Lower back pain that won't go away: what actually helps.

Back pain is one of the most common reasons people visit a GP, a physio or a myotherapist. For most people, a sore back after lifting, gardening or a long drive improves within a few weeks. For some, it hangs around for months, or settles and then keeps coming back.

If that's where you are, this guide explains what's likely going on and what tends to help. The short version: there is usually a lot you can do, and most of it doesn't involve resting.

Why some back pain lingers

It's natural to assume that pain which lasts must mean ongoing damage. For most persistent back pain, that isn't the case. Pain is the body's protective system at work, and over time that system can become more sensitive, so ordinary movements trigger pain even when the tissues have largely healed.

Several things can feed into that sensitivity:

• Moving less because of fear of making it worse, which leads to stiffness and lower fitness

• Poor sleep, which lowers your tolerance to pain

• Stress, worry and low mood, which are common when pain drags on

• Physical load at work or home that's more than your back is currently ready for

• General health, such as fitness, weight and smoking

None of this means the pain is "in your head". It's real pain, and these factors are also things you can work on, which is good news.

Do you need a scan?

Many people expect an X-ray or MRI to find the cause. For most lower back pain, scans don't change the treatment, and Australian guidance advises against routine imaging unless there are warning signs or specific reasons to suspect a serious problem.

Scans also commonly show things like disc bulges and wear-and-tear changes in people who have no back pain at all. Seeing those words on a report can make people more worried and less active, which doesn't help. If your GP thinks a scan is needed, they'll organise one.

What tends to help

Clinical guidelines for persistent lower back pain consistently point to the same core approaches:

Walking, strength training, Pilates-style exercise, swimming and yoga have all been studied, and no single type is clearly best. The right exercise is the one you enjoy enough to keep doing.

For back pain that lingers, movement is usually the medicine, and rest is usually the thing that keeps it going.

Where manual therapy fits

Hands-on treatment such as soft tissue work, joint mobilisation and dry needling can ease pain and stiffness in the short term for some people. Research suggests the benefits are modest, and they last longer when treatment is combined with exercise and staying active.

A good way to think of it: hands-on treatment can make it easier to move, and moving is what builds lasting improvement. A myotherapist or remedial massage therapist who sees it that way will give you treatment and a plan, and will aim to reduce how often you need to see them over time.

Choosing a therapist

For back pain that has lasted months, look for a therapist who:

On the directory, filter by Low back pain or Persistent pain & fibromyalgia, and read the "How they work" section on each profile.

Day-to-day habits

• Break up long periods of sitting with a short walk or a change of position.

• Pace activity instead of pushing through on good days and paying for it on bad ones. Steady and gradual works best.

• Look after sleep. A regular routine helps, and so does a position that's comfortable for you; there's no single "right" one.

• Use heat if it helps. A heat pack can ease pain enough to get moving.

• Expect flare-ups. They're common and usually settle. Have a plan for them, such as easing back on activity for a few days without stopping completely.

When to see a doctor

Go to an emergency department or call 000 if you have back pain with:

See your GP soon if your back pain comes with:

These are uncommon, but a myotherapist or massage therapist should ask about them at your first appointment and refer you if needed.

This guide is general information, not medical advice. If your back pain is severe, getting worse or comes with any of the warning signs above, see your GP before starting treatment.