Back pain: why the lower back is rarely the culprit
Low back pain that always returns to the same spot tells a story that starts somewhere else. What I look for in a session, and why I look at your feet.
There is a question I ask every time, and it surprises people: have you ever sprained an ankle?
They have had low back pain for eight months. That is what they came for. And I am asking about a sprain from 2019 they had almost forgotten.
The frog’s legs
In the morning one leg folds up in bed. At the desk one thigh crosses over the other, and it is the same one that comes back. In the evening a leg ends up under the hip. None of these positions is bad in itself.
What becomes interesting when someone is in pain is the habit: the same position, held for a long time, on the same side, replayed every day. The spot that hurts is rarely the one that started it.
The lower back is part of the pelvis
This is the point I find most useful to explain, because it changes how people understand their own pain.
Lumbar vertebrae do not exist on their own. They articulate with the sacrum, which belongs to the pelvis, which sits on the hips, which sit on the knees, ankles and feet. That column of support works together at every step.
When one link stops taking part, the others compensate. The lower back is the one that compensates most, because it sits at the crossroads.
What I look at, and what surprises people
Your feet. How you land on the heel, whether you roll more to one side, whether one support is shorter than the other.
Your hips. A hip that has lost fifteen degrees of rotation forces the lumbar spine to supply those fifteen degrees instead, several thousand times a day.
Your breathing. The diaphragm attaches directly to the lumbar vertebrae. High, shallow breathing held for months pulls on them constantly.
Your history. How you grew, what sport you played through adolescence, what injuries you had and how they settled. The growth of the spine and of the lower limbs is sensitive to a great deal, and the body keeps a record of those adaptations.
Why it comes back
Low back pain that returns to the same spot after every session means the work went to where it hurt, and not to what keeps the strain going for the rest of the week.
That does not mean the session did nothing. It relieved something, and relief counts. But if the source of the strain has not moved, the strain returns.
It is also why I ask so many questions before placing my hands. The history of a pain is more informative than the pain itself.
What should send you to a doctor first
Pain that started after an impact or a fall. Pins and needles or loss of strength in a leg. Fever, unexplained weight loss, or pain that wakes you at night. New difficulty passing urine alongside the pain.
In those cases medical advice comes before anything else, and I would refer you there in any case.