment techniques to help this condition.

Many people self refer for their back pain and so the physio has a responsibility to ensure the patient has not got a serious underlying condition. The physiotherapist goes through the patient's presenting condition and asks specific questions to rule out medically serious matters. Typical questions include a history of cancer, control of bladder and bowel, arthritic disease, epilepsy, diabetes, appetite loss, weight loss, sleep problems and night pain.

The physio is looking for the patient to react as if they have mechanical spinal pain, a condition where normal physical stresses such as sitting or walking have a worsening or easing affect on the pain. The examination starts by observing the posture and movement of the patient during the questioning and the physio follows this by examining the spinal posture and ranges of movement. Abnormalities of posture are common and not always important, with leg length differences, a reduction or increase in the back curves and a scoliosis being common findings.

Spinal pain usually reduces the normal movements the patient is able to perform and this pattern of movement loss gives an indication of the kind of lumbar problem. The range of lumbar flexion is often reduced with the lumbar spine staying stiff and with pain during the movement or at the end of the available range. The other spinal movements are also tested, with the physio also checking the muscle reflexes, muscle strength, hip ranges of movement, sacro-iliac joints and the skin sensibility. The physiotherapist will palpate the spinal joints, gathering information about the stiffness or pain reactions of the lumbar segments.

Once the therapeutic diagnosis is made the physio will set the treatment goals and plan of treatment. If stiffness is a problem, mobilisation techniques can be used and the patient taught mobilising exercises as a home programme. If pain is the main issue then analgesia might be recommended with gentle mobilising and exercise techniques to ease the joints.

Core stability and Pilates techniques are widely covered in the media and used by most if not all trainers in gyms and athletic clubs. Scientific research has shown the importance of the stabilising muscle groups in the spine and pelvis to maintaining normal neutral spinal posture and preventing overstrains. Patients start with simple stabilising work on a plinth, progressing to maintaining stability against more resistance and finally in functional or sporting activities.

Spinal joints do not appreciate being at end of their range for too long such as remaining slumped in sitting for a long period. This stretches the ligaments and can cause and maintain a pain problem. Physios teach patients to understand the new strange posture they are being asked to perform is the norm and that they need to perform it regularly until they do it naturally.

McKenzie therapy is a popular technique, based on the idea that the disc nucleus exerts a force on the walls of the disc and can cause pain problems. Physiotherapists use this to test increases or decreases in the disc forces by seeing if repetitive movements in one direction improve or worsen the pain problem, the "directional preference". The classification is postural syndrome (often young people slumping about), dysfunction (segment stiffness which needs stretching out) or derangement (disc bulging which is affected by spinal movements). Repetitive movements are used as part of the therapy.

Once the symptoms are under control, the patient is taught to pace their activities appropriately so as not to overstress their spinal joints at any one time and to work on their overall fitness. It is embarrassing that there isn't good evidence for any particular therapy for low back pain. However there is good evidence that increasing our overall fitness, both aerobic and muscular, improves back pain symptoms and makes it less likely that we will have further episodes.