Back pain treatment options: what helps and what doesn't

An evidence-based guide to treating low back pain and sciatica: staying active, exercise, physiotherapy, heat, short-term medicines, manual therapy, psychological approaches, injections and surgery.

7 min read · last reviewed October 1, 2026

When your back hurts, you want it to stop, fast. It is easy to feel pulled in many directions: rest or move? Pills or physio? A scan? A specialist? This guide brings together what the research and major guidelines say, so you can make choices with your care team.

The short version: for most people, the best treatment is to keep moving and build up activity and exercise, with a few extra tools to ease the pain while you heal.

The foundations: stay active and exercise

Stay active. Carry on with your normal activities as much as you can, even if you have to slow down or take breaks. Guidelines from the UK, the U.S. and Canada all agree on this. People who keep moving tend to recover faster than people who rest.

Exercise. For back pain that lasts more than a few weeks, exercise therapy is one of the best-studied treatments. A large Cochrane review in 2021, which pooled results from hundreds of trials, found that exercise eases pain and helps people do more compared with no treatment or usual care.

The good news is that no single type of exercise is the "best" one. Walking, strengthening, stretching, Pilates, yoga and tai chi have all been shown to help. The best exercise is one you enjoy and can keep doing. Start gently and build up a little at a time.

Something you can do today: Pick one activity you like, such as a short walk, and plan to do it every day this week.

Physiotherapy

A physiotherapist (physical therapist) can check your back, explain what is going on and set up an exercise plan that fits you. They can help you get back to work, sport or hobbies with confidence. Good physio is mostly active: they teach you exercises and ways to manage your pain yourself. In many provinces and states, you can see a physiotherapist without a doctor's referral. See our guide Choosing a physiotherapist.

Ways to ease the pain while you heal

• Heat. A heat pack or hot water bottle wrapped in a towel can relax sore muscles and ease pain, especially in the first few weeks. Use it for up to 20 minutes at a time, and never sleep on a heat pad.
• Hands-on treatment (manual therapy). Spinal manipulation, mobilisation or massage, from a physiotherapist, chiropractor or other trained practitioner, can give some people short-term relief. Guidelines say it works best alongside exercise, not on its own.
• Medicines, for a short time. If you need a pain medicine, anti-inflammatory medicines (NSAIDs) are usually the first choice for back pain, for the shortest time needed, if they are safe for you. They aren't safe for everyone, for example if you have stomach ulcers, kidney problems, heart disease or take blood thinners. Acetaminophen (paracetamol) on its own has not been shown to help low back pain much. Always ask your pharmacist or doctor which medicine is right for you.
• Mind and body approaches. For back pain that lasts, approaches such as cognitive behavioural therapy (CBT), mindfulness and relaxation can help. They don't mean the pain is "in your head." They help calm a sensitive nervous system and help you get back to living. Programmes that combine exercise with these approaches can be especially helpful for people with long-lasting pain.

What doesn't help (and can make things worse)

• Bed rest. Lying down for days slows recovery and weakens muscles. Short rests are fine; long rests are not.
• Routine early scans. X-rays and MRI rarely change treatment, and often show normal changes that cause worry. Your doctor will order one if there is a good reason.
• Long-term opioid medicines. Strong pain medicines like opioids don't work well for long-lasting back pain, and they carry real risks, including dependence, falls, constipation and overdose. Guidelines recommend against them for chronic back pain.
• Some nerve medicines for sciatica. Certain medicines used for nerve pain have not been shown to help sciatica, and can cause side effects such as dizziness and drowsiness.
• Back belts and corsets, traction, TENS and ultrasound. UK guidelines advise against these for low back pain, because there isn't good evidence that they help.

If you are already taking a medicine for your back, don't stop it suddenly. Talk with your doctor or pharmacist first.

Injections and surgery: for some people with sciatica

Most people never need an injection or an operation for back pain. They are mainly options for sciatica that is severe or isn't getting better.

• Epidural steroid injections. An injection of numbing medicine and steroid near the irritated nerve may ease severe sciatica for a while. It doesn't help everyone, and the effect often wears off over weeks to months. It can buy time to get moving.
• Surgery (decompression). An operation to take pressure off a nerve, such as removing part of a bulging disc, may be offered when sciatica hasn't improved with other treatment and your scan matches your symptoms. Surgery tends to ease leg pain faster. Over a year or two, many people who don't have surgery end up doing about as well. It is a personal decision to make with a spine specialist.
• Urgent surgery is needed for cauda equina syndrome (new bladder or bowel problems, or numbness around the genitals). This is an emergency. Go to an emergency department right away.

Operations to fuse the spine or replace a disc are generally not recommended for ordinary low back pain.

Putting it together

A typical path looks like this:

1. First few weeks: reassurance, stay active, heat, a short course of a pain medicine if needed.
2. If pain lasts or keeps coming back: a structured exercise programme or physiotherapy, sometimes with hands-on treatment, and support for sleep, stress and mood.
3. For severe or lasting sciatica: talk with your team about whether an injection or surgery is right for you.

Something you can do this week: Write down your three most important goals, such as walking the dog, sleeping through the night or getting back to work. Share them with your care team.

Questions to ask your care team

• What treatments do you suggest for me first, and why?
• Can you refer me to a physiotherapist or an exercise programme?
• Which pain medicine is safe for me, and for how long?
• What should I do if my pain flares up?
• Would an injection or surgery ever be right for me? What would need to happen first?
• Is there support for sleep, stress or low mood?

This article is general information, not medical advice. Talk with your health care team about your own situation. In an emergency, call 9-1-1 or your local emergency number.

In an emergency, call 9-1-1 or your local emergency number.

General information, not medical advice. It does not replace your own care team. If you think you or someone else is having a medical emergency, call 9-1-1 or your local emergency number. If you are in crisis or thinking about suicide, call or text 9-8-8 (Canada and the US).

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