Back Pain Treatment in North Vancouver

Common symptoms:

• Stiffness or aching in the lower back, especially in the morning or after sitting
• Sharp pain when bending, lifting, or twisting
• Pain spreading into the buttock or upper leg
• Difficulty standing upright after sitting for a long period
• A feeling that the back"gives out" or lacks support during activity

When should back pain be seen?

Most back pain settles and is not a sign of anything dangerous. A few situations need prompt attention.

It is worth an assessment rather than waiting it out if your back pain lasts beyond two to three weeks, disrupts your sleep, or has started reducing how much you move. In general, the sooner treatment begins, the more likely symptoms are to improve.

Why your lower back is the place that hurts

The lumbar spine is frequently the region compensating for a restriction somewhere else.

One school of thought asks a different question about back pain: not which structure is damaged, but which movement or control problem is producing the load.

On that view, the lumbar spine is frequently the region compensating for a restriction somewhere else. The regions examined include:

• The hips: Stiff hips mean the lower back moves further, more often, to make up the range.
• The thoracic spine and ribs: When the mid-back doesn't rotate, the lumbar spine twists instead — a joint built for very little rotation doing work it isn't shaped for.
• The diaphragm and breathing: Covered in its own section below.
• The abdominal wall and pelvic floor: Without coordinated control here, spinal loading rises.
• The feet and ankles: Restriction here changes how load arrives from the ground up.
• The neck: Included because the whole system is examined, and posture matters.

For nearly everyone with back pain, no single specific structural cause can be identified on examination or imaging (Hartvigsen et al., The Lancet, 2018). What the movement examination can find is which of the above is contributing in your case.

Dysfunction in the movement system

One school of thought puts the emphasis on how a joint behaves while it moves, rather than on what it looks like at rest. When a joint tracks well through a movement, the load spreads across the whole joint surface and the muscles around it don't have to compensate. When movement patterns are poor, the same joint takes load unevenly, the muscles work harder to control it, and the tissues carry more than they were designed to handle — repeated a few thousand times a day.

Which muscles are doing too much:

Painful muscles are usually overworking rather than weak. In back pain, the ones commonly found tight are the hip flexors, the lumbar erectors, quadratus lumborum, and piriformis; the ones commonly found underworking are the gluteal muscles and the lower abdominal wall.

Trigger points:

Tender points in these muscles frequently reproduce the back pain a patient describes. Settling them often reduces symptoms directly and makes movement work possible.

Breathing and the stability of your spine

The diaphragm is a breathing muscle, and it is also a postural one. Working alongside the abdominal wall, back muscles, and pelvic floor, the diaphragm generates pressure inside the abdomen (intra-abdominal pressure) that stabilizes the lumbar spine from the inside — before an arm or a leg moves. Raising that pressure produces a measurable difference in spinal stability independent of the big back muscles (Hodges et al., J Appl Physiol, 2000).

In people with chronic low back pain, this doesn't work as well. In one study, dynamic MRI taken during arm and leg loading showed smaller diaphragm movement and a higher resting position in people with chronic low back pain than in people without it (Kolář et al., JOSPT, 2012).

What that looks like in practice: Breathing into the upper chest rather than the lower ribs and abdomen, an inability to generate pressure low down, and the back muscles bracing to make up the difference.

What about the scan?

Degenerative changes in the spine are common, and they are common in people with no pain at all.

In a systematic review of imaging in people without symptoms, disc degeneration was present in 37% of 20-year-olds and 96% of 80-year-olds. Disc bulges: 30% at twenty, 84% at eighty. Facet joint degeneration: 4% at twenty, 83% at eighty (Brinjikji et al., AJNR, 2015).

Findings like these are largely a feature of getting older. They appear on a report as though they explain the pain, but they usually explain very little on their own — which is why guidelines advise against routine early imaging for ordinary back pain (Foster et al., The Lancet, 2018). Where red flags are present or recovery stalls, imaging becomes useful, and you'll be advised to see your family physician for medical evaluation.

Treatment for back pain at Scandinavian Clinic

Find where the load is coming from, restore movement, settle tone, restore the stabilising system, then retrain movement itself. Two people with identical scans can need entirely different treatment, and the movement examination is what decides.

• Examine the whole system: Breathing and posture first, then the neck, thoracic spine and ribs, lumbar spine, pelvis and sacroiliac joints, hips, and feet — tested against your symptoms to establish which findings are relevant to your pain.
• Restore joint function: Gentle, low-velocity mobilisation to restricted segments and joints — spinal, rib, pelvic, and hip — restoring normal joint play.
• Reduce muscle tightness: Massage and soft-tissue work including fascia, post-isometric relaxation, specific stretching, and trigger point treatment.
• Restore breathing and abdominal pressure: Retraining the diaphragm to work with the abdominal wall and pelvic floor, so the spine is stabilised from the inside rather than braced from the outside.
• Retrain the stabilising pattern in developmental positions: Dynamic Neuromuscular Stabilization uses positions from infant motor development — supine, side-lying, four-point kneeling, half-kneeling — not as an exercise fashion, but because these positions make correct coordination happen without you having to think about it. [Learn more about DNS →]
• Train movement, not isolated muscles: Hip hinging, squatting, rolling, reaching, lifting, and walking. The nervous system learns coordinated movement; it doesn't learn much from repetitions of a single muscle in isolation. Your home exercises emphasise quality of movement over quantity of repetitions.

Staying active alongside all of this matters: guidelines consistently favour keeping moving and returning to normal activity over rest, which tends to prolong the problem (Foster et al., 2018).

What to expect

Assessment and treatment begin in the same session. You'll be told what the examination found, which findings relate to your symptoms, and what the plan is.

Early sessions focus on settling pain and restoring movement. As that improves, sessions shift toward stabilising and movement work, and toward managing it yourself.

Uncomplicated back pain often improves over a handful of sessions. Long-standing or recurring back pain takes longer, and you'll get a realistic timeline based on what the assessment finds rather than a standard package.

The home practice carries a good share of the work. It's a small number of movements done well, not a long list.

The Scandinavian Clinic

• Comprehensive assessment: Finding where the load originates across the whole movement system.
• Swedish-trained orthopaedic manual therapy. Five years of university-level training in Sweden, with a strong emphasis on clinical reasoning and biomechanical assessment.
• Czech-trained in Dynamic Neuromuscular Stabilization: Trained in the Prague School tradition. [Learn more]
• Covered by most extended health plans: As a Registered Massage Therapist, Eva's treatments are eligible for extended health benefits.

See all conditions Eva treats

Frequently asked questions