For many people, the response is familiar: take a painkiller, apply some balm, rest for a few days and carry on.
Sometimes, that is enough.
But sometimes the pain keeps returning. It starts travelling into the buttock or leg. Sitting becomes uncomfortable. Getting out of bed becomes difficult. A long drive becomes unbearable. Or the pain disappears for a few weeks and then comes back again.
So what is actually happening?
And when does back pain need more than temporary pain relief?
At Vital Move Physiotherapy & Rehabilitation in Navelim, Goa, Dr. Benecia Cardozo believes that understanding the problem is an important part of treating it. Modern back-pain care is moving away from simply asking, “Where does it hurt?” and toward asking, “Why is this person experiencing pain, what is limiting their function, and what can we do to help them return to normal life?”
This approach is consistent with modern international guidance, which places education, physical activity, exercise and rehabilitation at the centre of care for most non-specific low back pain.
Why Is Lower Back Pain So Common?
Lower back pain is not just a problem for older adults.
It can affect office workers, drivers, athletes, manual workers, parents, students and older adults alike.
According to the World Health Organization, approximately 619 million people experienced low back pain in 2020, and that number is projected to rise to around 843 million by 2050. Low back pain is currently the leading cause of disability worldwide.
One of the most important things to understand is that about 90% of low back pain is classified as non-specific. That does not mean the pain is imaginary. It means that, after assessment, there may not be one identifiable structural disease or tissue injury that completely explains the person's symptoms.
This is one reason back pain can be confusing.
A person may have severe pain without a dramatic abnormality on an MRI.
Another person may have a disc bulge or degenerative changes on an MRI but experience very little pain.
In other words:
An MRI shows anatomy. It does not automatically explain pain.
That distinction is becoming increasingly important in modern physiotherapy.
Why Do We Ignore Back Pain?
Back pain is often normalized.
People say:
“It must be because I slept badly.”
“It's just age.”
“I lifted something heavy.”
“I have spondylosis.”
“My disc is out.”
“I'll take a tablet and it will settle.”
“I'll go to the doctor if it gets worse.”
The problem is not that every episode of back pain requires immediate medical intervention.
In fact, most acute episodes improve over time.
The problem is repeatedly ignoring pain that keeps returning, progressively limits movement or begins affecting everyday life.
WHO recommends self-management, physical activity and rehabilitation as important components of low-back-pain care, particularly because persistent pain can increasingly affect function, participation and quality of life.
The goal should therefore not simply be:
“How do I make the pain disappear today?”
It should also be:
“Why did this happen, what is keeping it going, and how do I become more capable of managing it?”
Where Can Back Pain Actually Come From?
There is no single structure responsible for every case of back pain.
Pain may arise from or be influenced by several structures and systems, including:
Muscles and soft tissues
The muscles surrounding the lumbar spine help control movement and provide stability.
These include the:
Multifidus
Erector spinae
Quadratus lumborum
Abdominal and trunk muscles
Gluteal muscles
Other muscles around the pelvis and hips
However, it is misleading to say that one particular muscle is “the muscle responsible for back pain.”
Back pain is usually more complicated than that.
Muscle strength, endurance, coordination, movement habits and physical capacity can all interact with pain.
Spinal joints
The small joints at the back of the spine, known as facet joints, can contribute to local back pain in some people.
Intervertebral discs
The discs between the vertebrae allow the spine to move and help distribute load.
A disc can develop degenerative changes or bulge/herniate.
But an important point is that disc abnormalities can also exist without causing pain.
Nerves
When a spinal nerve root becomes irritated or compressed, symptoms can extend beyond the lower back.
This is where terms such as radicular pain and sciatica become relevant.
Hip and pelvic regions
Pain perceived around the lower back may sometimes be influenced by structures around the hip or pelvis.
The nervous system and pain processing
Pain is not simply a measurement of tissue damage.
Sleep, stress, previous pain experiences, fear of movement, physical activity, work demands and psychological factors can influence how pain is experienced and how long it persists.
This is why modern guidelines increasingly emphasize a biopsychosocial approach rather than treating the spine as an isolated mechanical structure.
Can Back Pain Travel Down the Leg?
Yes.
Not all pain travelling into the leg is necessarily “sciatica,” but nerve-related pain can extend from the lower back into the buttock and leg.
Different nerve roots can produce different patterns.
For example, symptoms associated with the L5 nerve may extend toward the outer lower leg and top of the foot, while S1-related symptoms may travel toward the back of the calf and outer part of the foot.
This is why the location of pain alone is not enough.
A physiotherapist or doctor may need to assess:
sensation
muscle strength
reflexes
movement
neural tension
walking
symptom behaviour
functional limitations
The important question isn't simply “Where does it hurt?”
It is:
“What pattern does the pain follow, and what else is happening with it?”
What Should You Do First at Home?
For uncomplicated acute low back pain, the first response does not usually need to be complete bed rest.
Modern guidance encourages people to remain as active as reasonably possible and continue normal activities where tolerated.
1. Keep moving
Short walks and comfortable everyday movement can be preferable to spending the entire day in bed.
You may temporarily need to reduce activities that significantly aggravate symptoms, but complete inactivity can become counterproductive.
2. Avoid repeatedly testing the painful movement
If bending forward repeatedly causes a sharp increase in symptoms, you do not need to keep testing it every few minutes.
Give the irritated area time while gradually restoring movement.
3. Find comfortable positions
There is no universally correct sleeping position for every person with back pain.
The useful position is one that allows you to rest without significantly increasing symptoms.
4. Heat may help some people
A warm shower or heat pack can provide short-term symptom relief for some people.
It is a comfort strategy — not a cure for the underlying problem.
5. Gradually return to normal activity
The goal is not to protect your back forever.
The goal is to gradually restore your ability to bend, lift, walk, sit, work and exercise.
When Should You See a Doctor or Physiotherapist?
You don't necessarily need to wait until your back pain becomes severe.
Consider professional assessment when:
pain keeps returning
pain is interfering with work or sleep
symptoms are progressively worsening
pain is travelling into the leg
you develop numbness or weakness
you are avoiding normal activities because of fear of pain
the problem is not improving as expected
you are unsure what movements or exercises are appropriate
A proper assessment can help determine whether the presentation appears suitable for conservative rehabilitation or whether medical investigation is necessary.
When Is Back Pain an Emergency?
Most back pain is not caused by a dangerous disease.
But certain symptoms require urgent medical assessment.
Seek urgent medical attention if back pain is accompanied by symptoms such as:
new loss of bladder or bowel control
difficulty passing urine
numbness around the saddle/groin region
significant or progressive weakness in the legs
severe symptoms following major trauma
fever or significant systemic illness
unexplained weight loss or other concerning systemic symptoms
other features suggesting serious infection, fracture, cancer or neurological compromise
These symptoms should not be managed simply by continuing home exercises.
Clinical assessment comes first.
So Where Does Physiotherapy Fit In?
This is where modern physiotherapy becomes much more than massage.
A good physiotherapy assessment may look at:
Pain → movement → strength → mobility → neurological function → physical capacity → lifestyle → work demands → sleep → confidence with movement → goals.
The treatment then changes according to what is actually found.
Exercise therapy
Exercise is one of the most important tools in modern back-pain rehabilitation.
It may include:
trunk strengthening
hip strengthening
endurance training
mobility exercises
aerobic conditioning
movement retraining
graded exposure to activities
functional strengthening
There is no single “best back exercise” for everybody.
The most useful programme is one that is appropriate to the individual's presentation, capabilities and goals.
A Cochrane review found moderate-certainty evidence that exercise therapy improves pain compared with no treatment, although the magnitude of benefit varies between people and programmes.
Manual therapy
Hands-on treatment can sometimes help reduce pain and improve movement in the short term.
But modern guidelines generally position manual therapy as part of a broader treatment package, rather than something that should replace exercise and active rehabilitation. NICE specifically recommends manual therapy only alongside exercise, with psychological approaches included when appropriate.
That distinction matters.
Hands-on treatment can help you move. Rehabilitation helps you become capable of moving independently.
What About Posture?
Posture is often blamed for everything.
“Your posture is bad.”
“Your spine is out of alignment.”
“You are sitting incorrectly.”
The reality is more nuanced.
There is no single perfect posture that prevents all back pain.
Instead, one useful goal is movement variability.
If your work requires you to sit for eight hours, changing position, taking movement breaks and building physical capacity may be more useful than trying to maintain one rigid “perfect” sitting posture all day.
The same applies to standing, lifting and driving.
Your back is designed to move.
The objective is not to eliminate movement.
It is to build tolerance for it.
What Role Do Painkillers Have?
Medication can have a role.
But medication should not automatically become the entire treatment plan.
WHO states that medicines can reduce symptoms but should ideally be combined with other approaches, and that painkillers should not be considered the first-line treatment for low back pain.
For appropriate patients, doctors may consider medicines such as NSAIDs for short-term symptom control.
However, NSAIDs are not risk-free.
They can have gastrointestinal, kidney, cardiovascular and other adverse effects, and the appropriate choice depends on the person's age, medical history, other medications and risk factors. NICE recommends the lowest effective dose for the shortest appropriate duration.
This is why self-prescribing pain medication repeatedly for recurring back pain is not the same thing as treating the underlying problem.
What About Steroids?
This is where the distinction between back pain and nerve-related leg pain becomes particularly important.
Oral steroids
Routine oral corticosteroids are not recommended for uncomplicated low back pain, and NICE advises against oral corticosteroids for sciatica because evidence does not show an overall meaningful benefit and there are potential harms.
Epidural steroid injections
These are different.
For selected people with acute, severe sciatica, an epidural injection containing local anaesthetic and steroid may be considered in specialist care. NICE specifically distinguishes this situation from routine treatment of ordinary low back pain.
A 2024 systematic review and meta-analysis also found evidence supporting epidural steroid injections for short-term outcomes in sciatica associated with lumbar disc herniation, while this should not be interpreted as a permanent cure for the underlying condition.
The important message is:
Steroids may have a role in selected nerve-related conditions. They are not a universal treatment for back pain.
Do You Need an MRI?
This is one of the biggest misconceptions surrounding back pain.
An MRI can be extremely useful when there is a specific clinical reason for it.
But more imaging does not automatically mean better treatment.
NICE recommends against routinely offering imaging for low back pain or sciatica in non-specialist settings. Imaging is generally considered when the result is likely to change management.
Why?
Because scans can reveal abnormalities that are common even among people without pain.
If a scan shows a disc bulge, degeneration or another age-related change, it can be tempting to assume:
“That's what is causing my pain.”
But the clinical picture has to match the imaging.
A scan should answer a clinical question — not simply become the explanation for every ache.
Can Back Pain Actually Be Cured?
This is perhaps the most important question.
The answer depends on what we mean by cure.
Many episodes of acute low back pain improve substantially, sometimes without extensive treatment. WHO notes that most acute episodes resolve and many people recover well.
But recurrent or persistent low back pain is different.
For some people, there may not be one single structure that can be “fixed” permanently.
Instead, successful rehabilitation may mean:
less pain
better strength
greater movement tolerance
better sleep
returning to work
returning to sport
confidence in movement
fewer flare-ups
better self-management
improved quality of life
That is why modern rehabilitation increasingly focuses on function and participation, not simply chasing a zero-pain number. WHO emphasizes rehabilitation aimed at restoring independence and participation in meaningful daily activities.
What Does the Future of Back Pain Treatment Look Like?
The future is unlikely to be about finding one miraculous treatment.
It is more likely to involve better personalization.
We are moving toward rehabilitation that considers:
individual movement patterns
physical capacity
psychological factors
occupational demands
lifestyle
sleep
previous episodes
response to different exercise strategies
remote monitoring and digital rehabilitation
more precise classification of different pain presentations
Technology may increasingly help clinicians measure movement and monitor rehabilitation outside the clinic.
Digital physiotherapy and tele-rehabilitation may also improve access for people who cannot regularly attend a clinic.
But technology should support clinical reasoning — not replace it.
The fundamentals remain remarkably important:
understand the person, identify the relevant problems, restore movement and capacity, and help the person return to the life they want to live.
Dr. Benecia’s Take: Don't Just Treat the Back
For Dr. Benecia, the most important shift in back-pain care is moving away from treating the painful area in isolation.
A person does not experience “lumbar spine pain” in a vacuum.
They experience difficulty getting out of bed.
They struggle to sit through a workday.
They stop exercising.
They may avoid picking up their child.
They may stop playing sport.
They may become afraid of bending.
They may start believing that their spine is fragile.
That is where physiotherapy can play a much bigger role.
At Vital Move Physiotherapy & Rehabilitation in Navelim, Goa, the goal is to approach back pain through assessment, education, movement and progressive rehabilitation — while recognizing when a patient needs medical evaluation or specialist referral.
For Dr. Benecia, the question is not simply:
“How can we reduce your pain today?”
It is:
“How can we help you understand your pain, restore your confidence in movement and get you back to the life you want?”
That is a very different way of looking at back pain.
And perhaps that is exactly what modern back-pain treatment should be.
Back Pain in Goa: What Should You Remember?
If you are experiencing lower back pain in Goa, remember these principles:
1. Don't panic.
Most low back pain is not caused by a dangerous condition.
2. Don't ignore persistent or recurring pain.
Repeated episodes deserve assessment.
3. Don't assume your MRI is your diagnosis.
Imaging findings need to be interpreted alongside your symptoms and examination.
4. Don't rely entirely on painkillers.
Medication can have a role, but rehabilitation and active self-management are central to modern care.
5. Don't stay in bed unnecessarily.
Appropriate movement is generally encouraged.
6. Don't assume one exercise works for everyone.
Your programme should be based on your presentation, capacity and goals.
7. Don't ignore neurological or systemic warning signs.
Some presentations require urgent medical assessment.
8. Think beyond pain relief.
The long-term goal is to restore movement, strength, confidence and function.
Frequently Asked Questions About Back Pain Treatment in Goa
What is the best treatment for lower back pain?
There is no single treatment that is best for every person. For many people with non-specific low back pain, education, staying active and an individualized exercise-based rehabilitation programme form the foundation of care.
Can physiotherapy help lower back pain?
Yes. Exercise-based physiotherapy can improve pain and function, particularly when treatment is individualized and progressed appropriately. Manual therapy may also be used as an adjunct to exercise.
Should I get an MRI for back pain?
Not automatically. Routine imaging is not recommended for uncomplicated low back pain. Imaging becomes more useful when there are specific clinical concerns or when the result is likely to change management.
Is sciatica the same as back pain?
No. Sciatica generally refers to nerve-related symptoms travelling into the leg, often associated with irritation of lumbar or sacral nerve roots. Back pain can occur without nerve involvement.
Can steroids cure back pain?
Steroids are not a universal cure for back pain. Oral corticosteroids are not routinely recommended for sciatica, while epidural steroid injections may have a role in selected cases of acute, severe sciatica.
How long does lower back pain take to improve?
Many acute episodes improve over several weeks, but recovery varies considerably. Persistent or recurrent symptoms may require a more structured rehabilitation approach.
When should I see a physiotherapist for back pain?
Consider assessment when pain is persistent, recurrent, limiting your daily activities, affecting work or exercise, or when you are unsure how to safely return to normal movement.
Final Thought
Back pain is common.
That does not mean you have to simply live with it.
And treating it does not always mean finding something wrong on a scan, taking a stronger medicine or receiving a passive treatment.
Sometimes the most important step is understanding what is happening, identifying what your body currently cannot tolerate, and progressively rebuilding that capacity.
Back pain treatment is increasingly moving from simply treating pain to helping people move, function and live better.
That is the direction modern physiotherapy is taking — and it is the approach we believe deserves greater attention in Goa.
Vital Move Physiotherapy & Rehabilitation
Navelim, South Goa
This article is for educational purposes and does not replace an individual medical or physiotherapy assessment. Urgent symptoms should be evaluated by an appropriate medical professional.
Selected Evidence & References
World Health Organization — Low Back Pain WHO: Low Back Pain
World Health Organization — Guideline for Non-Surgical Management of Chronic Primary Low Back Pain WHO guideline
World Health Organization — Package of Interventions for Rehabilitation: Musculoskeletal Conditions WHO rehabilitation package
NICE — Low Back Pain and Sciatica in Over 16s: Assessment and Management NICE guideline NG59
Hayden et al. — Exercise Therapy for Chronic Low Back Pain, Cochrane Review.
Zhang et al. — Efficacy of Epidural Steroid Injection in the Treatment of Sciatica Secondary to Lumbar Disc Herniation, 2024.