Last month, Senior Physiotherapist Hardik Nimla and Senior Sports Therapist Ari Marsden led a workshop focussed on one of the most common – and often misunderstood – conditions we see in clinic: lower back pain and sciatica.
Back pain affects people of all ages and backgrounds, yet many still feel confused, worried, or fearful when symptoms persist. During the session, we shared a real client case study that showed how effective physiotherapy can be, even when surgery feels like the only remaining option.
The workshop went beyond a single story. Its aim was to help people understand why back pain happens, why it doesn’t always settle quickly, and – most importantly – what practical steps can support recovery. This blog brings together the key messages from the workshop for anyone living with lower back pain or sciatica.
Understanding lower back pain and sciatica
Lower back pain is rarely caused by a single structure or event. In most cases, it develops due to a combination of physical, lifestyle, and psychological factors, including:
- Reduced spinal or hip mobility
- Weakness or poor coordination of the core and gluteal muscles
- Prolonged sitting, repetitive movements, or poor posture
- Previous injuries, surgery, or long periods of inactivity
- Fear of movement following painful episodes
Sciatica is slightly different. It refers to symptoms caused by irritation or increased sensitivity of the sciatic nerve, which runs from the lower back down the back of the leg. Symptoms may include:
- Sharp or burning pain travelling down the leg
- Tingling or “pins and needles”
- Numbness or altered sensation
- Leg weakness in more severe cases
Importantly, not all leg pain is sciatica, and not all disc bulges cause pain. Many people have disc changes on scans without any symptoms at all.
One of the strongest messages from the workshop was this:
Scans do not predict pain or recovery. How you move, think, and respond to pain matters far more than what an MRI shows.
Why pain can persist (even when tissues heal)
A common belief is that pain should disappear once tissues have healed. Pain is far more complex.
During the workshop, we explained that persistent pain can be influenced by factors such as:
- Muscles remaining tense and protective for too long
- Reduced confidence in bending, lifting, or walking
- Avoidance of normal activities due to fear of causing damage
- Increased sensitivity of the nervous system
When movement is avoided for weeks or months, the body becomes less tolerant to load and activity. Muscles weaken, joints stiffen, and everyday movements can begin to feel threatening – even when tissues are safe.
This is why prolonged rest alone is rarely helpful for lower back pain or sciatica.
The role of physiotherapy in recovery
Physiotherapy is not just about exercise. It’s about understanding your pain, rebuilding confidence, and progressively returning to normal movement.
At the workshop, we discussed how a structured physiotherapy programme typically includes:
- Education to explain pain in a clear, reassuring way
- Strategies to manage flare-ups and day-to-day symptoms
- Gentle spinal and hip mobility exercises
- Strengthening of the core and lower limbs
- Posture and movement retraining for daily tasks
- Gradual exposure to movements that feel difficult or feared
For people with sciatica, physiotherapy focuses on calming nerve sensitivity, improving movement tolerance, and restoring normal function – not forcing painful movements or “pushing through” symptoms.
The fear of movement: the often-missing piece
One of the most powerful conversations during the workshop centred on fear of movement (kinesiophobia).
Many people with ongoing back pain become afraid to:
- Bend forward
- Sit on the floor
- Lift everyday objects
- Walk for longer distances
This fear is completely understandable. Pain is alarming, and people naturally try to protect themselves. However, over time, avoidance can actually reinforce pain and disability.
Through guided physiotherapy, movement is reintroduced gradually and safely. People learn that their spine is strong and adaptable, and rebuilding trust in the body is often a turning point in recovery.
Is surgery always necessary?
One of the most common questions we were asked was:
“If I have disc problems, does that mean I’ll need surgery?”
In many cases, the answer is no.
Research and clinical experience consistently show that a large proportion of people with disc-related back pain and sciatica improve with conservative management, including physiotherapy.
Surgery is usually considered only when:
- There is significant or progressive nerve damage
- Symptoms fail to improve despite appropriate rehabilitation
- Pain severely limits quality of life over time
For most people, physiotherapy is recommended as a first-line treatment before invasive options are explored.
Key takeaways from the workshop
- Back pain is common, but long-term pain is not inevitable
- Scans do not determine your future
- Movement supports healing when guided appropriately
- Fear and avoidance can slow recovery
- Physiotherapy treats both the body and the nervous system
Moving forward
If you attended the workshop, we hope it provided practical strategies, reassurance, and a clearer understanding of how to manage your back pain. If you couldn’t join, it’s important to know that support is available, and even long-standing pain can improve with the right approach. A physiotherapy assessment could be the first step towards lasting change, providing an individualised plan and guidance that empowers you to take control of your recovery.
Written by Hardik Nimla, Senior MSK Physiotherapist
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