By Dr. Ivan Hernandez, PT, DPT
Low back pain is one of the most common reasons people seek care—and one of the most misunderstood. The good news? Most back pain isn’t serious or dangerous. In fact, we don’t always need a perfect diagnosis to begin feeling better.
Here’s a simple way to understand how we approach back pain in the clinic—and what that means for you.
Step 1: Rule Out Serious Causes
First, we always screen for the rare but important signs of something more serious—things like fractures, infection, cancer, or cauda equina syndrome. If there’s any reason for concern, we refer out immediately. But in most cases, these “red flags” aren’t present.
Step 2: Look for Clear Patterns
Next, we check for nerve-related issues like disc herniation or spinal stenosis, as well as inflammatory causes like axial spondyloarthritis (AxSpA). These conditions have distinct signs and symptoms. If they aren’t present, we can usually rule them out.
Step 3: What if it’s Non-Specific Low Back Pain?
Up to 90% of back pain falls into this category. It doesn’t mean we know nothing—it means the pain isn’t tied to one clear structure. It could involve muscles, joints, discs, or ligaments—and is often influenced by sleep, stress, mood, and movement.
Step 4: So What Do We Do About It?
We build trust
We listen
We educate and simplify
We do meaningful movement
We strengthen when appropriate
We promote overall health
Back Pain is Complex, But the Framework is Simple
1. Rule out serious causes
2. Identify patterns
3. Educate and load
4. Reassess and progress
Most Back Pain Isn’t Dangerous
It needs structure
It needs reassurance
It needs movement
It needs a plan
Looking for care—or a team that practices this way?
Let’s talk.
