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Low back pain! Is it a bulge, is it sciatica, am I out of alignment? It's likely a bit more complicated than that.

A bit about low back pain

Low back pain is the leading cause of disability worldwide. It is a symptom, not a disease. For nearly all people with low back pain, it is not possible to identify a specific structure as the cause of pain. It is a complex condition with multiple contributors to both the pain and associated disability. These can be biophysical, psychological and social factors.

Disc bulges and "sciatica"

Sciatica means different things to different people and is a term I use with hesitation. Leg pain that has a cause from the lumbar spine is more accurately termed radicular pain. Altered sensation in the lower body like numbness, and nerve related muscle weakness with or without leg pain is termed radiculopathy. These two conditions may have a different management course.

A disc bulge may be a cause of radicular pain OR radiculopathy by impacting on the sciatic nerve. A disc bulge can also cause low back pain. However, over the last few decades with improvements in imaging it's a diagnosis that has perhaps too often been attributed as a cause of an individuals pain when there may be a number of factors not addressed.

Getting a scan for low back pain

In a small number of cases, imaging for low back pain is warranted. However, for the most part there is no evidence that getting imaging will improve outcomes. This is likely due to the fact that abnormalities on a scan do not correlate well to the pain experienced given often there are a number of factors at play. Studies have also shown that spinal abnormalities can show on an MRI scan of non symptomatic individuals.

I think I have a "bad back"

I would say you have a back that happens to be sore at the moment. The lumbar spine is inherently very strong and capable of adaptation and change. If you have persistent pain then addressing the underlying cause is important. Attributing the pain you experience with the back being bad is only going to strengthen unhelpful thoughts and beliefs about your pain and will impede recovery. Likewise, if you have been told your back is vulnerable, weak, out of alignment or somehow structurally damaged, it may be challenging to overcoming the notion that you simply may have more than one factor causing your pain, and that it requires a multimodal approach to improve.

When a niggle isn't going away

Ignoring pain that does not subside on its own may lead to longer recovery times and make management even more challenging.

What to do when you have low back pain

Low back pain is a complex symptom that requires an individualised approach to achieve good outcomes. Living with low back pain can be detrimental to your wellbeing, and getting advice regarding appropriate strategies for managing your low back pain should be a priority.

A comprehensive management approach should aim to find the main contributing factors to your pain, regain confidence to move again, promote self management strategies, and improve mobility and strength if required through targeted exercise and other physiotherapy treatment.

We are here to help, so if you currently experience low back pain get in touch for a full physiotherapy assessment and treatment.


Hartvigsen J et al (2018), What is Low Back Pain and Why We Need to Pay Attention. The Lancet, vol 391, issue 10137


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