Why back pain can keep coming back (and what to reassess)

If your back pain keeps returning to the same spot, you’re not unlucky. You’re not broken. And your back isn’t “just weak.”

You’ve probably had treatment. Maybe you’ve had several rounds of it. Massage, physio, chiropractic, a few weeks of exercises, some better mornings followed by the same familiar ache. And then life picks up again, you skip a few sessions, and you’re back where you started.

This cycle does not prove that treatment failed. It is a reason to reassess the diagnosis, load, recovery, and the tasks that keep provoking symptoms.

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The problem isn’t the pain location

“Dr. Devon Savarimuthu, DC, CSCS, says: ‘Where it hurts matters, but it is not the whole assessment. I also test the movements and loads that reproduce the problem, then use those as the baseline for the plan.’”

Most back pain treatment is built around where you hurt. Lower back pain gets lower back treatment. The muscle spasms there, the joint is tender there, so that’s where the work goes.

The painful area may be one part of a broader pattern. Hip movement, trunk capacity, training changes, sleep, work demands, and recovery can all matter. The examination tests which factors change the patient’s familiar task rather than assuming one universal driver.

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Why symptom-based care creates cycles

Research on low back pain recurrence shows that many people experience another episode within a year, especially when the underlying contributors are not addressed. (da Silva et al., Journal of Orthopaedic & Sports Physical Therapy, 2017)

This isn’t because chiropractic, physio, or massage don’t work. These tools absolutely work — when they’re applied to the right problem. The issue is in how the problem is identified in the first place.

A label such as “lower back pain” describes the region, not every contributor. A useful plan connects the clinical findings to a task, records a baseline, and checks whether that task changes.

The NICE guideline on low back pain and sciatica supports active care that combines movement, manual therapy when appropriate, and clear clinical reasoning rather than passive treatment alone.

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What a useful working diagnosis looks like

The first visit at Endura includes assessment and treatment. The goal is to form a defensible working diagnosis, establish a baseline, and decide what to change first.

This includes:

• Movement screening — how your body distributes load through your spine, hips, and pelvis when you move
• Physical tests — specific tests to find which structures are involved and how badly
• Neurological check — is a nerve involved? Is this purely a mechanical problem?
• History — what makes it worse, what relieves it, what patterns you’ve noticed

At the end of that first visit, you leave with an explanation of the findings, a written plan, and a baseline that can be retested. If the expected change does not happen, the plan changes or a referral is considered.

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What changes when you treat the pattern instead of the pain

When the assessment identifies a relevant, testable contributor, treatment becomes more specific.

If the hip isn’t extending properly and the lower back is picking up the load, treatment targets the hip — not the lower back that’s hurting. If the upper back is too stiff to rotate and the lumbar spine is compensating, treatment mobilizes the upper back — not the lumbar segments that are in pain.

The point is not to ignore the painful area. It is to combine symptom relief with active work that improves the task or capacity that matters to the patient.

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The Endura Method

The Endura Method is built around this principle. Assessment and treatment begin at the first appointment, progress is reviewed, and the visit frequency changes as the patient becomes more capable.

Visit 3 includes an honest progress update: whether the plan is working, whether it needs adjusting, or whether the case needs something outside what I do.

50-minute first visit — assessment and treatment in one visit.

If you’ve had back pain that keeps returning and haven’t gotten a structural answer for why, that’s where we start.

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Related reading

• Lower back pain treatment at Endura
• How the Endura Method works
• What actually happens at your first visit

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Book Your First Visit — (647) 951-5841 You’ll speak directly with Dr. Devon — not a receptionist.

→ About the Endura Method → Lower back pain at Endura

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Dr. Devon Savarimuthu, DC, CSCS practises at Endura Chiropractic, 3440 Yonge St, Lawrence Park, Toronto. Certified Strength and Conditioning Specialist since 2015. Doctor of Chiropractic, Palmer College.