If back treatment has not held, it may be because nobody looked below the waist.
Also called: lower back pain · lumbar pain · postpartum back pain
Your trunk works as a pressure system. The diaphragm above, the deep abdominal muscles around, the back muscles behind and the pelvic floor below all share the job of controlling load. When one part of that system is not contributing, the others take more than their share — and the back is often where that shows up.
This is why back pain and pelvic floor problems travel together so often. Pregnancy and birth change the whole system at once. So does a long period of guarding after an injury, or years of a breathing pattern that never reaches the lower ribs.
Most back care never assesses the pelvic floor at all. That is fine for a lot of back pain. But if yours has not responded to sensible treatment, or if it arrived alongside leaking, heaviness or a postpartum recovery, the pelvic floor is a reasonable place to look next.
Worth investigating if you recognise:
The assessment covers the back, hips and pelvic floor together, because treating any of them in isolation is what tends to leave people cycling. I want to see how you manage pressure, where your load goes, and which part of the system is not doing its share.
Manual therapy helps the tissue that is irritated, but it is rarely the whole answer on its own. The durable part is usually retraining how you breathe and brace, then progressively loading the pattern so it holds up outside the session.
Then the ordinary things: how you lift, sit, get out of bed, carry a child on one hip. Those are the repetitions that matter, and working at home means we can rehearse them where they actually happen.
Mostly because the assessment includes the pelvic floor, which standard back care usually does not cover. If your pelvic floor is part of how you manage pressure and it is not participating, treating the back alone tends to produce relief that does not hold.
Usually not. Most low back pain does not require imaging, and imaging findings often do not match symptoms. If your history or assessment suggests something that needs investigation, I will tell you and direct you to a physician rather than working around it.
Briefly at most. Prolonged rest generally makes back pain worse by reducing tolerance, so the usual approach is modifying which loads you meet in the short term while rebuilding capacity, rather than stopping.
It is extremely common, which is not the same as something you should wait out indefinitely. Postpartum back pain frequently reflects a trunk system still reorganising after pregnancy, and that responds well to being addressed directly.