LOWER BACK PAIN: WHY IT KEEPS COMING BACK AND HOW PHYSIOTHERAPY CAN HELP

Understanding Lower Back Pain

Lower back pain is one of the most common reasons people seek treatment. It may begin after lifting something heavy, sitting for long hours, exercising, travelling, poor movement habits, or sometimes without any obvious reason at all.

For some people, the pain settles within a few days. For others, it keeps returning despite rest, medication, massage, or temporary relief.

But an important question is often missed: Why does your lower back keep hurting in the first place?

At DHPC, we do not look at lower back pain as simply a painful spot that needs to be treated. We assess how your body is functioning as a whole and look for factors that may be contributing to your pain.

What Causes Lower Back Pain?

Poor or altered movement patterns

Reduced mobility of the spine, pelvis or hips

Muscle weakness or poor muscle coordination

Repetitive postures and prolonged sitting

Previous injuries

Overloading during exercise or daily activities

Changes in the way your body distributes load

Stress and changes in the nervous system’s response to pain

Problems outside the musculoskeletal system that may influence how you feel or move

Two people with the same diagnosis—such as a disc bulge or “spondylosis”—may therefore require completely different treatment approaches.

The scan may show a finding. Your assessment helps determine whether that finding is actually contributing to your symptoms.

Why Does Lower Back Pain Keep Coming Back?

A common pattern is: Pain → treatment → temporary relief → return to normal activity → pain returns.

This can happen when treatment focuses only on reducing pain without addressing the factors that continue to overload the body.

At DHPC, we look beyond the painful area and consider four interconnected pillars.

The DHPC 4-Pillar Model

1. Structure

We assess structural relationships and how different regions are positioned and interacting, including the spine and pelvic region, hip mobility, joint restrictions, load distribution, previous injuries and compensations.

2. Movement

Your body may have enough strength but still move inefficiently. We assess how you move—not just how much you can move—including spinal and hip movement, core control, muscle coordination, bending, lifting and functional movement.

3. Brain

Pain is not produced by tissues alone. The brain and nervous system influence how pain is experienced and maintained. Stress, poor sleep, fear of movement and previous painful experiences can influence the pain response. This does not mean your pain is “only in your head”; the nervous system is an important part of the pain experience.

4. Viscera

Where clinically appropriate, DHPC also considers visceral relationships as part of a broader assessment. The abdominal and pelvic regions are related to the spine, pelvis, breathing mechanics and movement patterns. This does not mean every back problem is caused by a visceral problem; it means relevant factors are not automatically ignored.

Our 3-Phase Approach to Lower Back Pain Treatment

Treatment is not necessarily about using the same technique at every session. The approach can progress through three phases depending on your assessment and individual needs.

Phase 1: Pain Control

The first priority may be to make movement more comfortable and reduce excessive pain or protective muscle tension. Depending on the individual’s condition, treatment may include appropriate hands-on techniques and modalities such as myotherapy, cupping therapy, dry needling, manual therapy, movement modification and gentle therapeutic exercises.

The objective is not simply to switch off the pain. We want to create enough comfort and movement capacity for the next stage of rehabilitation.

Phase 2: Alignment Correction & Internal Healing

Once symptoms are more manageable, the focus can shift towards factors that may be contributing to repeated stress on the body.

Improving joint and movement relationships

Addressing mobility restrictions

Correcting inefficient movement patterns

Improving muscle coordination

Appropriate osteopathic or manual techniques

Progressive therapeutic exercises

Addressing relevant internal or visceral contributors when indicated

The objective is to help your body move and distribute load more efficiently.

Phase 3: Return to Activity

Pain relief alone is not the final goal. The real question is: Can you return to the activities that matter to you without constantly worrying about your back?

Progressive strengthening

Core and hip conditioning

Functional movement training

Lifting and bending strategies

Exercise progression

Return to sports or physical activity

Prevention strategies for future episodes

The aim is to move from pain management to confidence in movement.

When Should You See a Physiotherapist for Lower Back Pain?

Your pain keeps returning

Pain continues despite rest

You find it difficult to sit, stand or walk for long

Certain movements consistently trigger symptoms

You have reduced strength or mobility

Back pain is affecting work, exercise or daily activities

You are repeatedly relying on temporary pain relief

You have had a previous back injury and symptoms have returned

When Should You Seek Medical Assessment First?

Lower back pain accompanied by new bowel or bladder problems, significant or progressive weakness, numbness around the groin/saddle area, major trauma, fever, unexplained weight loss, or other concerning symptoms should not simply be treated as routine back pain. Seek appropriate medical evaluation promptly.

Do You Need an MRI for Lower Back Pain?

Not necessarily. Terms such as “disc bulge,” “disc degeneration,” “spondylosis” or “L5-S1 problem” can sound alarming. Imaging can be useful in the right situation, but an MRI finding does not automatically tell us what is causing your pain.

Your symptoms, clinical examination, movement patterns and functional limitations need to be considered alongside any imaging. At DHPC, we assess the person—not just the scan.

Why Choose DHPC for Lower Back Pain?

At Dr. Harsha’s Physiotherapy Clinic, lower back pain treatment is based on personalised assessment rather than a one-size-fits-all protocol. DHPC’s approach centres on detailed assessment, root-cause-focused care and individualised rehabilitation for pain, movement and recovery.

Depending on individual findings, treatment may incorporate physiotherapy, manual therapy, osteopathic approaches, movement rehabilitation, dry needling, cupping, myotherapy and corrective exercise.

The objective is not to keep you dependent on treatment. It is to help you understand your body, restore better movement and return to the activities you value.

Frequently Asked Questions

Can physiotherapy help chronic lower back pain?

Yes. Physiotherapy can be useful for many people with persistent or recurrent lower back pain. Treatment should be based on individual symptoms, examination findings, movement limitations and goals.

Is lower back pain always caused by a disc problem?

No. Lower back pain can have multiple contributing factors. A disc finding on an MRI does not necessarily mean that the disc is the primary source of symptoms.

Should I rest completely when I have back pain?

Usually, prolonged complete rest is not the goal. The appropriate level of activity depends on the cause and severity of symptoms. In many cases, carefully graded movement is an important part of recovery.

Can physiotherapy help if my back pain keeps coming back?

Yes. Recurrent pain deserves a proper assessment rather than repeatedly treating each painful episode in isolation.

Do I need exercises for lower back pain?

Exercise is often an important part of rehabilitation, but the right exercise depends on the individual. An exercise that helps one person may not be appropriate for another.

Can sitting for long hours cause lower back pain?

Prolonged sitting can contribute to symptoms in some people. Rather than focusing on one perfect posture, it is often more useful to improve movement variety and physical capacity.

Is back pain treatment only about the spine?

Not necessarily. At DHPC, four broad pillars—Structure, Movement, Brain and Viscera—are considered when clinically relevant.

How long does lower back pain physiotherapy take?

There is no fixed number of sessions that works for everyone. Recovery depends on factors such as duration and severity, contributing factors, physical capacity, adherence and individual goals.

Don’t Just Chase the Pain. Understand the Cause.

Lower back pain can be frustrating—especially when it keeps returning after temporary relief. Instead of repeatedly asking, “What can I do to reduce my back pain today?”, it may be more useful to ask, “Why is my back struggling in the first place?”

At DHPC, we take a broader approach to that question. Through detailed assessment and our Structure–Movement–Brain–Viscera framework, we identify factors that may be contributing to your symptoms and build a treatment pathway around your individual needs.

Pain relief is the beginning. Better movement, better capacity and confidence in your body are the goal.