How can I fix my back pain?


Back pain presents differently for different people. But the treatments for “back pain” offered are typically generic. Things like core strengthening, dry needling, Pilates, manipulations or stretching are all possible treatments for back pain.

But when the root cause of the problem is ill-defined, selecting a particular “treatment” is kind of like aiming at an invisible target – you don’t know what you’ll get.

Defining the problem

The first step to “fixing” back pain is understanding what’s causing it. Back pain is a symptom not a diagnosis. And back pain symptoms can be caused by lots of different things. For example pain in your back that radiates into you buttock and thigh could be due to:

  • Referred pain from a stiff spinal joint
  • Nerve pressure from a disc
  • The SIJ
  • Stress and anxiety
  • Spinal stenosis…

And so on. So an effective treatment is really about directing the treatment at the source.

So how can I know the source? Do I need an MRI?

The evidence suggests that getting scans for back pain not only doesn’t help (in the vast majority of cases) it actually leads to worse outcomes and slower recovery compared to people who don’t get imaging. This is usually because findings on a scan even though they are considered normal often creates fear and activity avoidance in the individuals with back pain. And in most cases knowing the anatomical “source” of the problem is not possible.

So how can you work out the root cause?

Movement testing is the key

We can accurately diagnose back pain based off how it responds to repeated movement testing. The diagnosis is not based on a particular structure but rather a symptom response. Movement testing is a simple and non-invasive way to understand what is driving your symptoms.

Different types of back pain respond differently to movement. For example:

  • One type will follow a clear pattern and change rapidly (either get worse or better)
  • Another type will do well when you sit down and bend forwards
  • Another type will be very resistant to change no matter the movement
  • Another type will be easily aggravated with any movement

Matching the treatment to the diagnosis

After achieving an accurate diagnosis based off the movement testing then the treatment can be matched appropriately.

  • Sometimes this means rapid recovery with a simple exercise in one direction
  • Sometimes it’s a slower process involving strengthening or Clinical Pilates program
  • Sometimes it means getting an injection into a nerve root
  • Sometimes its a combination of pain education, goal setting and general movement

There is no one “fix” for back pain

What did wonders for your neighbour’s back may not be what you need.

The key is understanding the problem. And you can absolutely understand the problem when you take time to assess using repeated movement testing. Don’t be fooled by skipping straight to a “treatment”.

What you should look for when seeking help with back pain…

You should find someone that essentially does these things…

  1. Takes time to know your goals
  2. Works with you to understand the problem through movement testing
  3. Explains the root problem and treatment clearly
  4. Matches the treatment to the diagnosis
  5. Encourages you to fully engage in life – whatever that means for you


Tim Cathers (Physiotherapist)

Equip Physiotherapy – Winston Hills


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