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What's extremely rare is that someone has taken the time to determine which specific postures, movements or loads provoke their pain, and shown them how to avoid them. So, they keep provoking their pain, and walk away believing they're broken, when in reality they were never properly assessed.

If you've tried physiotherapy and still have low back pain, it's probably not because exercise in general doesn't work, or because you're a hopeless case. It's far more likely that you haven't had a thorough enough assessment to identify your specific pain triggers.

A term often used in this field is "non-specific low back pain." It sounds like a diagnosis, but it isn't. It just means that nobody has worked out what the specific cause of your low back pain is. So you get given this non-diagnosis and lumped together with other people who may have a completely different type of low back pain. One person's pain may get worse when they bend forward; another's when they arch back. If they're given the same programme, at best it may help one and harm the other.

So it was no surprise when a recent systematic review in the BMJ found that only around one in ten back pain treatments show real, lasting benefit. That's just what happens when people with very different pain triggers are grouped together and given the same programme. 

This isn't a criticism of physiotherapists because many are excellent. The issue is systemic. A thorough assessment, covering personal history, provocative pain testing, and tailored coaching, takes around three hours to carry out. But, most insurance only covers 30–45 minute sessions. That means treatment often begins before a detailed assessment can be done. 

I've seen this play out repeatedly. One client had been treated with spinal flexion exercises despite being flexion-intolerant; once we identified what to avoid, his pain resolved within months.

Another had been doing stretches for years that were aggravating a herniated disc and irritating her sciatic nerve; stopping them brought immediate relief.

A third had unknowingly been straining his spine through poor hip-hinge mechanics for seven years; correcting this, combined with targeted strengthening, made him pain-free (and, after checking in recently with him, still with no low back pain three years later).

None of them were broken. Each had a specific, identifiable pattern causing their pain. It simply hadn't been found yet.

A thorough assessment involves understanding your personal history, lifestyle and limitations of your individual anatomy; testing which movements, postures and loads provoke your pain; teaching "spine hygiene" so you don't re-aggravating your back daily; and coaching a personalised exercise programme based on what's found during the assessment. Without a proper assessment, any treatment plan is nothing more than hit and miss.

If you've tried standard treatments but you're still dealing with persistent back pain, you're not a lost cause. A much more likely explanation is that you just haven't been adequately assessed yet. When you identify your specific pain triggers and learn how to avoid provoking them, you give your spine the conditions it needs to begin healing itself.

Author: 

Andy Marlow is the only McGill Method certified provider based in the UAE. 

www.theback.coach