Common Causes, Treatments, and How We Get You Back to the Activities You Love.
If you've ever experienced low back pain, just know you're not alone. Low back pain is one of the most common reasons people visit a healthcare provider and one of the leading causes of movement disabilities and reduced physical activity. In fact, over 90% of people deal with low back pain at some point in their life.
But I’m gonna let you in on a little secret…
Most episodes of low back pain are highly treatable, and most people can recover without the need for excessive doctor visits, surgery, or long-term medications.
Unfortunately, there's also a lot of misinformation out there surrounding back pain, its causes, and the best ways to treat it. Even today, despite all the advancements in medical knowledge, many people have been told they have a "bad back," it’s a “genetic issue”, that they should stop exercising, or that they'll simply have to live with it because they're getting older. That's just not true.
There is always a solution.
At Competitive Edge Physical Therapy & Performance, we've helped hundreds of Columbus’ active adults return to lifting weights, running, CrossFit, golf, hiking, and simply enjoying life again without letting back pain control them.
This guide is designed to answer nearly every question you may have about low back pain and serve as your starting point for understanding what causes it, what actually works, and how to recover safely.
For the sake of this article, we will be referring to Low back pain as the discomfort felt between the bottom of your rib cage and the top of your hips.
Most often it can be described as:
Also, the pain may stay localized or travel into the buttocks or legs. But for the sake of this article we will stick to pain felt in the area in the picture above.
Back pain can develop:
Through all this there is one VERY important thing to understand:
Pain does not automatically mean damage.
Many people experience severe pain despite having no injury to the actual tissue or joints of the low back. So why does your back hurt? The answer to that question isn’t easy to explain, but let’s do our best to break it down.
Your spine is an incredibly strong structure. In the low back alone, there are multiple bones, discs between each vertebrae, countless ligaments connecting the bones together, several layers of muscle and tendons, very thick and strong fascia, not to mention the nerves, blood supply, fatty tissue, and skin.
Being such a complex area with lots of movement, we can only assume pain can come from one (or multiple) of these structures. There are some usual suspects, but pain, and especially back pain, is rarely caused by a single "thing."
Instead, it's usually the result of several factors coming together.
These can include:
It helps to think of your back pain like an overloaded system rather than a single thing that needs to be “fixed”.
Think of your back like a cup. Every stress you put on your back such as training, sitting, lifting, poor sleep, work, or simply doing more than you're used to will add a little water to that cup.
Most of the time, your body handles those stresses just fine. But when the cup gets too full and eventually overflows, that’s when you may start to experience back pain.
There may have been 20 different things slowly filling your cup over the course of the day/weeks/months before one final activity caused it to “overflow”.
That last squat, deadlift, run, or time you bent over may have been when you felt the pain, but it wasn’t necessarily the only reason the pain started.
Muscle Strain
The most common cause of back pain we see with our patients is a muscle or joint strain. We usually hear people describe these as the “throwing your back out” type of injuries. There is less evidence to believe that this pain is a joint in your back that is out of place, and more than likely you caused too much strain. (See the “overflowing cup” analogy above). Because of that, the muscles tense up and make the surrounding joints very stiff and painful, and because our spine was built for movement and contains numerous joints in a small area, that effect is magnified more than most other areas causing your movement to become very difficult and painful.
These things can occur after heavy lifting, yard work, repetitive bending or movement, or even things like a fall, or quick unexpected movement.
The tissues become irritated fast, but generally recover well.
The discs in your spine act like cushions between each vertebra, helping absorb and distribute forces as you move, lift, and exercise. Like any other structure in the body, they can become irritated from repetitive loading, doing more than your body is prepared for, or occasionally from a sudden increase in force. These are often associated with nerve irritation, more of which is covered below.
The good news is that a disc injury does not automatically mean you need surgery or have to stop being active. Many disc-related back problems improve with time and the right rehabilitation plan focused on gradually restoring movement, strength, and confidence.
The small joints in your spine, known as facet joints, can sometimes become stiff or irritated. When this happens, you may notice discomfort with prolonged standing, twisting or rotating your back. Some people also experience increased stiffness first thing in the morning or after sitting for an extended period of time.
Sometimes irritation or inflammation in the lower back can affect nearby nerves, causing symptoms that travel beyond the back itself. This may include pain that travels down the leg, along with tingling, numbness, or burning sensations. These symptoms are often broadly referred to as “sciatica,” but there can be several different reasons why a nerve becomes irritated, which is why identifying the underlying cause is important.
It often starts with one of the previously discussed causes, like muscle strain, joint, or disc irritation.
Sometimes back pain isn’t the result of a specific structure as we learned previously. Instead, the muscles that support and control your spine may not be prepared for the amount or type of stress being placed on them.
Just like any other part of the body, your back needs adequate strength and capacity to handle the demands of lifting, running, exercising, work, and everyday life. When those demands consistently exceed your current capacity, pain can develop. Building strength in and around the spine and gradually increasing what your back can tolerate is a crucial part of getting back to the activities you enjoy.
One of the biggest misconceptions about back pain is believing an X-ray or MRI tells the whole story. While there may be some scary words thrown around like disc bulge, degeneration, arthritis, stenosis, or herniation, these findings don’t always explain why you’re experiencing pain. In fact, many people without any back pain at all have “abnormal findings” on imaging.
An X-Ray or MRI is just one piece of the puzzle and should be considered alongside your symptoms, movement, strength, activity level, and overall clinical assessment. The goal shouldn’t be to simply “treat the image” but to understand what is actually limiting you and develop a plan to help you move, get stronger, and return to the activities you enjoy.
Research consistently shows many pain-free adults have findings such as…
At Competitive Edge, we always treat the person in front of us, not the picture of their spine.
While most back pain is not dangerous, we advise that you seek urgent medical attention if you experience any of the following symptoms.
Fortunately, these situations are very uncommon. But we must remain vigilant and treat these issues as a medical problem, and something that physical therapy will not be able to help until cleared by your physician.
Seeing “arthritis” or “degenerative changes” on an X-ray or MRI can sound scary, but these findings are incredibly common, even in people who have no back pain at all. Changes in your spine are a normal part of aging and don't necessarily mean they are the source of your symptoms. Your imaging is only one piece of the puzzle.
Taking it easy for a short period of time may help when your back is particularly irritated, but prolonged rest is rarely the long-term solution. Too much rest can actually lead to decreased strength, mobility, and confidence in movement. In most cases, gradually getting back to movement and activity you were doing before is an important part of recovery.
Imaging can be extremely valuable when there are specific reasons to use it, but most cases of back pain don't require an X-ray or MRI. A thorough evaluation looking at your symptoms, movement, strength, activity level, and history can often provide much more useful information for developing a treatment plan that gets results.
The overwhelming majority of people with back pain will never need surgery. Even conditions such as disc bulges and herniations can often improve with conservative treatment. Rehabilitation focused on gradually restoring movement, strength, and tolerance to activity is typically the first line of treatment.
Pain doesn't automatically mean there is damage happening in your back. Pain is your body's warning system, and that system can become more sensitive when an area is irritated or when you're doing more than your body is currently prepared to handle. Understanding this can help remove some of the fear around moving when your back hurts.
There isn't one "perfect" posture that prevents back pain, and having back pain doesn't automatically mean your core is weak. Your body is designed to move through many different positions. Instead of constantly trying to maintain perfect posture or brace your core, focus on regularly changing positions. Our body likes variety, so being in one position for too long, even if that position is “perfect posture”, will start to cause some discomfort or tightness. If you find yourself in a job or activity that requires prolonged positioning or sitting, try setting an alarm on your phone every 30 minutes to switch up how you’re sitting.
You don't necessarily need to stop lifting just because your back hurts. You may need to temporarily modify the weight, range of motion, exercise selection, volume, or intensity while symptoms settle down. In fact, appropriately dosed strength training is an important part of building a stronger, more resilient back and returning to the activities you enjoy.
Age and genetics can influence certain changes in the spine, but they don't determine your future or mean you're destined to live with back pain. Regardless of your age or family history, there are plenty of things you can control including your strength, activity level, sleep, recovery, and how gradually you expose your body to physical demands. Getting older doesn't mean you have to stop doing the things you love.
Exercise is almost always a resounding YES. But you’re probably telling me, “but my back hurts when I exercise, you must be crazy”. And to that I reference you to the Myth 7 above. If you can continue to exercise while making adjustments to weight, range of motion, exercise selection, volume, or intensity without increasing or aggravating pain, then you are in business!
The key is choosing the right exercises at the right time. Good exercises are progressive, individualized, and goal-oriented.
Also a good time to state that pain during exercise doesn't automatically mean you're causing harm. Things are sensitive, yes it may hurt a bit. But as long as the discomfort doesn’t get worse during or after that exercise it’s most likely safe to do.
Learning the difference between acceptable discomfort and symptom flare-ups is one of the most important parts of rehabilitation. And it’s where most people (and other physical therapists) miss the mark and make black and white decisions on “keep pushing” or “ completely stop”.
The research is clear, for those suffering with low back pain, there are a few obvious treatment choices for getting out of pain. We use them in the clinic on a daily basis with our patients. Whether you’ve been in pain for 10 hours or 10 years, or if your pain is a 1/10 or a 10/10, each of these have a place in every rehab plan we develop.
At different phases of the plan, there will obviously be different focuses; such as pain relief, basic movement rebuilding, coordination and stability, muscle activation, and strengthening and long term movement confidence building. We listed each in the order of how much we use them with our patients.
For active adults dealing with low back pain, exercise and strength training is arguably the most effective tool for getting back to the activities they love. Rather than avoiding movement or relying on rest, a progressive exercise program can help restore mobility, rebuild strength, and improve your body’s ability to handle everyday and training demands. Of course these exercises can look 1000 different ways.
If your pain is more severe, you better believe the exercises will look basic and low intensity to start. But if you have very little pain and can do quite a bit of movement, you better believe we’re going to turn up the intensity dial a bit, especially if you have aspirations to return to weightlifting or any high demand exercise or sport.
One of our favorite treatments for managing back pain! Dry Needling is helpful for reducing muscle tension and improving movement of an area, and has some immediate benefits for improving blood flow and tissue healing quality. Most patients feel little to no pain with this treatment. It is also a great precursor to exercise and movement therapies because it gives us such a momentum shift to get your body moving better!
In a nutshell, the manual therapy we use will be to help reduce pain and improve movement. Since every body is different, that will look different for each patient.
Used more in the early phases of a rehab plan, manual therapy can take many different shapes. It may start out as gentle joint mobilizations or soft tissue work to promote relaxation and pain relief. It could look like joint manipulations to reduce muscle tone and improve joint mobility. It might be some aggressive stretching to get joints and muscles activated and moving like they haven't been in years.
Learning better movement strategies can help your body handle the demands of lifting, running, and everyday activities more efficiently. This doesn’t mean there is one “perfect” way to move that fits every person, but our goal is finding strategies that feel comfortable, strong, and appropriate for the task at hand and for you specifically. By doing this we can reduce unnecessary stress on sensitive areas while allowing you to gradually build strength and confidence. The goal is to help you move without constantly worrying about pain or reinjury, both short term and long term.
While the education we utilize is always baked into our sessions, we can’t forget to mention its importance in developing stronger pain free humans. Understanding how pain behaves and understanding what's really going on in your body helps to reduce fear and helps you recover faster. Plus, you leave with the knowledge of what to do in other instances of pain and how to help yourself long term!
Passive treatments like these can provide temporary relief, but they rarely address the underlying issue when used by themselves. Instead, we often recommend using them as an extra tool to support the main work you’re already doing in physical therapy.
Examples of passive treatments include:
These all may help calm symptoms, but true lasting improvement usually comes from restoring strength, movement, and confidence in your body.
Not every ache or pain in your back means you need to see a physical therapist right away. But a physical therapist can help you understand why you’re hurting, what you can safely keep doing, and what needs to improve so you can get back to moving with confidence. Here are the top reasons when seeing a PT would be beneficial to you.
The sooner you understand what's driving your symptoms, the sooner you can start building a plan that gets you back to doing what you love. We often tell people the sooner you can get in to see us, the sooner your pain goes away and the less you need to see us. But of course not everyone is that way. We see many patients that delay doing much about their pain for months or years until it gets so bad they can’t do half the things they used to do. In those cases, there is still so much hope and potential, it just takes a little more time and effort to get the results you want.
Our goal isn't simply to help your back stop hurting, we are here to help you become more resilient than you were before the pain started.
That means every plan is built around your specific goals whether that's deadlifting 400 pounds, training for your first half marathon, playing golf without stiffness, or simply picking up your kids without hesitation.
Instead of handing you a sheet of generic stretches that every other patient gets and hoping for the best, we identify the main factors contributing to your pain and create a step-by-step roadmap for recovery. Along the way, we work to adjust your training, build strength and motion where you need it, improve overall movement quality, and gradually expose your body to the activities you've been avoiding to get your confidence back.
The end goal of PT isn’t just to feel pain free, it's developing more confidence, more movement capacity, and fewer setbacks as you continue to live your active lifestyle.
The best long-term strategy to prevent back pain is preparing your body to handle life's demands. That can look different for everyone based on habits and lifestyle though. Here are some non-negotiables to keep you feeling good and moving well.
Our spine is designed to move constantly, adapt to different stimuli, and become stronger over time. If we don’t use it, we lose the capability to do it. So the more consistently you challenge it with appropriate movement and strengthening, the more resilient it becomes, and the less injury you have.
We know better than anyone, low back pain is not only an annoyance, it can be frustrating, discouraging, and sometimes scary. But it DOES NOT have to define your future.
The vast majority of people can recover and return to the activities they enjoy with the right combination of education, movement, and progressive rehabilitation. It’s not about finding one “perfect stretch” or avoiding every movement that causes discomfort. What is going to give you the best long term results is having someone in your corner to help you understand your body, address the factors contributing to your pain, and gradually rebuild your movement, confidence and capacity.
If your back pain has been keeping you from lifting weights, running, exercising, or simply living the active life you want, know that there are effective solutions. If you take anything away from this article, let it be this: there is a path forward, you just have to be willing to take the first step. You don't have to settle for pain being your “new normal” and that it’s a normal part of getting older.
With the right plan, your best days of movement may still be ahead of you. If you have been dealing with low back pain that affects the way you move, exercise, or live the life you want, schedule a free phone call with our office so we can determine if you're a good fit for our program.