Back Pain Is Rarely Random
Why Your Back “Going Out” Isn’t Bad Luck And What It Actually Takes To Fix It
Gravity shows up every day.
It doesn’t take weekends off. It doesn’t ease up when you’re tired, stressed, or already dealing with something. Every time you stand up, sit down, carry something, train, or just move through your day, gravity is the constant on the other side of every effort your body makes.
Most people think about back pain as something that happens to them. A flare. An episode. A bad week. But what we see, over and over, is that back pain is almost never random. It’s the accumulated consequence of a body that’s been asked to handle load it no longer has the capacity to manage.
And capacity, the ability to exert more force on the world than it’s exerting on you, is exactly what most back pain treatment never actually rebuilds.
That’s the gap. And it’s why the same problem keeps coming back.
What “Going Out” Actually Means
The story is almost always the same.
You weren’t doing anything dramatic. You bent over to pick something up. You sneezed. You turned to reach for something on the counter. And your back locked up like a door slamming shut.
Nothing heavy. Nothing dangerous. Just a normal movement on an ordinary day, and suddenly you can’t stand up straight.
The instinct is to call it bad luck. But it rarely is. What usually happens is that the demands on your body gradually outpaced its ability to handle them. Not because your back is fragile. Because somewhere along the way, capacity slipped. Maybe you got more sedentary. Maybe stress and poor sleep piled up. Maybe a hip restriction quietly shifted more demand onto your lower back than it was meant to carry. Usually it’s some combination.
Your body is good at adapting around these things. It compensates, reroutes, finds workarounds. But those workarounds narrow the margin between what your back can handle and what your day actually asks of it. And eventually, picking up the laundry basket is enough to close the gap.
What do most people do at this point? They head to the first chiropractor with an opening and hope to be pain-free within a visit or two.
The Goal Should Go Beyond Pain Free
Here’s where most back pain care stops: getting you back to where you were before the flare.
The pain calms down. Movement returns. You feel functional again. Treatment ends, or tapers off, and life resumes. And for a while, that feels like success.
But ‘back to baseline’ isn’t a finish line. It’s a reset. The same capacity problem is still there. The same restricted joints, the same stabilization gaps, the same compensation patterns, now with slightly rebuilt margin. Until the next demand exceeds it.
Physiotherapist and pain science educator Greg Lehman has spent his career making a version of this argument: that what the body needs most isn’t protection from load, but progressive exposure to it. Load tolerance, the ability to handle increasing demand without breaking down, is trainable. And it’s the most important thing most back rehab programs never actually build.
The difference between a back that keeps cycling and one that actually holds up isn’t luck, or age, or genetics. It’s whether care stopped at symptom relief or kept going until real capacity was built.
Pain-free is the starting line. The finish line is a back that can handle your training, your work, and your life, with enough margin left over that a normal Tuesday stays exactly that.
What Your MRI Probably Isn’t Telling You
If you’ve had back pain for any length of time, you’ve probably had imaging. And if you’ve had imaging, you’ve heard words like “disc degeneration,” “disc bulge,” or “mild arthritis.” Words that feel like a verdict on your spine.
Here’s what most radiologists don’t say in their reports: these findings are extraordinarily common in people with no pain at all.
A landmark 2015 study published in the American Journal of Neuroradiology reviewed imaging findings across hundreds of pain-free adults. The results were striking: by age 50, more than half had disc degeneration visible on MRI. By 60, that number climbed to nearly 90%. Disc bulges, facet changes, and foraminal narrowing showed up at similar rates in people who reported no back pain whatsoever.
This doesn’t mean your pain isn’t real. It absolutely is. But it means the image cannot tell you which finding, if any, is causing it.
An MRI shows structure. It doesn’t show function.
It doesn’t show which hip stopped rotating and when. It doesn’t show the compensation pattern that’s been building for three years. It doesn’t show whether the stabilization system is firing on time. That information lives in how you move, and you can only find it by watching someone move.
The most persistent reason back pain endures is that people treat their imaging findings instead of their movement dysfunction. The disc degeneration becomes the story. But the disc degeneration was likely there before the pain started. The driver of the pain is almost always in the function, not the structure.
What’s Actually Driving It
Back pain that keeps returning almost always has a driver that isn’t the back itself.
The lumbar spine sits in the middle of a long chain. What happens above it and below it directly determines how much demand lands there. When a link in that chain stops doing its share, the lower back picks up the slack. And that compensation adds up.
The hip is the most common culprit. When a hip can’t rotate freely, the lower back compensates for it with every step, every squat, every time you bend to pick something up. That’s not a once-in-a-while thing. That’s thousands of repetitions a day.
The thoracic spine is the less obvious driver. When the mid-back gets stiff, especially from long hours sitting, every reach and every overhead movement pulls demand downward into the lower back instead.
And then there’s the stabilization system. The spine is protected not just by strong muscles, but by a coordinated pressure system involving the diaphragm, deep abdominals, and pelvic floor. When this system activates correctly, the spine is stabilized before load arrives. When it doesn’t, the spine absorbs force before it’s ready. This is the factor most back pain care never evaluates.
Back Pain That Keeps Returning Almost Always Has A Driver That Isn’t The Back Itself
The lumbar spine sits at the bottom of a long chain. What happens above it and below it directly determines how much demand lands there. When any link in that chain fails to do its share, the lower back compensates, and compensation has a cumulative cost.
The hip is the most common upstream culprit. A simple test reveals it clearly: stand on one leg and let the opposite hip drop toward the floor. Watch what the lower back does. In a well-functioning system, the hip abductors control that drop and the lumbar spine stays relatively neutral. In a compensating system, the lower back side-bends to catch it, sometimes dramatically. That movement happens thousands of times a day during walking, stairs, and single-leg loading. Over months, it accumulates.
Hip internal rotation is another telling test. Sit on the edge of a chair tall enough that your feet don’t touch the ground. Keep your knees together and swing your feet outward. If one side doesn’t go as far as the other, that hip is stiff, and your lower back is picking up the slack every time you move.
The thoracic spine is the less obvious driver. Sit against a wall and try to press your mid-back flat against it while keeping your low back neutral. For most people who sit for hours each day, this is surprisingly difficult. When the thoracic spine can’t extend, every reach, every carry, every overhead movement pulls the demand downward into the lumbar spine instead.
The stabilization system is the most commonly missed factor. The spine is protected not just by strong muscles, but by a coordinated pressure system involving the diaphragm, deep abdominals, and pelvic floor. When this system activates correctly, the spine is stabilized before load arrives. When it doesn’t, the spine absorbs force before it’s ready. Here’s the simplest way to feel this: take a big breath into your belly, hold it, and notice how rigid your trunk becomes. That’s intra-abdominal pressure, and it’s the primary stabilization mechanism your spine depends on during every loaded movement. When it works automatically, you don’t have to think about it. When it doesn’t, no amount of plank training compensates for the gap.
The Core Problem Nobody Talks About
At some point, someone probably told you your core was weak. Maybe they were right. Maybe you haven’t trained seriously in years and things have genuinely gotten weaker. Or maybe you’re the person who actually does train, heck, you may even have a rockin’ six pack, and still can’t shake the back pain.
Either way, you were handed the same advice: strengthen your core. And it probably didn’t solve the problem.
That’s because ‘strengthen your core’ is incomplete. Strength is part of the equation. But the coordination and timing of the stabilization system we described above is the part that almost nobody addresses. Planks and crunches train the muscles you can see. The real issue is usually the system you can’t.
The person who needs more strength and the person who already has it often end up in the same place: doing the right-sounding exercises that miss the deeper problem.
Which brings us to the most persistent myth in back rehab: that core weakness is the problem and core strengthening is the solution.
People do hundreds of planks. They add dead bugs to every warm-up. They make “core work” a daily habit. And their back still flares.
The exercises aren’t wrong. The understanding of the problem is.
Core stability is primarily about coordination, the automatic, pre-movement activation of the pressure system described above. In a well-functioning system, this happens before you’re aware of it. Before your foot leaves the ground. Before your arm reaches forward. The spine is supported before the demand arrives.
After a pain episode, after chronic stress, after months of sedentary patterns, that pre-activation timing gets disrupted. The global muscles (the ones you feel doing a crunch) often compensate by working harder. But they can’t replace the function of the deep system. They can generate force. They can’t generate the coordinated pressure that protects the spine moment to moment.
A useful starting point: lie on your back with your knees bent, feet flat. Place one hand on your lower ribs and one on your lower belly. Take a slow breath in, not into your chest, but outward in all directions: front, sides, and back. Feel your lower ribs expand laterally under your hand. On the exhale, let everything release completely before the next breath. This is the foundation of how the diaphragm is supposed to function as a stability muscle, not just a breathing one.
This isn’t an exercise. It’s a reset, a starting point for reconnecting the breathing mechanics that the stabilization system is built on. It’s also, for many people, genuinely difficult. Which tells you something about where the work needs to begin.
What Rebuilding Capacity Actually Looks Like
Most back pain care follows the same script. Calm things down. Get you moving again. Send you on your way.
And it works. For about three months. Then you’re back. Or something else starts up. And everyone acts surprised, even though this is the fourth time it’s happened.
Here’s the problem: getting out of pain and actually fixing the problem are two different jobs. Most care only does the first one.
Real recovery has a sequence, and the order matters.
First, we have to get the nervous system to stop overprotecting. Your back locks up for a reason. The body decided a certain range of motion is too risky, so it shut the door. That’s smart, initially. But a door that stays locked long after the threat is gone isn’t protective anymore. It’s just stuck. The first job is giving the nervous system enough evidence that it’s safe to open back up.
Then comes the part almost everyone skips: control. You’ve got the range back. Great. Can you actually stabilize through it? Can you load it without your body finding the same old workaround? Because if you just got range of motion back and immediately went to the gym, congratulations. You now have access to a position you can’t control. That’s not progress. That’s a setup.
Then, and only then, do you build. Progressive, intentional loading that teaches the back to handle what your Tuesday actually demands. Not a clinical environment. Your life. Sitting at a desk for eight hours. Picking your kid up forty times a day. Training the way you actually want to train. Carrying the groceries without thinking about it.
The goal isn’t a back that avoids load. It’s a back that handles load so well that nothing in your normal week comes close to exceeding what it can manage.
This takes longer than a few visits. It also actually works. Because it ends somewhere worth ending: with a back that’s more capable than it was before this whole thing started.
This Is For You If
Your back flares regularly and you’ve started to accept it as just how you are
You have imaging findings that have made you afraid to load your back
You’ve done PT, chiro, or massage, felt better, then watched it return
You’ve been told to strengthen your core, but the pattern hasn’t changed
You want to understand what’s actually driving this, not just manage the next episode
Book a Discovery Call
If you’ve been dealing with back pain that keeps coming back, you’ve probably already put in the effort. The issue isn’t that you haven’t tried. It’s that nobody took the time to figure out what was actually driving it.
If you’re ready to stop resetting and start rebuilding, come in. We’ll assess how your back is actually functioning, find what’s driving the pattern, and build a plan around your body, your goals, and your life.