This is the page the rest of this cluster points at. It gives the symptoms that need assessment today, the ones that mean book an appointment, and an honest account of what a physiotherapist can and cannot establish — because knowing the limits is part of knowing when to see a physio and part of not being disappointed when you do. It also describes the gate our own app puts in front of anyone who reports one of the urgent symptoms, because a company writing this page should be held to it.
Today, not next week
Some things are not an appointment-when-convenient matter.
Loss of bladder or bowel control, difficulty passing urine, or numbness in the saddle area — between the legs, around the back passage — alongside back pain, especially with weakness or numbness in both legs. This combination needs assessment the same day, urgently, in an emergency department if that is what it takes. It is rare and it is the reason this section is first.
Weakness that is getting worse. A foot that catches or drags, a leg giving way, weakness progressing rather than fluctuating.
Back pain after significant trauma — a fall, a crash, an impact — or after a minor one if you have osteoporosis or take long-term steroids.
Back pain with fever, feeling generally unwell, or unexplained weight loss.
A history of cancer, or new back pain that is constant, worse at night and not relieved by changing position.
That is not a diagnostic list, it is not exhaustive, and it is not a set of things to try to rule out yourself. It is a list of reasons to be examined by a person. Nothing on this site diagnoses anything and nothing on it is treatment.
When to see a physio
Now the ordinary version of the question, which is the one most people are actually asking.
Book an appointment if any of these apply.
- Pain that is not settling over several weeks, or that has plateaued at a level you are working around.
- Pain that keeps coming back — three episodes in a year is a pattern, not bad luck.
- Symptoms that travel below the knee, with or without numbness or pins and needles. These deserve assessment even without the urgent features above.
- Pain that is stopping you doing something you need or want to do — work, sleep, lifting a child, training.
- Morning stiffness lasting more than about half an hour, every day, in a younger adult, easing with movement and worsening with rest. That pattern is worth naming to a doctor. Morning back stiffness explains why.
- You have been managing it yourself for months and the plan has stopped changing.
None of those makes you a difficult patient or a time-waster, which is the belief that keeps people out of the room longest. Musculoskeletal pain is what the profession exists for, and a back that has hurt for six weeks is an entirely ordinary reason to book.
Grade: this is guideline-derived rather than trial-derived. The red-flag lists in NICE's guidance and the American College of Physicians' guideline, published in Annals of Internal Medicine in 2017, are consensus filters designed to catch rare serious causes, not validated diagnostic tests. They are the best available and they are not perfect.
What an assessment is like
Worth knowing, because the expectation is often wrong in both directions.
It is mostly a conversation. What brought it on, what makes it better and worse, what the last few weeks looked like, what you are avoiding, what you are worried about. The history does most of the diagnostic work in this field.
Then a physical examination: watching you move, testing how far each direction goes and what it provokes, and — if there are leg symptoms — testing strength, reflexes and sensation. Those last three are the reason a leg symptom needs a person. You cannot test your own reflexes and a web page cannot test them for you.
What you will usually leave with is a working explanation, a plan for movement and load, and a review date. What you will usually not leave with is a scan. That is a good sign rather than a brush-off, for the reason in the next section.
What it can and cannot say
Here is the part most articles skip.
A physiotherapist can usually tell you whether your presentation carries features needing further investigation, which directions provoke and which ease your symptoms, whether there is a neurological deficit, how much load the region is tolerating now, and what a sensible progression looks like from there.
They usually cannot tell you which structure is generating the pain. In the great majority of low back pain no specific cause is identified — that is what the Lancet 2018 low back pain series reports, at around 90 per cent or more — and confident naming of a structure is generally confidence outrunning the evidence.
A scan usually does not settle it either. Brinjikji and colleagues, in the American Journal of Neuroradiology in 2015, pooled imaging of people with no symptoms at all and found disc degeneration in 37 per cent of asymptomatic 20-year-olds and 96 per cent at 80, with disc bulges from 30 per cent to 84 per cent across the same span. Findings that common cannot establish a cause on their own, which is why guidelines advise against routine imaging without red flags — not to save money, but because the picture usually shows something that explains nothing and frightens the person looking at it.
Grade: solid for the imaging base rates. Large pooled samples, consistent direction, and it changed practice.
And no type of treatment has been shown to beat another by much. Cochrane's 2021 review by Hayden and colleagues found exercise probably reduces pain and improves function modestly, with small differences between exercise types; Saragiotto and colleagues' 2016 review found motor control exercise similar to other forms rather than superior. A physio who tells you the plan is movement you will keep doing is telling you what the evidence says, not fobbing you off.
What to bring
Ten minutes goes further with a record than with a story.
Write down when it started and what you were doing; which direction eases it and which provokes it; what time of day it is worst; what you have stopped doing because of it; anything that has changed in the last four weeks; and the medications you have tried and what they did.
If you have been measuring your range, bring the numbers with their dates. The Range Score composes whatever readings you have taken into one number and leaves the stations you skipped blank, and either that or a plain list of dated readings is more useful than a description. Be clear about what the numbers are: a range reading is not a pain score, and neither is the sitting-rising test, whose floor-to-standing score out of ten carries an association with mortality across a cohort of volunteers and says nothing at all about anybody's back. The toe touch test reads a forward fold, which Mayorga-Vega and colleagues' 2014 meta-analysis in the Journal of Sports Science & Medicine rated low in validity for the lumbar spine specifically, and it is a movement to skip entirely if bending forward is what provokes your symptoms.
The gate in the app
A site that publishes this page should be judged by what its own product does with the answer, so here is that.
Limber's onboarding asks one direct question before it will build anything: sharp pain, numbness or tingling, a recent injury, or post-surgery recovery — any of these, or none. Any answer other than "none of these" stops the flow. It routes to a screen that says to see a professional first, that Limber is for maintenance and mobility rather than treatment, and that it will be here for the maintenance work afterwards.
Two details matter about that screen. It is not dismiss-to-continue: acknowledging it exits the flow rather than unlocking it. And the only other option is to say you picked the answer by mistake, which is an honest escape hatch rather than a hidden continue button.
The app also asks which areas are sore and writes a contraindication flag from the answer, and here the honesty runs the other way. The picker offers three areas — the lower back, the neck and the knees. The neck flag removes two movements from the pool and the knee flag removes two. The lower-back flag currently removes none, because no movement in the 56-move catalogue carries it. That is a real gap in our own build and it belongs on our own page rather than in someone's review. It is not a safety failure — the red-flag gate above is the thing that blocks entry — but a flag that filters nothing is a promise with nothing behind it.
The rest of the cluster, including the evidence in full and the movements themselves, is under lower back. Leg symptoms have their own page in sciatica and stretching, which reaches the same recommendation as this one.
Questions
When should I see a physio for back pain?
Book if the pain is not settling over several weeks, if it keeps returning, if it travels below the knee, if it is stopping you doing something you need to do, or if you have been managing it yourself for months without the plan changing. Go the same day, urgently, if there is any change in bladder or bowel function, numbness in the saddle area, or leg weakness that is progressing.
Do I need a scan first?
Usually not, and being told you do not is a good sign. NICE and the American College of Physicians both advise against routine imaging for back pain without red-flag features, because findings that appear in most people without symptoms — disc degeneration in 96 per cent of asymptomatic 80-year-olds in the pooled data — cannot establish the cause of a symptom on their own.
Can a physio tell me what is wrong?
They can usually tell you whether anything needs further investigation, which movements provoke and ease your symptoms, whether there is a neurological deficit, and what a sensible progression looks like. What they generally cannot do is name the structure generating the pain, because in the great majority of cases no specific cause is identified, and confident naming is usually confidence outrunning the evidence.
What happens at the first appointment?
Mostly a conversation about what brought it on, what changes it, and what you are avoiding, because the history does most of the diagnostic work. Then an examination — watching you move, testing directions, and, if there are leg symptoms, testing strength, reflexes and sensation. You will usually leave with a working explanation, a plan for movement and load, and a review date.
Should I keep stretching while I wait for the appointment?
Gentle movement inside a comfortable range is usually reasonable, and guidelines favour staying active over rest. What is worth avoiding is pushing into the symptom, especially anything that reproduces a shooting or electric sensation down a leg. It is also worth not experimenting so hard that you arrive unable to say clearly which movements provoke what, because that is one of the most useful things you can bring.
Physio, doctor, or chiropractor?
That is a matter for you, and the honest position is that no type of exercise-based care has been shown to beat another by much in review. What matters more is that whoever sees you screens for the urgent features above, examines you properly, and gives you a plan that involves you moving rather than only being treated. Anyone who names a structure with great confidence and books you a long course before examining you is worth a second opinion.