If you’ve ever struggled with lower back pain, you know how frustrating it can be to pin down the cause. One doctor says it’s a disc. Another blames your posture. Someone else calls it “nonspecific.” You try therapy, medications, even surgery—and the pain keeps coming back.
The truth? Low back pain isn’t mysterious when you take a scientific approach. With the right evaluation process, most cases can be accurately diagnosed and effectively treated.
As Sherlock Holmes famously said:
“When you have eliminated the impossible, whatever remains, however improbable, must be the truth.”
Step 1: Eliminate the Rare but Serious Causes
Before addressing common culprits, skilled clinicians start by ruling out the rare—but serious—causes of back pain, such as:
- Cancer or tumors in the spine or spinal nerves
- Metastatic disease spreading from another area
- Aneurysms or vascular abnormalities
- Severe spinal injuries, such as fractures or dislocations
Fortunately, these conditions are uncommon and can usually be detected through a thorough history, examination, and appropriate imaging. Once they’re ruled out, attention can shift to the more likely—and more fixable—sources of pain.
Step 2: Identify the Two Primary Root Causes
In nearly three decades of clinical experience, I’ve found that most cases of lower back pain fall into two broad categories:
- Structural problems
- Functional problems
Understanding the difference between them is the key to achieving lasting relief.
Structural Problems: The Obvious but Less Common
Structural problems involve actual damage or deformity in the spine or surrounding tissues. Examples include:
- Disc herniations
- Ligament sprains
- Degenerative arthritis
- Genetic malformations
These types of issues are typically consistent and predictable. The pain appears in the same way each time you move a certain way, bend forward, or lift something heavy. The discomfort is localized and reproducible.
Although structural problems get the most attention, they make up only about 10–15% of all low back pain cases.
Functional Problems: The Real Root of Most Back Pain
The vast majority of low back pain—up to 80% of all cases—is functional, not structural. Functional problems arise when something in the body’s kinetic chain (the system that connects movement from your feet to your head) stops working correctly.
That dysfunction causes compensation elsewhere, often overloading the lower back.
For example:
- A toe or ankle issue might cause a subtle limp, forcing your back to absorb extra stress thousands of times a day.
- A tight hip or restricted shoulder might shift your posture, pulling your spine out of balance.
- Even small movement imbalances in the pelvis or rib cage can create long-term strain.
Because the pain location can shift—left, right, radiating, or localized—functional back pain is often mislabeled as “nonspecific.” But it’s not random; it’s compensatory.
Step 3: Stop Guessing and Start Testing
Too many clinicians still rely on guesswork when diagnosing back pain. They treat the symptoms, not the cause. The pain might improve temporarily, but it usually returns.
A scientific approach demands precision—systematic evaluation, motion testing, and pattern recognition. Only by identifying which joint or region is dysfunctional can treatment truly correct the problem.
That’s where chiropractic care and functional movement analysis shine. By examining the entire body—not just the site of pain—these approaches uncover the root cause and correct it naturally.
The Bottom Line
If you suffer from chronic or recurring lower back pain, there’s an 80% chance the root cause is functional or compensatory—not structural. Pills and injections might dull the symptoms, but they won’t fix the movement dysfunction creating the pain.
Find a clinician—ideally a chiropractor or movement-based therapist—who takes a whole-body, root-cause approach. With the right diagnosis and care, lasting relief isn’t just possible—it’s predictable.
Key Takeaway
Low back pain isn’t a mystery when you apply science.
By eliminating the rare, identifying the root cause, and treating the body as a **system—not a set of symptoms—**you can finally stop chasing pain and start restoring function.