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Chronic Low Back Pain is term that is used to describe symptoms that have persisted for duration of at least 3-6 months. There is not an individual treatment intervention that can be used to successfully address all the symptoms of chronic low back pain. For chronic low back pain, an assessment needs to take account of all the factors that contribute to the pain problem before a treatment plan is produced.

What is Chronic Low Back Pain?

Chronic Low Back Pain is a term that covers a wide range of contributing factors. The symptoms of chronic low back pain may start with an accident, injury or traumatic event but does not necessarily have to start in this way. Chronic low back pain can simply gradually develop over time. Latest research has confirmed that the initial injury is probably no longer the sole cause of the ongoing pain. It is likely that the Central Nervous System (CNS) and therefore the pain system will have become hyper-sensitive.

Symptoms of Chronic Low Back Pain

The symptoms of low back pain include:
  • Pain lasting at least 3-6 months in the lumbar spine area (lower back)
  • Pain radiating into the hips and pelvis
  • Pain down the legs
  • Discomfort in sitting/ standing/ twisting
If you have any of these symptoms you would benefit from a physiotherapy assessment to determine the cause of your pain and begin treatment.

What causes Chronic Low Back Pain?

There is not one single cause of chronic low back pain. The pain is likely to be due to a range of factors which may or may not be preceded by an initial injury. Even if the original cause of the low back pain was due to damaged tissues or other structures such as a disc, research evidence shows that it is often no longer the sole cause of the problem after 3-6 months. The problem now lies within the pain system itself which has developed increased sensitivity.

What problems caused by Chronic Low Back Pain can physiotherapy help with?

Chronic Low Back Pain can lead to a variety of problems which can be improved with physiotherapy treatment. These problems may include:
  • Avoidance of physical activity including work/leisure activities
  • Low mood
  • Deconditioned tissues/muscles
  • Increased fear
  • Increased anxiety
  • Reduced confidence
  • Reduced levels of fitness
  • Reduced mobility
  • Reduced flexibility/increased stiffness
Physiotherapy can help increase physical fitness and function through a process of graded exposure to normal activity. Your physiotherapist will help by reducing fears and concerns about harm and damage occurring during movement.

By exposing tissues to normal movement and stretch in a relaxed and paced manner without fear of harm, it is possible to improve the symptoms of chronic low back pain by retraining the pain system (ie. the Central Nervous System) to respond less protectively over time.

How is Chronic Low Back Pain diagnosed?

The term chronic simply means the length of time that the pain has been experienced. For back pain to become chronic, it must have lasted a minimum of 3-6 months. It is therefore diagnosed by taking a verbal account from the individual and a thorough physical examination.

How does physiotherapy help someone with chronic low back pain?

Physiotherapy can reduce the symptoms of chronic low back pain by:
  • Reducing fear
  • Promoting confidence
  • Increasing flexibility
  • Increasing normal movement patterns
  • Increasing physical activity
  • Improving mood
  • Developing skills in pacing activity
Your physiotherapist will carry out a detailed physiotherapy assessment and will help to gradually reduce your chronic low back pain over time.

What would physiotherapy treatment for Chronic Low Back Pain involve?

Physiotherapy treatment for Chronic Low Back Pain can include:
  • Increasing Understanding of the Pain System
  • Graded Exposure to Normal Movement
  • Exercise

Increased Understanding of the Pain System

Research has shown that developing an increased understanding of how pain systems work helps people to reduce their fears which are significant barriers to regaining normal movement. The more that we understand about why things hurt, the less anxious and threatened we feel and the less the pain system becomes sensitive. At Manchester Physio, we understand that explaining pain is very important to support recovery.

Graded Exposure to Normal Movement

Your physiotherapist will help you to gradually expose the Central Nervous System/Pain System to normal movement. This will help to retrain that system to be less sensitive during future activity. As the Central Nervous System will have become sensitive in chronic pain, it is important that normal and harmless movement is restored. This can only be done successfully in a very gradual and graded way and a step by step approach to reintroducing normal movement will be undertaken.


Exercise helps to lift mood, recondition tissue, improve flexibility and promotes functional physical activity. Normal function requires movement and so exercise will be used in a gentle way to remind the central nervous system that exercise, movement and function are all essential parts of life and should not be reacted to quite so protectively. Your physiotherapist will show you a gentle approach to stretching, strengthening and typical movement patterns.


Chronic Low Back Pain is a generic term for pain in the lumbar spine that has been experienced for at least 3 to 6 months. Research has shown that the most effective treatments for Chronic Low Back Pain involve retraining the Central Nervous System/Pain System itself. Your experience physiotherapist will help you to do this through a variety of approaches including exercise and graded exposure to normal activity levels in combination with fear reduction.

If you have Chronic Low Back Pain and think that you would benefit from seeing one of our experienced physiotherapists please call 0161 833 0077 or email to book an appointment.

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