Southern Oregon Sports & Spine

Lower Back; Start with the right diagnosis- Treat with a minimalist approach

In my opinion, lower back and pelvic pain are not treated properly. There is way too much unnecessary surgery, and repeated steroid injections. Way too many people are being told that they have arthritis and nothing can be done. Way too many people are getting treated over and over by their chiropractor, PT, or massage therapist, without a clear way forward.

Does your medical doctor, chiropractor, osteopath or PT know how to accurately diagnose your lower back, buttock and/or hip pain? Good medicine always starts with a diagnosis, figuring out what is wrong. Different branches of medicine have different ways of looking at this. If you continue to suffer, someone needs to find out what is wrong. We have a different approach to this.

Here is my list of “most missed” diagnoses.

1- The “flexion-intolerant “ lower back, an unhappy lumbar disc that is causing lower back and/or buttock pain, rather than true sciatica. This is a common problem, and is usually invisible on x-rays and/or MRI. If you injured yourself lifting or bending over, if you have a central lower back ache, if it is taking forever to get over your “back strain”, there is a good chance you have this. The key to recovery; stop doing the wrong movements, usually involving either bending in an unsafe way, or doing forward bending exercises. Forward bending exercises are counter-intuitive. They can feel good in the moment, but 30-60 minutes later, your back starts hurting again.

2- The second one is a problem that is over-diagnosed; the Sacro-Iliac. If your chiropractor, PT, or osteopath is manipulating your SI, over and over, with only temporary relief, and you keep going “out,” it means you probably have some other problem. True SI problems are relatively rare.

3- Maigne Syndrome is irritation of the little cluneal nerves that comes from the upper lumbar and lower thoracic spine, and cause buttock and hip and leg pain. Very few practitioners seem to know anything about these. (See my thoraco-lumbar junction articles at

4- The hip joint can cause hip pain, groin pain, and can contribute to lower back problems. Yes, you could have hip arthritis. But often, the hip gets stuck forward, causing all kinds of problems. Patients keep trying to stretch or open their hip, often the wrong approach.

5- Whomever you are seeing, are they teaching you what exercises to do, and what exercises and movements to stop? You need to be an active part of your own care. If you have ongoing or recurring lower back, buttock or hip pain, give us a call. We will help figure out the missing pieces. So many problems can be solved in a simple way, once you know what is wrong, and what you can do. We always attempt to get you well as quickly as possible, and give you the tools to help yourself.


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