Low back pain is the leading cause of years lived with disability worldwide, and most people will experience it at some point. The great majority of episodes are non-specific — meaning no single structure can be identified as the culprit — and the great majority settle.
What determines the outcome is largely how it is managed. Prolonged rest, fear of movement and repeated passive treatment tend to prolong the problem; accurate assessment, reassurance, and graded return to loading tend to resolve it.
There is also a particular group whose back pain is not really a back problem at all — where the abdominal wall and pelvic floor are not contributing to trunk load transfer, and the back is compensating. That pattern is common after pregnancy and abdominal surgery, and it is routinely missed because nobody assesses the pelvic floor in someone presenting with back pain.
What we assess and treat
Acute low back pain
A recent episode, often severe and frightening but usually settling well. Early management focuses on staying active, managing pain, and avoiding the rest-and-fear cycle.
Persistent back pain
Pain lasting beyond three months. Needs a different approach — graded loading, pacing, and addressing the nervous system sensitivity that develops alongside.
Postnatal back pain
Extremely common and frequently linked to abdominal wall and pelvic floor function rather than the back itself. See postnatal physiotherapy.
Pregnancy-related back pain
Managed safely throughout pregnancy with positioning, manual therapy and targeted exercise. See pregnancy physiotherapy.
Sciatica and nerve pain
Leg pain, pins and needles or numbness from nerve irritation. See sciatica treatment.
Post-surgical back pain
After abdominal, gynaecological or spinal surgery, where guarding and altered load transfer are frequently involved.
Pelvic girdle pain
Pain at the sacroiliac joints or pubic symphysis, often mistaken for low back pain. See pelvic girdle pain.
Coccyx pain
Tailbone pain, worse on sitting, with a direct pelvic floor connection. See coccyx pain.
The pelvic floor connection
The abdominal wall, diaphragm, deep back muscles and pelvic floor together form a pressure system that stabilises the trunk during effort. When one component is not contributing, the others take on more load.
After pregnancy, caesarean or abdominal surgery, the abdominal wall and pelvic floor are frequently inhibited — painful, weakened, or simply not recruiting normally. The back compensates, and over months that compensation becomes symptomatic.
The practical implication is that treating such a back with back exercises alone tends to plateau. Restoring pressure management and pelvic floor function often resolves back pain that has resisted conventional treatment for a long time.
This is why assessment here includes the abdominal wall and pelvic floor for anyone whose back pain began after pregnancy or abdominal surgery, or who has bladder or bowel symptoms alongside it. That combination is a strong clue.
How treatment works
Assessment and screening
A full history and physical examination, including screening for the small proportion of back pain caused by something requiring medical referral. Where relevant, assessment of the abdominal wall and pelvic floor.
Explanation and reassurance
Not a token gesture. Understanding that most back pain is not caused by damage, that imaging findings such as disc bulges are common in people with no pain at all, and that movement is safe, measurably improves outcomes.
Manual therapy
Hands-on treatment to reduce pain and restore movement. Useful for making activity possible in the early phase — a means of enabling exercise rather than a treatment in itself.
Graded exercise
The intervention with the strongest evidence. Progressive loading rebuilds capacity and tolerance. The specific exercises matter far less than the fact of progressive, consistent loading.
Load and pressure management
How you lift, breathe and brace during real tasks — not just during exercises. This is where the pelvic floor and abdominal wall are integrated back into the system.
Activity and pacing
Staying active is protective. For persistent pain, structured pacing prevents the boom-and-bust cycle that keeps symptoms flaring.
Do you need a scan?
For most back pain, no — and imaging early can be counterproductive.
Disc bulges, degeneration and other findings are extremely common in people with no back pain whatsoever, and their prevalence rises steadily with age. Finding one on a scan therefore does not establish that it is causing your pain, and being told you have "degeneration" or a "bulging disc" frequently increases fear and reduces activity — both of which worsen outcomes.
Imaging is genuinely useful where there are features suggesting a specific cause, progressive neurological symptoms, or where surgery is being considered. Your physiotherapist screens for those and will refer you on if they are present.
Seek urgent medical care for: numbness around the saddle area, difficulty passing urine or loss of bladder or bowel control, progressive weakness in both legs, or back pain with fever, unexplained weight loss, or a history of cancer. These need immediate assessment.
Frequently Asked Questions
Should I rest with back pain?
Only briefly. Prolonged rest is associated with slower recovery and greater disability. Current guidance recommends staying as active as your pain allows, continuing normal activities where possible, and returning to full activity progressively. Short periods of relative rest during a severe acute flare are reasonable, but bed rest as a treatment is not.
Do I need an MRI scan for back pain?
Usually not. Findings such as disc bulges and degeneration are very common in people with no pain at all, so their presence does not establish the cause of your symptoms — and being told about them often increases fear and reduces activity, which worsens outcomes. Imaging is appropriate where there are features suggesting a specific cause, progressive neurological symptoms, or where surgery is being considered.
Why has my back pain started since having a baby?
Very commonly because the abdominal wall and pelvic floor are not contributing normally to trunk load transfer, so the back compensates. Add the relentless lifting, carrying and feeding postures of new parenthood, plus sleep deprivation, and the pattern becomes established. Treating such a back with back exercises alone tends to plateau — restoring abdominal and pelvic floor function is usually what resolves it.
Can pelvic floor problems cause back pain?
They can contribute. The pelvic floor forms part of the pressure system that stabilises the trunk, alongside the diaphragm, abdominal wall and deep back muscles. When it is weak, overactive or poorly coordinated, load transfer becomes inefficient and the back takes up the slack. If your back pain began after pregnancy or abdominal surgery, or you have bladder or bowel symptoms alongside it, that connection is worth assessing.
How long does back pain take to settle?
Most acute episodes improve substantially within six weeks, though recurrences are common. Persistent pain lasting beyond three months needs a different approach focused on graded loading, pacing and addressing nervous system sensitivity, and improvement there is measured over months rather than weeks. Staying active throughout is one of the strongest predictors of a good outcome.
Is my back pain caused by a slipped disc?
Probably not, and "slipped disc" is a misleading term — discs do not slip. The great majority of back pain is non-specific, meaning no single structure can be identified as responsible. Genuine disc-related nerve compression usually produces leg symptoms that dominate the back pain, along with specific neurological findings on examination.
Clinically reviewed by Jency Sudha, Consultant Pelvic Health Physiotherapist & Biofeedback Specialist — last updated 26 July 2026
The information on this page is for general guidance and does not replace individual clinical assessment. If your symptoms are new, worsening, or accompanied by bleeding, fever or severe pain, contact your GP or NHS 111.
Back Pain That Has Not Responded?
If your back pain began after pregnancy or abdominal surgery, the pelvic floor is worth assessing.
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