Why Does My Back Hurt? Common Causes of Lower Back Pain and Lower Back Pain Treatment

Published by Spine & Sport Center | Dr. Shane Conrad, DC

Lower back pain is the number one cause of disability worldwide, affecting roughly 80% of people at some point in their lives. It does not discriminate based on age, gender, or economic status. And yet, despite how common it is, most people still don't understand why they have lower back pain. And more importantly, they don’t know what to actually do about it.

This article is here to guide you towards recovery.

 

WHY DOES YOUR BACK HURT? THE REAL ANSWER IS SHOCKING

When people experience back pain, they imagine something dramatic is going on: a slipped disc, a shifted vertebra, or a torn muscle. While structural damage is possible, typical lower back pain is more of a neurological injury than it is a physical injury. Let me explain…

Lower back pain is typically the result of several overlapping issues: joint dysfunction, muscle imbalance, fascial restriction, movement breakdown, and a nervous system that has learned to amplify pain signals.

Every time your back hurts, it's actually learning how to hurt you more effectively in the future.

Understanding this concept is the first step toward treating lower back pain. The inconvenient truth is that the more casual you are about treating lower back pain, the more likely your back pain will recur. People focus on the pain, not the problem. When the pain resolves, so too must the problem. If only reality were this simple…

Rest is not a form of treatment. Focusing on the presence or absence of pain ensures the underlying problem remains unaddressed. You can’t feel it anymore, but it's still there. Lingering under the surface like a submarine, waiting for the right moment (or usually the exactly wrong moment) to resurface and attack. Nothing ruins your day (or week) more than bending over to tie your shoes and “throwing your back out”. These simple activities trigger the event, and we explain it away as we are just “getting older”. We blame our body; for it has betrayed us. But in reality, WE BETRAYED OUR BODY by not properly caring for it when it asked for help…

If you listen to your body when it whispers, then you won’t have to hear it scream.

 

HOW PHYSICAL INJURY BECOMES NEUROLOGICAL INJURY

1. Joint Dysfunction and Altered Mechanoreception

Your lumbar spine contains joints that are densely packed with mechanoreceptors. These specialized sensors communicate position, load, and movement information from the joint to your brain.

When joint function is impaired, the signals to the brain degrade. This can occur following a sports injury, a car accident, static postures (think computer use), or years of repetitive movements. Joint dysfunction alters the information travelling from the joint to the brain. This causes the brain to perceive a “problem” with the joint, causing increases in muscle tension around the dysfunctional joint. The muscle tension further alters how well the joint can move, and joint dysfunction further increases. A vicious cycle develops and perpetuates itself.

This is where Chiropractic adjustments shine! It’s not just about "putting bones back in place." The adjustment is a neurological intervention that restores healthy signalling from the joints to the brain.

2. Motor Control Breakdown

In healthy individuals, the stabilizing muscles of the spine activate before our arms and legs move. Spinal stability depends on this anticipatory muscle contraction. In people with back pain, this anticipatory activation is delayed or absent entirely. Instead of your spinal stabilizers activating before movement occurs, your spinal erector muscles activate after movement has already started. Movement occurs in an environment of instability instead of stability. This is what causes your back to “pinch” or “tweak”.

This is a problem you can’t stretch your way out of. It requires targeted rehabilitation specific enough to retrain the spinal stabilizing system. Back pain treatment that doesn't address motor control will never fix the problem in your back causing you back pain..

3. Fascial Restriction and Densification

Fascia is richly innervated with proprioceptors (position sensors) and nociceptors (pain sensors). Fascia responds to both mechanical load and inflammation. Injuries and repetitive loads can over time lead to fascia becoming restricted, a process called “Densification”. Densified fascia is less flexible and more pain sensitive than healthy fascia. Lower back pain treatment that does not take into account densified fascia is missing a large part of the underlying issue.

Soft tissue therapies that target fascia are the tools necessary to address this dysfunction. Chiropractic adjustments alone won't restore fascial health.

4. Central Sensitization and Pain Neuroscience

Leading scientists studying pain have shown that in chronic low back pain patients, the nervous system becomes sensitized. When the brain receives pain signals from the lower back, it amplifies those signals above what is normal. Light touch can become painful. Normal movements (like bending forward) are perceived by the brain as threatening. The brain is in an over-reacting state that standard treatment can’t resolve.

This has profound implications for back pain treatment: effective care must treat the brain, not just the lower back. Pain education, rehabilitation exercises, and movement-based therapies are not optional.

5. Disc Pathology (Which Is Less of a Villain Than You've Been Told)

Disc herniations (sometimes called “slipped discs”), disc bulges, and degenerative disc disease can cause lower back pain. However, research has found that around 52% of people without any back pain had disc bulges visible on MRI, and 38% had disc degeneration. What this evidence implies is that while disc pathology may be present, your MRI findings ARE NOT necessarily the source of your pain. This also explains why many lower back surgeries that address the MRI findings fail to provide the patient with significant improvement in the lower back pain.

 

WHAT’S MISSING IN LOWER BACK PAIN TREATMENT?

When you walk into most Chiropractic offices, you will receive adjustments only. By now you should understand that this isn’t bad care; but it is incomplete care. For many patients, especially those with chronic or recurring lower back pain, it simply isn't enough.

What's missing?

• An understanding of the brain’s role in the pain experience.
• Qualified assessment of fascial involvement and soft tissue health.
• Identification of poor motor control and weak stabilizing muscles.
• Meaningful rehabilitation structured to rebuild damaged movement patterns.
• Dry needle Acupuncture to address hyperactive soft tissues and nerves.
• A provider who understands the science and applies it to your care.

The evidence strongly indicates that a multimodal approach produces superior outcomes compared to any single intervention alone. Combining spinal manipulation with soft tissue therapy, dry needling, and meaningful rehabilitation is the standard of care. Does your Chiropractor meet this standard? If not, that might explain why your results are lacking.

THE SPINE AND SPORT CENTER DIFFERENCE:

At the Spine and Sport Center, we are not a traditional chiropractic office.

Each of our providers brings the knowledge and techniques necessary to properly address every aspect of your injury. Each treatment applies the techniques in a progressive manner, by a provider who is focused on your recovery and understands the science. When you come in with low back pain, you're not just getting an adjustment. You're receiving a comprehensive clinical program that is focused on results and supported by science and decades of clinical experience.

 

PRECISION CHIROPRACTIC ADJUSTMENTS

Our doctors focus their adjustments on restoring motion and enhancing joint mechanoreceptor function. We don’t “crack” backs for temporary relief or YouTube clicks! We assess the quality of joint motion, joint sensitivity, and neurological output — and adjust accordingly. We take the time necessary to provide these adjustments in a comfortable 1-on-1 setting that is private and won’t have you feeling like herded cattle.

SOFT TISSUE THERAPY

Your muscles, tendons, and fascia are not passive bystanders. They are active sensory organs that are actively involved in how well your spine moves and handles loads. Hands-on myofascial therapies are vital to address the layers of tissue that surround and protect your spine. A treatment plan that does not address the soft tissues is destined to fail.

DRY NEEDLING

All our doctors integrate dry needle acupuncture into our comprehensive treatment plans. Myofascial trigger points within soft tissues are notoriously resistant to massage and stretching. These “knots” are hyperirritable, causing pain and dysfunction in the muscles at a neurological level.

EXERCISE AND ACTIVE REHABILITATION

Passive treatment (adjustments, soft tissue work, dry needling) creates the environment necessary to make changes in the body. Active rehabilitation is what “locks in” those changes. Our rehabilitation specialist creates individualized exercise progressions that retrain the deep spinal stabilizers, normalize movement patterns, and build the body’s neuromuscular ability to protect the spine under load. A rehabilitation program designed specifically for you is essential for long-term recovery. You deserve better than a random video on YouTube.

THE SPORT PERFORMANCE APPROACH

High performance athletes have the same physiology as the rest of us. Working with athletes is therefore not much different than working with the average joes. We apply the same high-performance care to you. Whether you’re training for your first marathon and simply want to be able to carry in your groceries - pain is a measure of poor function. If you are poorly functioning, you can’t perform at the level you need to. Our advanced sports certifications ensure a deep understanding of movement biomechanics, training loads, and your life-specific demands that most Chiropractic offices ignore. You deserve the best care available. And we strive to provide that care to every one of our patients on every visit!

WHEN SHOULD YOU SEE A BACK PAIN CHIROPRACTOR?

You know it's time to seek help if any of the following apply to you:

• Your back pain is severe and has lasted more than three days without improvement
• You have recurring episodes of back pain more than twice a year.
• Your pain is affecting your sleep, ability to work, or participation in hobbies you enjoy.
• You have pain, numbness, tingling, or weakness travelling down your
• You are performing at a level in your sport (or life) that you are used to.
• You've self-diagnosed your back pain on Google and have been doing the same three stretches from a video you found on YouTube for the last week, and it's not working…

You shouldn’t wait for permission, a referral, or for it to get worse. Back pain that is addressed early prevents the “bad stuff” from taking hold and will shorten your recovery by weeks if not months, compared to the “wait and see” approach.

 

LOWER BACK PAIN RELIEF: WHAT TO EXPECT FROM CARE

Not all back pain is the same. The duration that you have been experiencing your pain has a significant effect on how it will typically respond to care.

ACUTE back pain is classified as pain that has been present less than six weeks. The primary factor in this situation is typically a physical injury to the tissues. At this point, the neurological consequences of pain have yet to entrench themselves. As such, proper treatment can resolve this situation quite quickly. It is important in situations that involve acute low back pain that you seek care as soon as possible and be as aggressive in your treatment plan as your schedule allows. Pain typically resolves in a few weeks' worth of care.

SUBACUTE back pain results from failure of acute back pain to resolve in the first 6 weeks following the injury. The subacute phase can last up to three months during which the neurological consequences of pain begin to amplify the physical pains that the patient is experiencing. Additionally, the neurological effects can also start to show measurable disruptions in movement patterns, muscle strength, and spinal stability. Treatment that begins in the subacute phase requires a more comprehensive plan that includes both hands-on treatment and active rehabilitation. Most patients begin noticing meaningful change within three to six weeks of consistent care, but full resolution may take months.

CHRONIC back pain (more than three months in duration) is vastly more complex. Chronic lower back pain takes a minimum of 8-12 weeks of integrated care (hands-on therapies + rehab exercises) to show improvements; and may take 8-12 months (or longer) to show significant improvements in difficult cases. In the hardest cases, chronic pain may never fully resolve, so the goal is to reach an improvement that is relevant to the patient. In chronic pain, achieved results will require ongoing treatment that combines exercise with manual therapies (Chiropractic, Massage, Acupuncture). Manual therapies without exercise are not an effective long-term strategy in these cases.

 

CHOOSING THE RIGHT CHIROPRACTOR FOR BACK PAIN

When you're choosing a Chiropractor for back pain, here are the questions worth asking after you’ve had your initial evaluation:

• Did they explain why your back hurts?
• Did they use fear tactics when talking with you? (i.e., if you don’t fix this now, you will be crippled ten years from now)
• Did they assess your movement and motor control?
• Do they offer more than adjustments? (Soft tissue work, dry needling, rehabilitation)
• Did they outline clear treatment goals and expected recovery timelines?
• Do they have any specialized training above what their peers have?
• Do they understand neuroscience, or did they talk about outdated spinal misalignment?
• Did they propose a short-term, pay-as-you-go treatment plan (4-12 weeks) or a long-term treatment plan (6-12 months) that was expensive and offered discounts for payments in full?

If the answer to these questions is largely "yes," you've found someone trustworthy.

THE BOTTOM LINE

Your back hurts because the human spine is a profoundly complex structure and something in that system has broken down. The good news is that back pain, even chronic and severe back pain, is rarely permanent with the right diagnosis and treatment. Joint motion can be restored. Fascia can be mobilized. Muscles can be retrained and strengthened. And the result will be a decrease in your symptoms of pain and disability.

But it takes a practitioner who understands all of the complex layers of care.

At Spine & Sport Center, we offer comprehensive, science-driven care that is individualized. We go beyond the Chiropractic adjustment and address all the contributing factors to your back pain. We have the experience, expertise, and dedication to guide you through the process. This is what we do. And we do it better than anyone else.

SCIENTIFIC REFERENCES

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