Teresa’s TCM Clinical Reflections (20)

What Do Patients Often Overlook About Lower Back Pain?

Subtitle: From pain and scan results to long-term physical load, Teresa shares several commonly overlooked issues in lower back pain

By Teresa Shen, BHSc (Acupuncture), ACC Registered Treatment Provider, Registered Chinese Medicine Practitioner (NZ)

Lower back pain is a very direct symptom. Patients usually know exactly where it hurts, what it feels like and when it becomes worse.

But feeling the pain clearly does not necessarily mean we understand what is causing it, how the problem developed, or whether the body has fully recovered.

This is something I explain frequently in clinic.

Here are several issues that I think patients with lower back pain often overlook.

1. If the Pain Is Gone, Does That Mean I Am Fully Recovered?

After treatment, a patient may tell me:

“My pain is gone. I’m better.”

That is certainly an important sign. But as a clinician, I cannot judge recovery only by whether the patient still feels pain.

Reassessment matters.

A patient may move without pain but still have significant tenderness around the sacroiliac region. Muscles around the lower back or buttock may remain tight and tender. A neurological test may still reproduce symptoms. Sometimes the pain has disappeared, but sensation in the area remains unusually sensitive or altered.

These findings may indicate that recovery is not yet complete.

Returning too quickly to heavy lifting, strenuous work or intense exercise may then contribute to recurrence.

So I want to know more than:

“Does it still hurt?”

I also want to know:

How much has actually recovered, and what has not?

2. Do Not Let a Scan Frighten You

Many patients become worried when an MRI, CT or X-ray report contains words such as “disc protrusion”, “bulge”, “degeneration” or “fusion”.

I often remind them:

A scan is static. A patient is living and changing.

An abnormality on imaging does not automatically mean it is the cause of the patient’s current pain.

Some structural changes may have existed for years without symptoms. A disc problem may genuinely have caused back and leg pain in the past, but after inflammation and nerve irritation settle, the patient may become pain-free even though the disc abnormality is still visible on MRI.

The same principle applies to other test findings. HLA-B27, for example, is associated with certain inflammatory conditions, but a positive result alone does not establish a diagnosis.

The important question is not simply:

“What did the scan find?”

It is:

Does that finding explain what is happening to this patient now?

3. The Human Body Is Not a Car

Sometimes patients approach treatment a little like taking a car to a mechanic:

“My back is painful. I have come for treatment. Please fix it.”

But the human body does not work like a machine where one damaged part can simply be replaced.

If the back has not recovered but the patient continues heavy lifting, works a full physical day immediately after treatment, or keeps doing activities that repeatedly aggravate the injury, recovery may be delayed.

The practitioner has a role, but so does the patient.

Rest, appropriate protection, modifying physical load and gradually returning to normal activity are all part of recovery.

Recovering from lower back pain is not only the clinician’s job. The patient has to participate too.

4. Lower Back Pain Does Not Always Come From the Back

When someone says, “My lower back hurts,” it is natural to think about the spine, muscles, ligaments, joints and discs.

But not every pain felt in the lower back originates there.

Kidney stones and some kidney or urinary conditions can cause back or flank pain. Some pelvic or gynaecological conditions may cause lumbosacral symptoms. Inflammatory spinal disorders also require a different approach from an ordinary muscular strain.

More rarely, persistent back pain may be related to cancer or metastatic disease.

This is why I sometimes recommend further medical investigation even when the patient’s main complaint is simply “back pain”.

Where the pain is felt does not always tell us where the disease is.

5. First-Time Pain Does Not Mean the Problem Started Today

Patients sometimes tell me:

“I’ve never had back pain before.”

But having no previous pain does not necessarily mean nothing was developing.

I once treated an older patient whose back pain became significant after retirement. When I asked about his previous occupation, he told me he had worked in a shipyard, often bending and working in confined spaces for hours.

His current back pain therefore could not be understood only by looking at what happened that week.

Years of bending, sitting, lifting, repetitive work and muscular loading can gradually accumulate. The body may compensate for a long time before symptoms finally appear.

The pain may have started today, but the problem may have been developing for years.

6. Why Can One Sneeze or Simple Bend Suddenly Trigger Severe Pain?

Patients sometimes say:

“I only sneezed.”

“I just bent down to pick something up.”

“I got out of bed and suddenly couldn’t straighten my back.”

The final movement is not necessarily the whole cause.

If muscles, joints, discs or nerves are already irritated or under excessive load, a cough, sneeze or ordinary bending movement may simply provide the final trigger.

After all, everyone bends, coughs and sneezes. Not everyone suddenly develops severe back pain.

So I do not look only at the final movement.

I also ask:

What had this back been through before that moment?

7. Not Every Back Pain Is a Minor Problem

Most lower back pain is not caused by serious disease and can improve with appropriate conservative care.

But because back pain is common, we should not assume every case is simply muscular strain.

If pain keeps worsening, does not respond as expected, becomes unusually severe at night, or does not fit a typical musculoskeletal pattern, the diagnosis needs to be reconsidered.

Inflammatory spinal disease, significant neurological compression and, more rarely, cancer or bone metastasis can all present with back pain.

I once saw a patient who had undergone breast cancer surgery many years earlier. She later developed severe lower back pain that became particularly intense at night and did not improve with ordinary treatment.

That was not a situation to simply continue treating as routine back pain. Further investigation eventually identified destructive bone changes and metastatic disease.

Cases like this are uncommon, but clinicians still need to think about them.

A common symptom does not guarantee a minor cause.

Final Reflection

These are issues I find myself explaining repeatedly to patients with lower back pain.

Patients are not expected to diagnose themselves. Part of our responsibility as clinicians is to translate clinical knowledge into language they can understand.

At the same time, patients sometimes need to look beyond what they feel at that moment and understand why reassessment, further investigation or temporary activity modification may be recommended.

Clinicians need to explain professional judgement clearly, and patients need to leave some room for that judgement.

Book an Appointment

If your lower back pain keeps returning, has not improved as expected, or your scan shows abnormalities but you are unsure whether they explain your current symptoms, a clinical assessment may help clarify the situation.

We consider your history, pain pattern, movement, clinical findings and available imaging or medical information before discussing the appropriate next step.

Book an Appointment: https://booking.mananotes.co.nz/PHD-WIN/v2

Disclaimer

This Clinical Reflection is provided for general health education and shares Teresa’s clinical observations. It does not constitute individual medical advice, diagnosis or treatment.

Most lower back pain is not caused by serious disease. However, medical assessment is important if pain is progressively worsening or associated with significant night pain, progressive weakness or sensory changes, bowel or bladder dysfunction, saddle-area sensory changes, fever, significant trauma, unexplained weight loss, or new persistent back pain in someone with a history of cancer.