Why your low back keeps coming back

Nearly every week, someone tells me a version of the same thing. They had a massage, it felt wonderful, it lasted about three days, and then their back went right back to where it was. They usually say it a little apologetically, as though the massage failed a test they set it.

It did not fail. It was probably answering the wrong question.

The sore spot is usually the victim

Low back pain is very often a place that is being overworked rather than a place that is injured. If your hips do not extend properly — and if you spend most of the day sitting, they probably do not — then something has to make up the difference every time you stand, walk or lift. That something is frequently the muscles either side of your lumbar spine, and they will complain about it.

Rub the complaining muscles and they will feel better. Genuinely better, for a few days. But nothing has changed about the job they are being asked to do, so they tighten straight back up. That is not a mystery, that is the arrangement working as designed.

So the useful work is often somewhere that does not hurt at all: hip flexors, glutes, the muscles down the side of the thigh, sometimes the mid back. People are frequently surprised at how little time I spend on the actual sore spot, and then surprised again a week later.

The second half nobody mentions

Here is the part that gets left out of most conversations about this.

When pain has been around for months or years, your nervous system stops treating it as news and starts treating it as a standing condition. It keeps muscle tone up. It keeps you braced. It flinches ahead of movements that used to hurt, even after the tissue itself is fine.

You cannot knead that out. It comes down through time, safety and predictable input — which is the actual clinical reason a genuinely relaxing hour matters for someone in chronic pain. It is not the soft option, and it is not a nice extra on top of the real work. For long-standing back pain, it is frequently the thing that makes the hands-on work hold.

This is why I get slightly irritable about the idea that there is “the massage that fixes things” and “the massage that feels nice”. For a back that has been grumbling since spring, you need both, and you probably need them in the same hour.

What actually helps it stick

A few things make the difference between three days and three months:

• Longer sessions, at least at first. Ninety minutes is not indulgence when there are several regions involved. Sixty gets one of them.
• Closer together, then further apart. Weekly or fortnightly while things are changing, then spacing out. Not a package of ten bought up front.
• Something small to do between visits. Usually two movements, not a programme. I will write them down for you.
• Honest reporting. If it helped for two days, tell me. That is not bad news, it is the most useful measurement we have.

When it is not this

Sometimes low back pain is not a movement pattern. Pain that shoots down a leg, that comes with numbness or weakness, that wakes you every night regardless of position, or that arrived with no plausible cause deserves a doctor before it deserves me. Same for anything that follows a fall or an accident.

I will tell you when I think that is what we are looking at. Being the person who says “this needs a scan, not a table” is part of the job, and I would rather lose the booking than waste your money.