Day: June 9, 2025

Lower Back Pain Symptoms, Diagnosis, and Treatment

The vast majority of doctors and practitioners alike focus on purely the symptoms of lower back pain. They base both their diagnosis and treatment plan purely on what the symptoms are telling them whilst completely overlooking the underlying cause.

This is the main reason why the majority of people who present to their doctor or practitioner with acute back pain, do not respond to treatment and medication and end up going on to be chronic back pain sufferers (defined as having back pain for greater than 3 months).

This is also the main reason why up to 40% of back pain patients who go undergo back surgery recover from surgery feeling no better if not worse than before they went under the knife.

In order to address both the symptoms and the cause of back pain, providing initial pain relief then lasting relief it is important that we look at what needs to be covered in both the diagnosis and the treatment plan.  

The symptoms of lower back pain that result in direct pain:

1. Pain derived from compromised, restricted joints such as SIJ (sacroiliac joint) and facet joints.
2. Pain derived from compromised, tight muscles of the lower back such as; the intrinsic muscles that support and stabilise the spine and the quadratus lumborum muscles
3. Pain derived from nerve impingement. Either through direct contact by a herniated disc, or from inflammatory pressure.
4. Pain derived from inflammation present in and around the structures of the lower back
5. Pain derived from solidified connective tissue (fascia) that is either present to protect the back or has been built up over a period of time.

The symptoms of lower back pain that may or may not result in direct pain:

1. Intervertebral disc issues; such as herniations (bulge) and ruptures.
2. Degenerative changes to the vertebral structures (wear and tear)
3. Foraminal stenosis (narrowing of bone pathways.)

 It is important to diagnose which of the above symptoms is causing back pain, however it is imperative that a more holistic view is taken in the diagnosis of what caused the symptoms in the first place.

Typical underlying causes that bring on lower back symptoms.

1. Postural weaknesses that place excessive load on the structures of the lower back
2. Postural alignment issues that create an excessive lordotic curve to the lumbar spine which comprises the way the muscles, joints and intervertebral discs function.
3. Protective, compensatory patterns that tighten and fatigue the lower back muscles.

Therefore the lower back pain diagnosis must cover

1. The exact symptoms of the lower back producing pain and restricting function.
2. The exact cause of what has brought on the symptoms

In turn the treatment plan must address both the cause and the symptoms of back pain.

1. Treatment techniques need to be engaged to reduce pain, inflammation and restricted movement.
2. The rehabilitation plan must look to lengthen the tight and shortened muscles creating excess tension on the lower back
3. The rehabilitation plan must focus on strengthening the weak and lengthen postural muscles integral to supporting the lower back and pelvis.

By focusing in on both the symptoms and cause of lower back pain, can eliminate repetitive lower back flare ups and give back pain sufferers the confidence to carry out daily actions without the fear of putting their lower back out.

Why is lower back pain considered one of the hardest conditions to address?   

Many practitioners dread the complexity of a chronic lower back sufferer attending their clinic. If time hasn’t healed the patient’s condition, if many other practitioners have attempted, yet failed to provide lasting relief then how are they going to be able to help?

Some practitioners work to a formula, if they cannot help after 4 sessions or after a certain amount of  weeks then they will tell the back pain sufferer that their treatment approach is most likely not going to help them. The majority of practitioners who have difficulty treating lower back pain, try different approaches trying to find a solution to their patients pain, with the process often taking many months if not years until the patient seeks treatment elsewhere.

The lower back is a complex part of the human anatomy. There are many different structures that make up and support the lower back and any number of these structures can be the source of pain for the back pain patient. Identifying the source of the pain, and how best to treat it is one of  the most difficult tasks for practitioner treating chronic back pain sufferers.

We need our lower back in order to carry out most daily activities, in fact the only time our lower back gets to rest is often times when we are lying down in bed. This makes resting an injured back, or a recently treated lower back very challenging, which is another factor in the complexity of addressing a lower back complaint.  

The most common complaint amongst chronic back pain sufferers about treatment received from practitioners is that it only provides temporary relief from their pain. They feel much better in the hours/ days post treatment, with a greater range of movement and reduced pain only for the pain and restriction to return soon after their appointment.

The frustration for both the patient and practitioner is why the pain continues to return, why the pain areas shift around and why the MRI scans do not show a significant cause for the ongoing condition.

From experience in both seeing many practitioners as a back pain sufferer, then as a practitioner who has mentored other practitioners who want to specialise in chronic back pain, my observation has been that the vast majority of practitioners focus on the symptoms of back pain and completely overlook the underlying cause.  

Practitioners treat the symptoms that cause pain,  which makes the back pain patient feel better temporarily, only for the pain to return. This pattern continues with both the back pain sufferer and the practitioner aware of why it occurs.

If the body is not strong enough to support its own weight – then there will be significant biomechanical changes to compensate for this weakness. The most common underlying cause of back pain is muscular imbalances that compromise the structures of the lower back. The symptoms are the pain or damage that occurs to the structures of the lower back, and if you keep treating the symptoms and overlook the muscular imbalances then you will continue the same pattern of short term symptomatic relief.

Granted, lower back injuries are complicated in comparison to other regions of the human body. However correct postural analysis will clearly outline that the structures of the lower back are compromised resulting in pain and dysfunction.

Addressing the postural imbalances in conjunction with treating the symptoms will provide chronic lower back pain sufferers both temporary relief and a lasting solution to their pain.