Low Back Pain: How I Think About Finding the Cause, Not Just Quieting It

Low back pain is one of the most common reasons anyone sees a physician, and one of the most common reasons people feel frustrated with their care. Many of the patients I see have already been through some version of the same cycle: rest, a prescription, maybe an x-ray, and advice to come back if it does not improve. For some people that is enough. For many, the pain keeps returning, and no one has explained why.

I approach it differently, and I want to walk through how.

Why low back pain is complicated

The low back is not a single structure. Pain can come from the muscles and fascia that support the spine, from the facet joints that connect the vertebrae, from the sacroiliac joints where the spine meets the pelvis, from the discs between the vertebrae, or from irritation of a nerve root, which is what most people mean when they say sciatica. Sometimes more than one of these is involved at once.

This is why generic advice so often falls short. A treatment that helps a facet joint problem may do very little for a muscular or sacroiliac issue. Before I can treat your back well, I need to understand which structures are actually driving your pain.

What the standard approach tends to miss

Two things happen often in conventional care that I try to avoid. The first is reaching for imaging too quickly. An MRI can be valuable in the right situation, but in many cases it shows changes, like mild disc degeneration, that are extremely common and may have nothing to do with your pain. Treating the scan instead of the person leads to unnecessary worry and sometimes unnecessary procedures.

The second is defaulting to medication that masks the pain without addressing what is causing it. Managing symptoms has a place, particularly early on, but it is not a plan on its own.

How I evaluate your back

My first visit is largely a conversation and a hands-on exam. I want to know when the pain started, what makes it better or worse, whether it travels down a leg, and how it affects your work, sleep, and activity. Then I examine how your spine and pelvis move, where the restrictions are, and how the surrounding muscles are responding.

That assessment usually tells me more than a scan would. It is also where my osteopathic training matters, because I am trained to evaluate the body as an interconnected system rather than a collection of separate parts.

Osteopathic manipulative treatment for the back

For many patients with low back pain, osteopathic manipulative treatment (OMT) is a good starting point. OMT is a hands-on approach where I use techniques such as myofascial release, muscle energy, counterstrain, and, when appropriate, high-velocity low-amplitude adjustments to improve how the spine and pelvis move and to relieve the tension patterns that are contributing to pain.

OMT is not a one-time fix for everyone, and how many sessions help varies from person to person. But it addresses the mechanics of the problem directly, and many patients feel meaningful relief without medication or injections.

Movement, strength, and rehabilitation

Hands-on treatment works best when it is paired with the right movement. As a sports medicine physician, I look closely at how you move and where you may be compensating, because low back pain is frequently connected to weakness or stiffness somewhere else, often the hips or core.

I regularly work alongside physical therapy, and I see rehabilitation as part of the treatment plan rather than an afterthought. The goal is not only to relieve the current episode but to reduce how often it comes back.

When injections are part of the picture

Some back pain comes from specific structures, such as the facet or sacroiliac joints, that can respond to targeted, image-guided injections. I want to be clear about my role here: I do not perform spinal injections. When I believe an injection into a structure of the spine is worth considering, I refer to a spine interventionalist, a physician who specializes in image-guided spinal procedures, and I coordinate that care alongside the hands-on and rehabilitation work we do together.

Regenerative medicine approaches such as PRP are an area of growing interest for back pain as well, but the research is still developing and is less established than it is for joints like the knee. Where a regenerative or other injection into the spine might be appropriate, that also falls to a spine interventionalist. My focus is on evaluating your pain accurately, treating what I can with OMT, behavior patterns and rehabilitation, and making sure you get to the right person for anything I do not perform myself.

When back pain needs more urgent attention

Most low back pain is not dangerous, but some symptoms warrant prompt evaluation. Numbness in the groin or inner thighs, loss of bladder or bowel control, progressive weakness in a leg, a fever alongside back pain, or significant pain following a serious injury are all reasons to be seen quickly rather than waiting. I would rather you reach out and be reassured than sit on something that needs faster attention.

I am also clear with patients about when a problem is outside what I can treat. If your situation calls for surgical evaluation or another specialist, I will tell you and help point you in the right direction.

The bottom line

The majority of low back pain can be improved without surgery and without relying on long-term medication, but it starts with understanding what is actually causing the pain in your particular case. That is the part that so often gets skipped.

If you have been living with back pain and feel like no one has taken the time to figure out why, I would be glad to. You do not need a referral, and I do not work with insurance, so our time together is spent on you rather than on a coverage decision made by someone who has never examined your back.

No referral needed. No insurance required. Book a consultation directly at leewardhealth.me.

I'll take time to discuss all of it.