Back Pain: What to Do, How Long Does It Last, and Who Should You See?

By Marie Messager, Osteopath, D.O., at the Osteo Versailles Chantiers and Grand Siècle clinics

Have you ever bent over to pick something up and, all of a sudden, found yourself unable to stand up straight? A “stiff back”—also known as lumbago or a back spasm—is one of the most intense pains there is, but also one of the most reassuring once you understand it. Here’s what’s happening in your back, the right steps to take in the first few hours, the signs that indicate you should see a doctor right away, and what an osteopath can (or cannot) do for you.

The short answer: A stiff back is most often a common, non-serious form of lower back pain that improves within a few days and resolves in 90% of cases in less than 4 to 6 weeks, according to the French National Authority for Health (HAS). The best treatment is to stay active and avoid prolonged bed rest. Seek immediate medical attention if you have a fever, weakness in one leg, urinary problems, or numbness in the perineum. Outside of these situations, an osteopath, doctor, or physical therapist can help you resume your activities more comfortably.

The medical term is acute low back pain: pain in the lumbar region (the lower back) that comes on suddenly. The National Health Insurance program notes that it is also known as “back pain,” “lumbago,” or “a strain in the lower back,” and that it is often accompanied by a feeling of stiffness or difficulty performing certain movements (Ameli).

In the vast majority of cases, this is what is known as “common” lower back pain: it is not caused by any serious medical condition, and the spine is not “damaged,” even if the pain is severe.

The lumbar spine consists of five vertebrae (L1 through L5) that rest on the sacrum. Between each vertebra, an intervertebral disc acts as a shock absorber, and two small posterior joints guide movement. Surrounding the spine, numerous muscles stabilize the entire structure: the paravertebral muscles (on either side of the spine), the quadratus lumborum, and, deeper within, the psoas.

When one of these structures—a joint, disc, ligament, or muscle—is irritated, the nervous system often reacts with a protective reflex: the muscles contract strongly to limit movement. It is this defensive contraction that creates the sensation of being “stuck,” sometimes leaning to one side or bent forward. The stiffness is therefore a protective reaction rather than a “displaced” vertebra. No, a vertebra does not “pop out” of place during a common episode of lumbago.

People often blame a “sudden, awkward movement.” In reality, as the French National Health Insurance points out, what we call a sudden, awkward movement is actually part of the ordinary movements of daily life (Ameli). The triggering action—such as bending over, carrying a case of water, or getting out of a car—is often the last straw that breaks the camel’s back, adding to a situation already strained by fatigue, stress, a sedentary lifestyle (working from home, commuting), unusual physical exertion (moving, gardening, resuming exercise too quickly), poor sleep, or a history of lower back pain.

This is the most important—and most counterintuitive—piece of advice. The French National Health Insurance system (Ameli) is clear: staying in bed for more than a day or two is not the answer, and staying active helps you get better faster (Ameli, key messages). In fact, the French National Authority for Health (HAS) considers physical activity to be the primary treatment for common low back pain (HAS, 2019).

In practical terms, if the pain is very severe, you can lie down for a few hours to relieve it, then start walking again in short sessions as soon as possible—even slowly, even just a few minutes at a time.

Two positions often provide relief: lying on your back with your legs resting on a sofa (hips and knees bent at 90°), or lying on your side in the fetal position with a pillow between your knees.

Slow, low-amplitude movements “calm” the nervous system and help the muscles let go of their protective tension:

• rock the pelvis while lying on your back with your knees bent (arch your back, then gently press your lower back against the floor); - slowly roll your knees from right to left while remaining lying down;
• Walk slowly around your home, then outside.

The rule: Moderate discomfort is acceptable, but pain that increases significantly is a sign that you should reduce the range of motion. You’ll find more ideas in our article “6 Simple Exercises to Relieve Back Pain.”

Many people find relief by applying a source of heat (such as a hot water bottle or a hot shower) to their lower back. This helps you relax and makes it easier to move. For pain relievers, ask your doctor or pharmacist for advice: they are the only ones who can recommend a medication suited to your situation and medical history. Osteopaths do not prescribe medication.

The HAS recommendsself-management and a return to daily activities, including an early return to work if possible (HAS, fact sheet). If your job involves physical labor, talk to your doctor or your occupational health physician.

The good news is that the most severe pain usually subsides within a few days, and the HAS reports that in 90% of cases, common low back pain improves within 4 to 6 weeks (HAS).

As a general guide, here's how things often unfold:

The HAS recommends reassessing the situation 2 to 4 weeks after an acute flare-up. After 3 months, the condition is considered chronic low back pain, a topic we discuss in detail in our article on chronic back pain.

A stiff back is rarely serious, but certain signs should prompt you to see a doctor right away. The HAS refers to these as “red flags” (HAS):

This is a medical emergency: call 15 (SAMU) or go to the emergency room if you experience difficulty urinating or having a bowel movement, loss of bladder control, or numbness in the perineum or inner thighs (“saddle anesthesia”). These symptoms may indicate nerve compression (cauda equina syndrome), which requires immediate surgical intervention.

If the pain radiates down your leg below the knee, it could be sciatica: read our article on sciatica and talk to your doctor about it.

The primary care physician diagnoses common lower back pain, rules out any more serious causes, and may prescribe pain medication, a sick leave if necessary, or physical therapy. If there are any warning signs, you should see the primary care physician (or go to the emergency room) first.

The HAS recommends physical therapy involving active patient participation (exercises, rehabilitation) for people with low back pain that is persistent or at risk of becoming chronic.

An osteopath is a primary-care practitioner: you can see one without a prescription. The HAS classifies manual techniques (manipulations, mobilizations) as a possible option, provided they are part of a treatment plan that combines physical activity and patient education, and not as a stand-alone treatment (HAS, fact sheet). A meta-analysis published in JAMA found that spinal manipulations for acute low back pain resulted in a modest improvement in pain and function in the short term, with adverse effects that were most often minor and transient (stiffness, temporary discomfort) (Paige et al., JAMA 2017).

During an in-office consultation, your osteopath will: - ask you detailed questions (circumstances, medical history, treatments, associated symptoms) and look for warning signs. They will refer you to a physician if there is the slightest doubt, as required by Decree No. 2007-435 (Légifrance); - perform an examination of the mobility of the pelvis, spine, hips, and chest; - use gentle manual techniques tailored to your current pain (mobilization, muscular, or fascial techniques). Joint manipulations that produce a “cracking” sound are never mandatory and are performed only with your consent (see “Understanding the ‘Crack’”); - Above all, provides you with practical advice on how to move in the days that follow and how to minimize the risk of recurrence.

What an osteopath does not do: He does not make medical diagnoses, does not prescribe medication or imaging tests, and does not replace your doctor. He does not “put a vertebra back in place”: His goal is to help you regain mobility and comfort so you can resume your activities. Doctors, physical therapists, and osteopaths complement each other. See also our comparison of physical therapy and osteopathy.

A first episode of lumbago is often followed by others. The most effective measures are simple:

Our two offices are located in Versailles: Versailles Chantiers (2 rue Alexis de Tocqueville), a few minutes’ walk from the Versailles-Chantiers train station, and Versailles Grand Siècle (3 rue de l’École des Postes).

They see patients from Versailles and neighboring towns (Viroflay, Le Chesnay-Rocquencourt, Saint-Cyr-l’École, Buc, Jouy-en-Josas, Vélizy-Villacoublay…), including on Saturdays.

To learn more about what happens during a session, see the Osteopathy Consultation page. To make an appointment, visit the appointment booking page or call 01 84 73 29 34.

The two are complementary. You can see an osteopath without a prescription; they combine manual techniques with advice on movement. A physical therapist is particularly recommended for persistent pain and can prescribe active exercises. If you experience any warning signs (fever, weakness in one leg, urinary problems), see a doctor first.

The most severe pain usually subsides within a few days. According to the HAS, 90% of common cases of low back pain improve within 4 to 6 weeks. If the pain does not improve after 2 to 4 weeks, or if it worsens, see your doctor again.

No, no more than a day or two. The National Health Insurance and the HAS recommend staying active and gradually resuming your activities, since movement speeds up recovery.

Most often, this is a protective muscle spasm in the lower back—alarming but harmless. However, it is a medical emergency if it is accompanied by urinary or bowel problems, numbness in the perineum, or weakness in the legs: in that case, call 15.

Unless there are warning signs, no. The HAS states that imaging is not indicated during an acute episode of common low back pain. Your doctor will decide whether you need one.

Emergency appointments are sometimes available at our offices in Versailles, including on Saturdays. Call the office or check availability online. If you have any warning signs, see a doctor first.