Two questions showed up in my inbox this week, in almost the same words: "Will my lower back pain go away on its own?" and "Is sciatica curable?" Here is the honest answer from 25 years of fixing backs in Honolulu, most of them after physical therapy, chiropractic, massage and injections had already been tried.
Most episodes of lower back pain do ease on their own over a few weeks. You rest, you move carefully, the spasm settles, and one morning you get out of bed and it is mostly gone. So you go back to your life.
And then it comes back. Different month, same spot. Or it comes back a little lower, or it shows up in the hip, or it shoots down the leg this time. If that is your pattern, your back pain is not "going away." It is going quiet. The thing that caused it is still there, waiting for the next long drive, the next paddle, the next weekend of yard work.
In my studio, the people who tell me "it usually goes away on its own" are the same people who have had it for five, ten, fifteen years.
Everybody treats the place where it hurts. Your lower back hurts, so the heat, the adjustment, the massage, the injection all go to the lower back. That brings relief, sometimes real relief. But the lower back is almost never where the problem starts.
Your body is held together by fascia, a continuous web of connective tissue that wraps every muscle and every joint from your feet to your skull. It works as one system. When your hips stop rotating, your lower back starts doing the turning. When your glutes switch off from years of sitting, the small muscles of the lower back take over a job they were never built for. When your mid-back stiffens up from a desk and a phone, every twist you make gets borrowed from the lumbar spine.
In all three cases the pain is in the lower back and the cause is somewhere else. Treat the pain and it fades. Leave the cause and it returns. That is the whole story of recurring back pain.
Sciatica is not a diagnosis. It is a description: pain, tingling or numbness running from the lower back or buttock down the leg, because the sciatic nerve is being irritated somewhere along its path. The question is what is irritating it.
Sometimes it is a bulging disc pressing on a nerve root. Sometimes it is a tight, overworked piriformis or glute clamping down on the nerve where it passes through the hip. Sometimes it is a narrowed canal, which is what spinal stenosis means. In every one of those cases the nerve is caught in the middle of a mechanical problem, and mechanical problems respond to mechanical fixes: restore the rotation the hips lost, get the glutes working again, take the load off the structure that is pinching.
I had sciatica myself. A car rear-ended me at a stoplight, and the next morning I could not bend over to get the milk out of the refrigerator. The scans showed degenerative discs and bulging discs, and a surgeon offered me an operation with a 30 percent chance of success. I did not take it. I found the research on fascia, built a sequence around it, and fixed my own back. That was 25 years ago, and I still have not needed the surgery.
So is it curable? I will say it the way I say it to clients: in 25 years, every person who has followed the protocol all the way through has felt better. Many made a full recovery. The ones who did not fully recover still feel far better than they did, and they know exactly what to do on the day the nerve tries to act up again. That is what I can promise. Nobody honest can promise you more than that.
A bulging disc on an MRI scares people, so here is something your scan report will not tell you: plenty of people with no back pain at all have bulging discs on their scans. The bulge is common. The bulge plus a body that has lost its rotation and its glute strength is what hurts.
Stenosis is the same conversation. The canal is narrower, which means there is less room for error. The work is to give the spine back the support it was supposed to have from the hips, the glutes and the mid-back, so the lumbar spine stops absorbing every load on its own. I have done this work with people who were told surgery was the only option. One of them, a golfer, had already been through two failed spinal injections when he walked in. He was back on the course within a month and is still training with me 17 years later.
Some things need a physician first, today, not a trainer: numbness that is spreading, weakness in a leg that is getting worse, any change in bladder or bowel control, or pain that started with a fall or an accident in the last few days. Get those checked. Once you are cleared to exercise, come see me. I work alongside your doctor, never instead of one.
Stop asking whether it will go away and start asking where it starts. That is a 20-minute question. In my movement screen I put your body through tests you are supposed to fail, and every one you fail shows me where the load is going wrong. You leave knowing where your pain actually comes from, whether we ever work together or not.
If you want the longer version first, I wrote a free five-page guide, Why Your Lower Back Pain Keeps Coming Back. No email required.
- Dan
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