Back Pain

When imaging looks “fine,” stretching helps briefly, and the flare-ups keep returning with sitting, commuting, or training.
An adult of African descent holding their lower back in pain, indicating discomfort or injury.

The Clinical Reality

In desk workers and active patients, recurrent back pain is often less about “damage” and more about how the low back is managing load. Prolonged sitting and commuting can increase tissue sensitivity and protective guarding in the paraspinals, thoracolumbar fascia, hip flexors, and glutes. Training volume, sleep disruption, and stress can further lower tolerance and make symptoms easier to trigger.

Common patterns include limited hip contribution with bending, a bracing strategy that over-recruits the low back, reduced trunk endurance, and a hinge that shifts load into sensitive lumbar tissues. Symptoms can also include neural sensitivity in some cases, where the back feels “tight” but the nervous system is the limiting factor.

Why Standard Care Fails

Standard care often falls into two extremes. The first is symptom suppression through medication, passive modalities, or generic stretching, which may reduce discomfort but does not consistently change load tolerance or movement strategy. The second is a structural explanation based on imaging that does not match real-world symptom behavior. Many disc bulges and degenerative findings are common in people without pain, and they do not automatically explain why symptoms spike with a specific chair, hinge, or training week.

The gap in care is a precise functional assessment: how your symptoms change with sitting, standing, bending, lifting, and breathing and bracing. Without that, treatment can miss the driver of guarding and sensitization that keeps flare-ups recurring.

Signs & Symptoms

Do any of these sound familiar?

Pain with sitting and commuting

Builds gradually during long meetings, subway rides, or car time, then feels “stuck” when standing up. Often improves briefly with walking but returns after the next sitting block.

Bending or lifting sensitivity

Symptoms spike with forward flexion, picking up a bag, or repeated hinges. Many patients report a cautious, guarded hinge that shifts work into the low back instead of hips.

Morning stiffness or end-of-day tightening

Stiff on waking or after the workday, with a sensation of protective tightness rather than a single sharp point. Symptoms often correlate with sleep quality and stress load.

Unilateral low back or SI-region ache

One-sided ache near the beltline or upper glute that flares with walking speed changes, stairs, or single-leg training. Often linked to hip rotation limits and glute recruitment patterns.

Recurrent flare-ups with training

Flares after a spike in volume or intensity, particularly deadlifts, squats, Olympic lifting, or high-rep conditioning. Symptoms may feel fine during the session and worsen later that day or the next morning.

Root Cause Contributors

The mechanical drivers behind your symptoms

Paraspinal and thoracolumbar myofascial guarding

Protective tone in lumbar extensors and thoracolumbar tissues can raise resting sensitivity and reduce tolerance to sitting, bending, and load transfer.

Hip flexor and anterior hip stiffness with limited hip extension

Common in prolonged sitting and running. Can increase lumbar extension demand during walking, standing, and lifting, especially when fatigue sets in.

Impaired hip hinge mechanics and load sharing

A hinge that avoids hips or over-braces can drive repetitive lumbar strain sensations. Small technique errors become meaningful when combined with high training volume or long workdays.

Reduced trunk endurance and bracing strategy mismatch

Not a “weak core” label. Often a coordination issue: difficulty sustaining low-level trunk support, or bracing too hard and fatiguing quickly, leading to flare-ups later.

Neural mechanosensitivity (when present)

Irritability of lumbar nerve roots or peripheral nerves can present as back tightness, glute ache, or leg symptoms that change with positions and tension tests, even without dramatic imaging findings.

What to Expect

Your roadmap to recovery
Weeks 1 to 2
Symptoms become more predictable. Many patients notice improved ease with standing up from sitting, less protective tightness, and a clearer understanding of which movements and loads are currently tolerated.
Weeks 3 to 6
Improved sitting and commuting tolerance with fewer spikes. Hinge mechanics feel more accessible, and training can often resume with modified volume and more confident technique.
Weeks 6 to 10+
Capacity increases across workdays and workouts. The goal is fewer flare-ups, faster recovery when symptoms do appear, easier lifting and carrying, and better sleep continuity due to reduced nighttime discomfort.

Frequently Asked Questions

Get answers to common questions

Yes, with appropriate medical context. Many imaging findings are common and do not fully predict pain. Our focus is whether your symptoms align with a functional driver such as guarding, load intolerance, hinge mechanics, hip contribution, or neural sensitivity. If your presentation suggests a condition requiring medical management, we will coordinate referral.

They can help reduce protective muscle guarding and modulate pain sensitivity, particularly in the paraspinals, glutes, hip flexors, and thoracolumbar tissues. This often makes it easier to restore hinge mechanics, rebuild trunk endurance, and tolerate strength training without repeated flare-ups.

It depends on irritability, chronicity, and training load. Many patients start with 1 to 2 sessions per week for a short initial phase, then taper as tolerance improves and movement work becomes the primary driver. We reassess frequently based on measurable changes such as sitting tolerance, hinge comfort, and recovery after training.

Not necessarily. We usually adjust training rather than eliminate it. The goal is to keep you active while reducing symptom provocation: modifying volume, selecting tolerable patterns, and improving bracing, hinge strategy, and hip contribution. If a temporary pause is advisable, it is time-limited and paired with a plan to rebuild capacity.

We screen for neural involvement when relevant. Some referral patterns are muscular, while others reflect nerve irritability. Your exam helps us differentiate these possibilities and select an approach that respects nerve sensitivity while restoring movement tolerance. New or progressive weakness, numbness, or changes in bowel or bladder function warrant immediate medical evaluation.

We avoid simplistic labels. Many recurrent cases involve a combination of tissue sensitivity, protective guarding, and a movement strategy that overloads the low back under fatigue or prolonged sitting. Trunk endurance matters, but so does coordination, breathing and bracing habits, and how the hips share load during bending and lifting.

Ready to Find Real Answers?

Schedule a free 15-minute discovery call to discuss your case and determine if our approach is right for you.

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