Low Back Pain

What low back pain is

Low back pain is pain in the lumbar spine — usually somewhere between the bottom of the rib cage and the top of the pelvis — coming from joints, discs, muscles, ligaments, or nerves of the lower back. The large majority of cases are mechanical: the pain is driven by how the lower back is moving and loading rather than by serious underlying disease. Most respond well to conservative care, and most don’t need imaging or specialist referral to get better.

What’s actually going on

The lumbar spine is built for both stability and motion — five vertebrae stacked over the pelvis, supported by discs, ligaments, deep stabilizers, and the larger movers of the trunk and hips. Low back pain almost always involves the interaction of these tissues rather than a single isolated structure. A disc that’s mildly irritated tends to come with the joints around it locking up, the muscles around the joints guarding, and the larger movement patterns through the pelvis and hips compensating in subtle ways.

That’s why the helpful frame for most low back pain is mechanical — it’s about how the system is moving and loading, not about a single broken part. Imaging changes (mild disc bulges, age-related arthritis, “wear and tear”) are extremely common findings in people with no pain at all, which is why rushing to imaging early in a typical low back pain episode often raises more questions than it answers.

When to see someone

The vast majority of low back pain doesn’t need imaging or a specialist. It does benefit from getting it looked at — earlier rather than later — so you don’t spend weeks compensating around it.

Reasons to come in:

• Pain that’s lasted more than a week without clear improvement
• Pain that’s interfering with sleep, work, or activity
• Pain that radiates down the leg, especially below the knee
• Recurrent low back pain that keeps returning
• Pain after a fall, accident, or specific incident

Reasons to seek urgent medical care instead (these are uncommon but important):

• New weakness or numbness in one or both legs
• Loss of bladder or bowel control
• Severe pain after significant trauma
• Fever with back pain
• A history of cancer with new, unexplained back pain

These are signals that something other than a typical mechanical low back issue may be going on, and a trip to your family doctor or emergency department is the right first step.

How we treat it

For uncomplicated low back pain, our approach blends:

• Assessment first. A focused history and physical exam to figure out which structures are involved and which patterns are driving the symptom.
• Hands-on care. Chiropractic adjustments, joint mobilizations, and soft-tissue work like Active Release Technique® and Graston Technique® to restore motion and settle protective muscle tension.
• Registered massage therapy in parallel, particularly for patients with significant muscle guarding or stress-related tension layered on top.
• Exercise. A short, focused rehab program — typically core control, hip mobility, and graded loading — to rebuild capacity and reduce recurrence.
• Education. What’s going on, what to expect, and what to avoid in the early phase versus what to start adding back as it settles.

Most patients notice meaningful improvement within two to four visits. If we’re not seeing the progress we’d expect, we re-assess — and if your situation warrants imaging or a referral, that’s the conversation we have.

What about prevention

Most “back-saving” advice is overstated. The single most consistent thing across the research is regular movement and a baseline of capacity — back muscles, hip strength, the ability to load through the trunk without pain. Sitting isn’t the enemy people make it out to be; sitting in one position for hours every day with no movement breaks and no underlying capacity is what tends to be the problem.

A short, consistent exercise habit — even 10–15 minutes a few times a week — does more for back resilience than any specific posture rule or ergonomic gadget.

Related reading

• Low back pain after the first weekend in the garden — what’s actually happening when spring planting flares your back, and the 48-hour plan to recover.
• What I tell golfers in the first month of the Okanagan season — the back-and-hip patterns that put golfers in the clinic every April.