Physiotherapy for low back pain and sciatica.

• Non-specific low back pain. The most common kind. No single structure can be named, and it usually settles as the back is loaded and moved again in a graded way.
• A sensitive nerve (sciatica). A nerve in the low back gets irritated and refers pain, numbness or weakness down the leg. It follows a path rather than staying in the back.
• Facet joints and muscles. The small joints and the muscles of the back can become painful and guarded, often after an awkward movement or a busy few days.
• Load and deconditioning. A back that has done less for a while tolerates less. Pain often appears when activity jumps up faster than the back has been prepared for.
• After a car crash. A collision can strain the low back and neck together, and ICBC covers the physiotherapy that follows, with no referral needed.

• Keep gently moving. Short, frequent walks and easy position changes are usually better than lying still for long stretches. Movement your back accepts is the goal, not pushing into sharp pain.
• Change position often. Long sitting stiffens a sore back. Stand, walk a little, and shift how you sit through the day rather than holding one posture for hours.
• Find easing positions. Many people find a bit of relief lying on their back with the knees bent and feet supported, or on their side with a pillow between the knees. Use what settles yours.
• Warmth for muscle guarding. A warm pack on the low back for 10 to 15 minutes can ease muscle tightness. Use whatever helps you move more comfortably.
• Ease back into activity. As the worst settles, build your activity back up in steps rather than jumping straight to what set it off. A flare is information your therapist uses to adjust load, not a setback.

This is general information, not a treatment plan or a diagnosis. Stop any movement that sharply increases your pain or sends symptoms further down the leg, and get urgent care for the red-flag symptoms listed above. The right exercises for you depend on what your assessment finds.

• Imaging is not routine. Most low back pain does not need a scan. Early imaging often shows normal age-related changes that are also seen in people with no pain, and it does not usually change the plan.
• When a scan does help. Imaging is useful when the assessment points to a specific problem, such as significant nerve compression, or when red flags are present. Then it guides the next step, and your therapist will refer you on.
• Surgery is the exception. Most back pain and most sciatica improve without surgery. It is considered in a minority of cases, usually significant nerve compression with weakness that is not improving, and that call belongs to a surgeon.
• Physiotherapy is first-line. For most non-specific low back pain and most sciatica, active exercise and graded loading are a sensible first step. We tell you plainly if your case should be reviewed by a doctor instead.

• Extended health insurance. Most plans cover physiotherapy. We direct-bill most insurers up to your plan limit, and you pay any balance on the day.
• ICBC (after a car crash). If your back pain follows a collision, it is treated within ICBC's pre-approved physiotherapy, with no referral needed. Bring your claim number and we bill ICBC directly.
• MSP. MSP helps only with a limited number of physiotherapy visits for people on its supplementary benefits (lower-income households). It is not a general physiotherapy benefit.
• WorkSafeBC. If your back injury is work-related and the claim is accepted, physiotherapy is covered at no direct cost to you.