Low Back Pain: Breaking the Cycle
Low back pain can change the rhythm of your entire day. Sitting, sleeping, working, exercising, or simply putting on your shoes may suddenly become difficult. When the pain is intense and no clear cause has been identified, it can also leave you wondering what is wrong and whether it is safe to keep moving.
Most cases are classified as nonspecific low back pain. This does not mean the pain is imaginary or unimportant. It means the symptoms cannot be reliably traced to one particular muscle, joint, ligament, disc, or other structure. More often, several factors interact, including tissue irritation, joint and muscular function, physical loading, movement patterns, sleep, stress, and general health.
The encouraging news is that most episodes are not caused by a serious condition. A thorough assessment can help identify contributing factors, rule out problems requiring medical attention, and guide an individualized plan for reducing pain, restoring function, and returning to movement with greater confidence.
Article Index:
Signs and Symptoms
Low back pain can feel different from one person to another. It may begin as a dull ache, a sudden sharp pain, or stiffness that makes everyday movement difficult. Common symptoms include:
Pain: Discomfort may be localized or spread across the lower back and often changes with posture, movement, or activity.
Stiffness: The back may feel tight after sitting, sleeping, or remaining inactive.
Muscle Spasms: Muscles may tighten or contract involuntarily in response to pain or irritation.
Limited Mobility: Bending, twisting, lifting, or putting on shoes may become uncomfortable.
Referred Pain: Pain may extend into the hips, buttocks, or upper thighs.
Protective Movement: You may move cautiously, lean to one side, or avoid activities that provoke the pain.
Pain travelling farther down the leg with tingling, numbness, or weakness may indicate nerve involvement rather than uncomplicated nonspecific low back pain and should be properly assessed.
Symptoms can range from mild and short-lived to severe and persistent. Importantly, pain intensity does not always reflect the extent of tissue damage. A thorough assessment can help identify contributing factors and determine the most appropriate course of care.
Anatomy and Biomechanics
The lower back is not a single structure working in isolation. The lumbar spine, pelvis, muscles, fascia, ligaments, discs, joints, and nervous system work together to support the body while allowing us to bend, twist, walk, and lift.
Potential contributors to low back pain include:
Intervertebral Discs: These structures distribute load and allow movement between the vertebrae. Disc changes are common and do not always cause pain, although irritation or nerve compression can sometimes produce symptoms.
Facet Joints: These small spinal joints guide movement and contribute to stability. Irritation may cause localized pain and restricted motion.
Muscles and Fascia: The erector spinae, multifidus, abdominal muscles, and thoracolumbar fascia help control movement and transfer force through the trunk.
Ligaments: These tissues connect and stabilize the vertebrae while limiting excessive movement.
Nerve Roots: Irritation or compression may produce pain, tingling, numbness, or weakness extending into the leg.
Because these structures function as an interconnected system, nonspecific low back pain cannot usually be traced to one tissue. Assessment therefore focuses on identifying contributing factors and restoring comfortable, coordinated movement.
Examination and Diagnosis
If your back hurts, you naturally want to know why. Although it is not always possible to identify one painful structure, a thorough examination can reveal important patterns, rule out concerning conditions, and guide the next steps in your care.
The assessment may include:
Your Clinical History: How the pain began, what makes it better or worse, previous episodes, general health, and any symptoms requiring further investigation.
Orthopedic and Functional Assessment: How your lower back, pelvis, and hips move, along with joint mobility, muscle function, posture, and everyday movements.
Neurological Assessment: Strength, sensation, reflexes, and nerve mobility when symptoms suggest possible nerve involvement.
Vascular Assessment: Circulation testing when the symptoms or health history indicate that it may be necessary.
The following clinical videos provide a closer look at these examination procedures.
Low Back Examination
See how orthopedic and functional tests help practitioners assess movement and identify factors that may be contributing to low back pain.
Lower Limb Neuro Examination
A practitioner-focused review of strength, sensation, reflexes, and other signs of possible nerve involvement.
Peripheral Vascular Examination - Key Points
A demonstration of key circulation tests used when vascular involvement is suspected.
When Is Imaging Needed?
Severe back pain can make an X-ray or MRI seem like the obvious next step. However, most people with nonspecific low back pain do not require immediate imaging. Scans often reveal disc degeneration, bulges, arthritis, and other age-related changes in people who have no pain at all. For this reason, imaging findings must always be interpreted alongside the history and physical examination.
Different forms of imaging provide different information:
X-rays: Primarily show bones, alignment, fractures, and advanced degenerative changes.
CT Scans: Provide greater detail of bones and may be useful when a fracture or complex structural problem is suspected.
MRI: Shows discs, nerves, muscles, and other soft tissues in greater detail.
Imaging may be appropriate when there are signs of significant trauma, progressive neurological changes, fracture, infection, cancer, cauda equina syndrome, or when persistent symptoms have not responded as expected and the results would change the treatment plan.
Differential Diagnosis: Could Something Else Be Causing the Pain?
Most low back pain is nonspecific, but similar symptoms can sometimes arise from other conditions. A careful history and physical examination help determine whether further testing, imaging, or referral is needed.
Conditions to consider include:
Lumbar Disc Herniation: A displaced or irritated disc may affect a nerve root, causing leg pain, tingling, numbness, or weakness. Disc changes can also occur without symptoms.
Lumbar Spinal Stenosis: Narrowing around the spinal nerves may produce leg pain, heaviness, numbness, or weakness that commonly worsens with standing or walking.
Spondylolisthesis: One vertebra shifts relative to another. Some cases are painless, while others contribute to back pain or nerve-related symptoms.
Sacroiliac or Hip Conditions: Problems involving the sacroiliac joint or hip can produce pain in the lower back, buttock, groin, or thigh.
Inflammatory or Systemic Conditions: Inflammatory spinal disease, infection, fracture, or cancer can occasionally present as back pain, often with additional warning signs.
Differential diagnosis is about recognizing the overall pattern, ruling out important conditions, and selecting the safest and most appropriate course of care. Routine imaging is generally unnecessary unless the findings are likely to change management of the condition.
Manual Therapy: Supporting Movement and Recovery
When your back hurts, hands-on treatment can play an important role in reducing pain, restoring mobility, and making everyday movement easier. The techniques selected should reflect the examination findings and form part of a broader plan that includes education, continued activity, and progressive exercise.
Approaches may include:
Spinal Manipulation: A controlled, high-velocity, low-amplitude thrust applied to selected spinal joints. It is used to address restricted or painful movement, reduce pain, and improve mobility when examination findings indicate that it is appropriate.
Spinal Mobilization: Slower, graded movements applied to spinal joints to reduce stiffness and encourage more comfortable movement.
Soft-Tissue Therapy: Techniques directed toward muscles and fascia to reduce sensitivity, muscular tension, and restrictions that may be contributing to pain or altered movement.
Motion Specific Release (MSR): An integrated approach that combines soft-tissue procedures, joint mobilization or manipulation, nerve mobilization, and exercise according to the individual’s presentation and response.
The following videos demonstrate several approaches that may be considered as part of an individualized treatment plan.
Chiropractic Adjustments
See how spinal manipulation may be incorporated into the management of low back pain when examination findings indicate it is appropriate.
SI Joint Pain - Unravelling the Mystery
Explore the sacroiliac joint, its relationship to the spine and pelvis, and how practitioners assess and manage pain in this region.
Fascial Expansion: MSR Low Back Pain Protocol
This practitioner-focused demonstration shows how fascial expansions may be incorporated into an MSR approach to low back pain, drawing on fascial relationships, kinetic-chain concepts, and acupressure principles.
Exercise: Rebuilding Movement and Confidence
When back pain makes movement feel threatening, exercise can provide a gradual path back to everyday activity. There is no single best routine for everyone. The program should reflect the person’s symptoms, abilities, goals, and response to movement.
Depending on the individual, exercise may include:
Mobility and Flexibility: Gentle spinal, hip, and lower-limb movements can reduce stiffness and restore comfortable ranges of motion.
Strength and Endurance: Exercises for the trunk, back, and hips can build the capacity needed for lifting, walking, working, and recreation.
Balance and Proprioception: When relevant, balance exercises can improve body awareness, coordination, and confidence during movement.
Functional Exercise: Squatting, bending, lifting, carrying, and other task-specific movements prepare the body for the demands of daily life.
Exercise should begin at an appropriate level and progress as function and confidence improve. The following routines provide several options that can be adapted to individual needs.
Stop Back Pain Fast
Miki Burton, registered massage therapist, demonstrates a gentle movement routine intended for episodes of acute low back pain.
5 Minute Low Back Pain Relief
A brief mobility routine for people who experience lower back discomfort or stiffness after prolonged sitting.
The 6-Minute Plank Routine
This routine builds on the beginner plank series by developing greater trunk strength and endurance. Practise the intermediate routine until you can perform it with good control before progressing to the advanced level.
Improve Your Balance - Advanced Exercises
These advanced exercises challenge balance, coordination, and body awareness. They may support rehabilitation, reduce fall and injury risk, and improve physical performance. You should be comfortable with the beginner exercises before attempting this routine.
How MSR Approaches Low Back Pain
Low back pain rarely exists in isolation. Movement through the lumbar spine is influenced by the pelvis, hips, lower limbs, trunk muscles, fascia, nervous system, and the demands of daily life. The MSR approach considers how these factors may interact rather than focusing only on the painful area.
Key elements include:
Thorough Assessment: Examining movement, joint and muscle function, neurological findings, health history, and activities that may be contributing to the problem.
Individualized Clinical Reasoning: Selecting treatment according to the person’s presentation rather than applying the same protocol to everyone.
Integrated Manual Therapy: Combining soft-tissue procedures, joint mobilization or manipulation, and nerve mobilization when indicated.
Progressive Exercise: Using mobility, strength, balance, and functional exercise to help restore capacity and confidence.
Reassessment and Referral: Monitoring progress, adapting the plan, and referring for further investigation or collaborative care when necessary.
Developed through more than 30 years of clinical practice, Motion Specific Release brings these elements together within one adaptable framework. The goal is not simply to reduce symptoms, but to help each person understand their condition, return to meaningful activity, and develop greater independence in managing their health.
References
Brinjikji, W., Luetmer, P. H., Comstock, B., et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816.
Finucane, L. M., Downie, A., Mercer, C., et al. (2020). International framework for red flags for potential serious spinal pathologies. Journal of Orthopaedic & Sports Physical Therapy, 50(7), 350-372.
Foster, N. E., Anema, J. R., Cherkin, D., et al. (2018). Prevention and treatment of low back pain: Evidence, challenges, and promising directions. The Lancet, 391(10137), 2368-2383.
GBD 2021 Low Back Pain Collaborators. (2023). Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: A systematic analysis of the Global Burden of Disease Study 2021. The Lancet Rheumatology, 5(6), e316-e329.
George, S. Z., Fritz, J. M., Silfies, S. P., et al. (2021). Interventions for the management of acute and chronic low back pain: Revision 2021. Journal of Orthopaedic & Sports Physical Therapy, 51(11), CPG1-CPG60.
Hartvigsen, J., Hancock, M. J., Kongsted, A., et al. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356-2367.
Hayden, J. A., Ellis, J., Ogilvie, R., Malmivaara, A., & van Tulder, M. W. (2021). Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews, 2021(9), CD009790.
Maher, C., Underwood, M., & Buchbinder, R. (2017). Non-specific low back pain. The Lancet, 389(10070), 736-747.
National Institute for Health and Care Excellence. (2016, updated 2020). Low back pain and sciatica in over 16s: Assessment and management (NG59). NICE.
Oliveira, C. B., Maher, C. G., Pinto, R. Z., et al. (2018). Clinical practice guidelines for the management of non-specific low back pain in primary care: An updated overview. European Spine Journal, 27(11), 2791-2803.
Rubinstein, S. M., de Zoete, A., van Middelkoop, M., Assendelft, W. J., de Boer, M. R., & van Tulder, M. W. (2019). Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: Systematic review and meta-analysis of randomised controlled trials. BMJ, 364, l689.
World Health Organization. (2023). WHO guideline for non-surgical management of chronic primary
Disclaimer:
The information and videos on the MSR website are provided for educational purposes only. They are not intended to diagnose a condition, recommend treatment for an individual, or replace care from a qualified healthcare provider. Accessing this website does not establish a practitioner-patient relationship.
Clinical examination and manual therapy demonstrations are intended for qualified healthcare professionals who have the appropriate training and are legally authorized to perform these procedures within their scope of practice. They should not be attempted on yourself or another person based solely on website content.
Exercises may not be appropriate for everyone. Consult a qualified healthcare provider if you are uncertain whether an exercise is suitable for you, and discontinue any activity that causes a significant increase in pain or new symptoms.
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About Dr. Brian Abelson
Dr. Brian Abelson is a chiropractor, author, and educator with more than 30 years of clinical experience in musculoskeletal care, rehabilitation, and sports performance. He is the developer of Motion Specific Release (MSR) and Clinical Director of Kinetic Health in Calgary, Alberta, Canada.
A perpetual student, Dr. Abelson continues to explore the relationships between anatomy, biomechanics, clinical reasoning, manual therapy, and exercise. Through his clinical work, articles, videos, and courses, he translates complex concepts into practical information for the public and healthcare practitioners, with an emphasis on patient-centred and multidisciplinary care.
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This article provides an introduction to the assessment and management of low back pain. MSR Pro takes the next step by connecting clinical reasoning with examination procedures, manual therapy, exercise prescription, and patient education.
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Clinical Procedures: Detailed video instruction covering soft-tissue therapy, joint mobilization and manipulation, nerve mobilization, and fascial expansions.
Examination Resources: Orthopedic, neurological, and functional assessment videos, supported by downloadable examination forms.
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