Condition
Low Back Pain
The most common reason people find us, and the most commonly mistreated.
84%
of adults experience significant low back pain at some point
Most low back pain is mechanical, and most of it resolves — but only after somebody works out which of the four common mechanisms is actually driving it.
What it feels like
- Aching or stiffness across the belt line, often worse in the morning
- Sharp catching pain on bending, twisting, or standing from a chair
- Pain that eases with walking but worsens with prolonged sitting
- Pain that eases with sitting but worsens with standing or walking
- Difficulty finding a comfortable sleeping position
What tends to cause it
- Facet joint irritation from extension and rotation loading
- Disc involvement, with or without nerve symptoms
- Sacroiliac joint dysfunction, usually one-sided and low
- Muscular strain and protective guarding
- Deconditioning after a long layoff, illness, or desk-bound period
Low back pain is close to universal, overwhelmingly mechanical, and usually gets better. Those three facts should be reassuring, and mostly they are. What they hide is that “mechanical low back pain” is not one condition — it is at least four, they respond to different treatment, and the difference is not obvious from where you are standing.
The four patterns
Disc. Worse with sitting, bending forward, and first thing in the morning. Better standing and walking. May refer into the buttock or leg. Coughing and sneezing hurt.
Facet joint. Worse with standing, walking, and leaning back. Better sitting and leaning forward. Usually a band of pain across the low back, often one side.
Sacroiliac joint. One-sided, low, often pointed to with one finger just inside the back of the pelvis. Worse with single-leg loading — stairs, getting out of a car, rolling in bed.
Muscular. Diffuse, achy, worse with sustained positions and after activity. Improves with movement and heat. Usually the most straightforward of the four.
Read those again and notice that disc and facet have almost exactly opposite aggravating factors. The same generic advice cannot serve both, which is why “core exercises and stretching” helps some people enormously and makes others worse.
What actually predicts a good outcome
Not the severity of your pain. Not what shows up on imaging. The strongest predictors are how quickly you resume normal activity, whether you believe your back is fundamentally damaged, and whether you build capacity back afterward.
That second one matters more than people expect. Patients who believe their spine is fragile move less, brace more, and recover slower — and the fear is usually installed by a well-meaning provider showing them a scary picture of a normal, age-appropriate disc.
Your back is not fragile. It is one of the most robust structures you own, and it is currently irritated.
How we treat it here
Work out which mechanism you have
Discs hurt with sitting and flexion. Facets hurt with standing and extension. SI joints hurt on one side, low, and are provoked by single-leg loading. These feel similar to you and behave completely differently under testing. This distinction is the entire first visit.
Calm the irritable structure
Manual therapy, adjustment of restricted segments, soft tissue work for guarding, and where a disc is involved, decompression. The goal in weeks one to two is simply to lower the irritability enough that you can move.
Reload deliberately
Movement is the treatment, not the reward for finishing treatment. As soon as you can tolerate it we start progressive loading — because the strongest predictor of another episode is the one you just had.
Re-exam at visit six
Same measurements as intake. If they have not moved, the diagnosis is wrong or the plan is wrong, and we change one of them rather than continuing.
Low back pain
Questions we get about this.
Should I get an MRI?
For most low back pain, no — at least not initially. Imaging guidelines from essentially every major body recommend against routine early imaging without red flags, and the reason is that MRIs of pain-free people are full of disc bulges, degeneration, and annular tears. Finding one of those on your scan does not establish that it is causing your pain, and it does measurably worsen outcomes by making people afraid to move. We image when there are red flags, when there is a progressive neurological deficit, or when conservative care has failed and it would change what we do next.
Should I rest?
Not beyond a day or two. Bed rest was standard advice for decades and the evidence now points clearly the other way — extended rest slows recovery. Stay as active as the pain allows, modify what you need to, and keep moving.
Why does it keep coming back?
Usually because the episode got treated and the underlying capacity never did. Pain resolves well before tissue tolerance returns, so people go back to full load six weeks early. The loading phase is the part that changes recurrence rates.
Is my posture the cause?
Less than you have been told. The research linking specific postures to back pain is much weaker than the internet suggests. Sustained positions matter more than which position it is. The best posture is genuinely the next one.
New patient special — $59 New Patient Visit
Get your low back pain properly examined.
One visit, a real diagnosis, and a plan with a visit count and an end date. If it turns out we are not the right provider, we will say so and point you to who is.
Columbus, OH · Same-week appointments · Most insurance accepted