5 Most Common Causes of Lower Back Pain and How Physiotherapy Helps

Lower back pain is one of the most prevalent health conditions in the world today. Studies estimate that up to 80 percent of adults will experience lower back pain at some point in their lives, making it the single leading cause of disability globally. In Nepal, the combination of sedentary desk jobs, heavy physical labour, poor ergonomics, and limited access to specialist care has made back pain a major source of suffering and lost productivity. At TRX Physiotherapy and Chiropractic Centre in Kathmandu, Dr. Prawesh Upreti evaluates hundreds of patients with lower back pain every year. Understanding the root cause of your pain is the first and most important step towards effective, lasting treatment.

Not all lower back pain is the same. Some patients describe a dull, constant ache that worsens with prolonged sitting. Others experience sharp, stabbing pain that comes on suddenly with movement. Still others feel a deep, radiating discomfort that travels down the leg. Each pattern points to a different underlying cause, and treating the wrong cause is one of the most common reasons why back pain persists for months or even years. In this article, we outline the five most common causes of lower back pain and explain how physiotherapy addresses each one at its root.

Cause 1: Muscle Strain and Ligament Sprain

The most frequent cause of lower back pain is a strain of the muscles or ligaments that support the spine. This typically happens during sudden awkward movements, heavy lifting without proper technique, or during sports activities. The muscles and ligaments in the lumbar region bear the entire weight of the upper body, and when they are overstretched or torn, the resulting inflammation causes significant pain and stiffness.

Symptoms of muscle strain include localised pain and tenderness in the lower back, muscle spasms, and difficulty straightening up after bending. The pain is usually worse with movement and eases with rest. Most acute strains resolve within a few days to weeks, but without proper rehabilitation, the surrounding muscles can become weak and guarded, leading to chronic pain and repeated injury.

At TRX Physiotherapy, treatment for muscle strain begins with a thorough biomechanical assessment to identify which muscles are affected and why the injury occurred in the first place. Treatment includes soft tissue release, targeted strengthening exercises for the deep stabilising muscles of the lumbar spine, and education on safe movement patterns to prevent recurrence. Our physiotherapists work with each patient to restore full strength and flexibility rather than simply waiting for the pain to subside.

Cause 2: Disc Herniation and Bulging Disc

Between each vertebra in the spine sits an intervertebral disc, a cushion-like structure that absorbs shock and allows movement. When the outer ring of this disc weakens or tears, the soft inner material can bulge outwards or herniate completely, pressing on nearby spinal nerves. This is commonly known as a slipped disc, herniated disc, or disc prolapse.

Disc herniation most commonly occurs in the lumbar spine at the L4-L5 or L5-S1 levels. Symptoms include lower back pain combined with pain, numbness, tingling, or weakness that radiates down one or both legs, a condition known as radiculopathy or sciatica. The pain is often aggravated by sitting, coughing, sneezing, or bending forward, and relieved by lying down or walking.

At TRX, disc herniation is treated using a combination of non-surgical spinal decompression therapy, manual therapy, and specific therapeutic exercises. Spinal decompression creates negative pressure within the disc space, gently drawing the herniated material back towards the centre and promoting healing. This approach has helped many of our patients in Kathmandu avoid surgery entirely, achieving lasting relief and restored function.

Cause 3: Degenerative Disc Disease

As we age, the intervertebral discs naturally lose water content and become less flexible. This gradual wearing down of disc tissue is called degenerative disc disease, and while it is a normal part of ageing, it becomes problematic when it causes pain or instability. The discs become thinner, reducing the space between vertebrae and increasing stress on the facet joints and surrounding soft tissues.

Patients with degenerative disc disease often describe chronic, low-grade lower back pain that is punctuated by episodes of acute flare-ups. The pain may be worse in the morning after waking, or after prolonged static positions. Some patients also experience referred pain into the buttocks and thighs. In advanced cases, bone spurs can form, narrowing the spinal canal and causing a condition called spinal stenosis.

Although degenerative disc disease cannot be reversed, its symptoms can be effectively managed through physiotherapy. At TRX, our approach focuses on strengthening the core muscles that support the spine, improving flexibility and movement quality, and teaching patients how to protect their spine during daily activities. Many patients with degenerative changes experience dramatic reductions in pain and significant improvements in function with a consistent, evidence-based physiotherapy programme.

Cause 4: Poor Posture and Sedentary Lifestyle

One of the fastest-growing causes of lower back pain in Kathmandu is postural dysfunction resulting from prolonged sitting and screen use. Office workers, IT professionals, students, and drivers are especially vulnerable. When we sit for extended periods, particularly in poorly designed chairs or with rounded shoulders and forward head posture, the muscles of the lower back and hips become imbalanced. The hip flexors shorten, the gluteal muscles weaken, and the lumbar stabilisers lose their ability to support the spine effectively.

This muscular imbalance places abnormal stress on the lumbar discs and facet joints over time, leading to chronic pain that does not resolve with rest alone. Many patients in this category have been told their X-rays are normal, yet they suffer daily. This is because postural pain is a functional problem, not a structural one, and it requires a functional solution rather than imaging-based diagnosis.

Physiotherapy and chiropractic care are the most effective interventions for postural lower back pain. At TRX, we perform a detailed postural analysis to identify the specific imbalances contributing to each patient's pain. Treatment includes spinal adjustments to restore joint mobility, targeted exercises to strengthen weak muscles and lengthen tight ones, and practical guidance on workstation ergonomics and movement habits.

Cause 5: Sciatica and Nerve Compression

Sciatica is not a diagnosis in itself but rather a symptom of an underlying condition in which the sciatic nerve, the largest nerve in the body, becomes compressed or irritated. The sciatic nerve originates from the lumbar and sacral nerve roots and travels through the buttocks and down each leg. When it is compressed, usually by a disc herniation, bone spur, or piriformis muscle tightness, patients experience a distinctive burning, shooting, or electric shock-like pain that radiates from the lower back down the back of the leg, sometimes reaching the foot.

Sciatica is a common presentation at TRX Physiotherapy. Many patients arrive having been told they need surgery, yet in the majority of cases, non-surgical treatment is highly effective. Treatment depends on identifying the exact source of nerve compression. For disc-related sciatica, spinal decompression therapy is often the most effective modality. For piriformis syndrome, deep soft tissue release and specific stretching protocols are used. Neural mobilisation techniques are used to restore the normal movement and mobility of the sciatic nerve within its tissue.

How Physiotherapy Treats Lower Back Pain at TRX

At TRX Physiotherapy and Chiropractic Centre, every patient with lower back pain begins with a comprehensive clinical assessment. Dr. Prawesh Upreti reviews the patient's history, performs a detailed physical examination including postural analysis, range of motion testing, neurological screening, and orthopaedic special tests, and reviews any available imaging. This allows him to identify the specific tissue involved, the severity of the condition, and the most appropriate treatment pathway.

Treatment at TRX combines hands-on physiotherapy, chiropractic adjustments, advanced modalities such as LLLT laser therapy, TECAR radiofrequency, and spinal decompression, alongside a prescribed home exercise programme. Patients are educated about their condition and given the tools to manage their own recovery between sessions. The goal is not just to reduce pain in the short term but to address the underlying cause and build lasting resilience against future episodes.

If you are experiencing lower back pain in Kathmandu, do not wait for it to become a chronic problem. Early intervention leads to faster recovery and better long-term outcomes. Contact TRX Physiotherapy at Thapathali Complex or call us on +977-9851408989 to book your assessment today. Our team is here to help you recover fully and get back to the life you enjoy.