Back Pain

What Causes Back Pain?

Back pain is the most common musculoskeletal complaint I see. Everyone gets it at some point — desk workers across Chester and Cheshire, gym-goers pushing heavy deadlifts, runners training across Cheshire.

Here’s the thing: back pain rarely means your back is “damaged” or “broken.” There’s no disc hanging out, no vertebrae crumbling, no structural catastrophe. Most back pain is about load exceeding your back’s current capacity — whether that’s from sitting hunched over a keyboard for years, ramping up lifting volume too quickly, or just the cumulative effect of deconditioning and sedentary living.

The classic scenario: you bend down to pick something up, feel a twinge, and suddenly you can barely move. “My back went.” It didn’t go anywhere. What happened is your muscles went into protective spasm because they weren’t prepared for that load at that angle. Annoying, painful, but fixable.

Common Back Problems I Treat

Here’s what typically brings people through the door across Chester and the wider Cheshire area.

Non-Specific Lower Back Pain

The big one. No specific structural cause found on scans, but very real, very limiting pain. Common among desk workers who’ve spent years in poor positions and gym-goers who’ve ramped up squatting or deadlifting volume without the strength foundation to support it.

Symptoms: Pain across the lower back, worse with prolonged sitting or standing, stiffness in the morning, difficulty bending forward or backwards.

This responds brilliantly to movement-based rehab, progressive strength training, and pain education. The problem isn’t that your back is fragile — it’s that it’s been deconditioned and sensitised. We build capacity and confidence.

Timeline: Most people see significant improvement within 6-8 weeks with proper rehab. Some acute episodes settle faster; chronic cases that have been rumbling for months or years take longer but still improve.

Disc-Related Pain

Disc bulges, herniations, nerve root compression. Often seen in deadlifters, manual workers, or people who’ve had a significant bending or twisting injury.

Symptoms: Pain in the lower back, often radiating down one leg (sciatica), numbness or tingling, worse with forward bending, coughing, or sneezing.

Here’s what most people don’t know: disc bulges are incredibly common in people with zero pain. An MRI will show “degenerative changes” or “bulging discs” in a huge percentage of the population who feel completely fine. So having a bulge doesn’t mean you’re doomed.

Most disc-related pain settles with conservative management — modified activity, strength work, nerve mobility exercises. Only a small minority need surgery, and even then it’s usually when there’s severe nerve compression causing progressive weakness or loss of bowel/bladder control.

Timeline: 6-12 weeks for most disc-related pain to settle. The disc itself might not “heal” but symptoms resolve as sensitivity decreases and strength improves.

Facet Joint Pain

Pain from the small joints in your spine. Common in sports or activities involving repeated extension — gymnasts, swimmers doing butterfly, people who hyperextend their backs lifting.

Symptoms: Pain on one side of the lower back, worse with arching backwards or twisting, sometimes a catching sensation.

Responds well to movement modification, core strengthening, and learning to control your spine position under load rather than just extending through the facets every time you lift or move.

Timeline: 4-8 weeks typically, depending on how much modification is needed to your training or daily activities.

Muscular Back Pain

Acute muscle strains from lifting, sudden movements, or just overdoing it in the gym. The “I tweaked my back deadlifting” scenario.

Symptoms: Sharp pain, muscle spasm, difficulty moving initially, localised tenderness.

This usually settles quickest of all back problems if you manage it sensibly. Early gentle movement is better than bed rest. Gradually build back up to normal activity without panicking.

Timeline: 2-4 weeks for most muscular strains. Grade 1 strains might settle in a week or two. More severe strains need a month of progressive loading.

Upper Back and Thoracic Pain

Pain between the shoulder blades, often related to sustained desk postures or overhead activities. Common in office workers across Chester and Cheshire, swimmers, and anyone who spends hours hunched over a laptop.

Symptoms: Aching between the shoulder blades, stiffness, sometimes referred pain into the neck or shoulders.

Often comes with tight chest muscles and weak upper back muscles from years of sitting. Responds well to mobility work, strengthening the upper back, and sorting out your desk setup.

Timeline: 4-8 weeks with consistent rehab. Postural habits take time to change but symptoms improve faster than you’d think once you start moving properly.

What You Can Expect in Your Assessment

I’ll take a detailed history — when it started, what makes it worse, what you’ve tried, whether there’s any leg pain or neurological symptoms.

Then I’ll assess your back — range of movement in different directions, strength testing, neurological examination if there’s leg pain, and specific tests to identify whether it’s disc-related, facet joint, muscular, or non-specific.

Often I’ll watch you bend, squat, or lift to see how you move and where the problem might be coming from.

By the end of the session, you’ll have:

Should I Get a Scan?

Usually not straight away. Clinical assessment tells me more than most scans when it comes to back pain.

MRI findings often don’t correlate with symptoms. Plenty of people with “awful-looking” scans — multiple disc bulges, degenerative changes, facet arthritis — have zero pain. And people in agony can have completely clean scans.

Imaging creates anxiety. You get told you’ve got “degeneration” or “wear and tear” and suddenly your back feels more fragile than it actually is. That fear-avoidance behaviour makes recovery harder.

You might need imaging if:

• There are red flags like unexplained weight loss, night pain, bowel/bladder changes, progressive neurological weakness
• Symptoms aren’t responding to rehab as expected after 8-12 weeks
• You’re being considered for injections or surgery and imaging is needed to guide treatment

If imaging is needed, I’ll guide you on the best route — NHS referral via your GP (free but slower), or private MRI if you want results quickly.

Why Rest Alone Doesn’t Work

People rest their back, pain settles a bit, they go back to the gym or bend down to pick something up, and it flares up again. Sound familiar?

Here’s why that happens: rest reduces pain by removing the aggravating load, but it doesn’t fix the underlying problem — usually weakness, poor load tolerance, or fear of movement.

When you return to activity at the same level you were at before resting, you’re asking a deconditioned back to handle loads it couldn’t manage when it was stronger. No surprise it breaks down again.

What Does Back Pain Rehab Actually Involve?

Depends on the specific diagnosis, but here’s what most back rehab programmes include:

Strength training: Building capacity in your core, glutes, hamstrings, and back muscles. This is non-negotiable. If you’re not getting stronger, you’re not fixing the problem. Deadlifts, squats, loaded carries — the exact movements people are often scared of are usually the ones that build the most resilience.

Load management: Modifying training volume, intensity, or exercise selection to keep symptoms manageable while you build capacity. That might mean reducing deadlift weight temporarily, swapping barbell squats for goblet squats, or avoiding repeated forward bending for a period.

Movement quality: Sometimes there are movement patterns contributing to the problem — hyperextending through your lower back when you squat, rounding excessively when you deadlift, bracing poorly under load. We address these where relevant, but we don’t obsess over “perfect posture.”

Progressive return to activity: Once you’ve built strength and symptoms are settling, we gradually reintroduce the activities you want to get back to. This is structured, not guesswork — specific benchmarks and criteria to progress through.

Pain education: Understanding that some discomfort during rehab is normal and not harmful. Learning the difference between pain that’s a warning sign and pain that’s just your back adapting to increased load. Your back isn’t fragile. Tissue damage and pain aren’t the same thing.

How Long Does Recovery Take?

Realistic timescales for common back problems:

Acute muscular strain: 2-4 weeks. The sharp initial pain settles within days if you keep gently moving. Full return to heavy lifting takes a bit longer.

Non-specific lower back pain (acute episode): 4-6 weeks to settle significantly. Complete resolution might take 8-12 weeks with proper rehab.

Chronic non-specific back pain: Ongoing management. You’re not fixing this in six weeks if you’ve had it for years. But significant improvement — less pain, better function, confidence in movement — usually comes within 8-12 weeks of starting proper rehab.

Disc-related pain with leg symptoms: 6-12 weeks for most cases. Severe nerve compression with progressive weakness might need specialist input, but the majority settle with conservative management.

Facet joint pain: 4-8 weeks depending on how much you need to modify aggravating activities while building strength.

Upper back/thoracic pain: 4-8 weeks with consistent mobility and strengthening work.

These are broad ranges. Your specific timeline depends on how long you’ve had the problem, injury severity, and how well you stick to the rehab programme.

When to Book an Assessment

Location and Booking

I run a clinic in Chester at 59 Silver Road, with appointments available Monday, Wednesday, Thursday, and Friday.

Whether you’re a desk worker from Chester with chronic lower back pain, a gym-goer who’s tweaked their back deadlifting, or a runner dealing with stiffness that won’t shift, I can help.

Book online to see available slots, or get in touch if you’ve got questions before booking.

No hard sell. No obligation. Just honest physio focused on getting you back to doing what you want to do, pain-free.