Lower back pain

It's rarely just the back

Low back pain is the most common reason people come to see me. It's also the condition where the cause is most often somewhere other than where the pain is.

The lumbar spine sits at the intersection of several systems — it carries the weight of everything above it, connects to the pelvis below, and is the area most asked to compensate when something upstream or downstream stops moving properly. When the hips get tight, the back does more work. When the mid-back loses its rotation, the low back twists instead. When the diaphragm isn't moving well, the lumbar muscles fire continuously just to hold you up.

It's also worth knowing that imaging often shows things that look concerning — bulging discs, signs of wear — even in people who have no pain at all. What matters more than what the picture shows is how the whole structure is moving: which segments are restricted, what's compensating, and whether the breath and core are doing their share. That's what determines whether pain settles or keeps recurring.

Most of what I do with low back pain is find which pattern is driving the current episode — and release it.

The patterns I see most often

• Hip-driven. Tight hip flexors or restricted hip rotation force the lumbar spine to make up the difference. Treating the back alone does little.
• Thoracic-driven. A stiff mid-back that has lost its natural rotation passes that demand down to the low back.
• Sacroiliac-driven. A locked SI joint makes one side of the low back feel chronically tight and vulnerable.
• Diaphragm-driven. The diaphragm anchors to the lower spine and ribs. When breath stays shallow, the small stabilizing muscles of the back take over the diaphragm's job and stay tense around the clock.
• Visceral. Tension in the connective tissue around the organs — especially after abdominal surgery, or with chronic digestive patterns — can pull the lumbar spine out of its natural curve.
• Stress-pattern. Prolonged bracing of the diaphragm and psoas, common with sustained stress, keeps the lumbar muscles switched on at low volume all day.

How I assess and treat it

Every session starts with a real conversation — what happened, when it started, what you've tried, what makes it better, what makes it worse. Old injuries matter, even ones from decades ago.

Then I watch you move: standing, bending, walking, sitting down. And then hands-on assessment — finding where motion has been lost, where the tissue is guarded, where the real restriction is living.

The treatment that follows is tailored to what each session reveals. Common techniques: muscle energy (you contract a specific muscle against my resistance to restore joint motion), counterstrain (passive 90-second positioning to release tender, irritable tissue that won't tolerate direct work yet), gentle joint mobilization, and breath and diaphragm work when those are part of the picture. Joint manipulation has a place, but only after the surrounding tissues are ready.

The question isn't "what hurts" — you already know that. The question is what the back is compensating for.

What recovery looks like

For an acute episode — something that started in the last few weeks — most people see significant change within two to four sessions. For long-standing patterns with hip, diaphragm, or ribcage drivers, plan for four to eight visits over two or three months, paired with movement work between sessions. Old injuries (whiplash, falls, surgeries) can leave fascial restrictions that benefit from occasional maintenance every couple of months.

Between sessions, I'll usually give you a few specific movements to hold the change. Not a workout. Something small, precise, and done daily.

In health, Eli Mead, D.O.M.P.