Why Your Back Pain Might Not Be Coming From Your Back
- Physology
- Feb 9
- 7 min read
Updated: Feb 14
I was working with a client last month who'd spent two years treating her lower back pain. She'd seen three physiotherapists, had countless sessions focused directly on the painful spot, and was starting to believe this was just her life now.
When I assessed her, the restriction creating her back pain was in her hip flexors and anterior fascia. The back pain was real — she felt it exactly where she described. But the mechanism causing it was somewhere else entirely, pulling through the fascial network like a rope under tension.
This pattern repeats in my practice constantly.
The research is clear: pain location doesn't necessarily indicate the true source. The area where you feel pain may not be where the restriction generating that pain actually lives. Yet traditional approaches keep treating the spot that hurts, wondering why relief doesn't last.
The Gap Between What Research Shows and What Practice Delivers
I started noticing something years ago when clients would tell me their healthcare journey stories. GPs and physiotherapists were working hard, following their training, but they could never actually put their hands on the pain in a way that reached the underlying mechanism.
They'd treat the site. They'd follow protocols. But they weren't accessing the fascial restrictions creating the problem.
The research has been there for years. We know fascia is almost as sensitive as skin. We know it transmits mechanical forces through interconnected chains. We know restrictions in one area create compensatory patterns elsewhere.
But that knowledge hasn't permeated standard clinical practice yet.
Educational institutions preserve what they've always taught because curriculum revision requires coordination that exceeds bureaucratic capacity. Practitioners deliver what they learned, creating fidelity to outdated models even when research has moved forward.
The result is a systematic gap where people fall through.
What I Feel That Scans Can't See
During consultations, I show clients cadaver dissection videos where you can see fascial restrictions around muscles that would have caused pain when the person was alive. Those same restrictions don't show up on scans because scans aren't designed to highlight fascia in that way.
It's a revelation moment for most people.
They've been told nothing is wrong because the imaging came back clear. But the restriction is there — it's just invisible to the technology being used. Ultrasound studies now confirm what hands have been feeling for decades: palpable fascial densifications correspond to real structural changes that create referred pain patterns.
When I place my hands on someone, I can feel different types of tissue restriction. Sometimes it's a muscle spasm. Sometimes it's muscles stuck together with fascial adhesions. Sometimes it's dense, thickened fascia that's lost its glide capacity.
Each type requires different technique and pressure. Each type tells me something about how long the restriction has been there and what compensation patterns have formed around it.
Traditional approaches don't make these distinctions because they're not spending enough time with hands on tissue to develop that tactile discrimination. The system doesn't allow for it.
Understanding the Tug: How Restrictions Create Distant Pain
The pain you feel is real. It's at the exact location you describe. But the restriction causing that pain may be pulling from somewhere else along the fascial chain.
Think of fascia as a continuous network of connective tissue running through your entire body. When one area gets restricted — through injury, repetitive strain, or compensatory holding patterns — it creates tension along the chain.
Your body is always trying to achieve balance and stabilise itself against gravity. Movement comes after stability. When fascia restricts in one area, your body compensates by adjusting tension elsewhere to maintain that stability.
You feel the compensation as pain.
The research confirms this. Studies show that prolonged referral from one trigger point causes other trigger points to develop in referred areas, which then activate and refer pain themselves, creating multiple overlapping pain patterns.
This is why chasing the pain doesn't work. You're treating the symptom site whilst the mechanism remains untouched.
Why Traditional Assessment Misses the Pattern
I developed a systematic assessment approach because I noticed no one else had one. Traditional healthcare didn't have an agreed baseline for how the body should function — no roadmap to compare against a patient's current state.
Without that baseline, you can't identify compensation patterns. You can't see how the body has reorganised itself around restrictions. You can't trace the chain from pain site back to restriction source.
Most practitioners I've encountered also weren't strong with hands-on assessment. They'd been trained in protocols and techniques, but not in the kind of tactile investigation that reveals fascial restriction patterns.
The specialists were particularly limited in this way. Highly credentialed, deeply knowledgeable about their domain, but without the manual palpation skills to feel what was actually happening in the tissue.
This isn't a criticism of individuals. These are good practitioners working within a system that hasn't integrated current research into its training models.
What Happens When You Address the Actual Mechanism
My sessions run two hours, which sounds excessive until you understand what that time allows.
The nervous system needs time to trust. When you're working with chronic pain, the body has learned to guard and protect. You can't rush past that. The extended session length lets me gradually access deeper structures and create release without triggering protective responses.
I work through the fascial restrictions systematically, following the compensation patterns back towards their source. The order matters. You can't just release everything at once — you have to respect how the body has organised itself and unwind it in a sequence that maintains stability.
As I work, I explain what I'm finding and why it matters. Clients need to understand the mechanism. They need to know their pain isn't random, isn't permanent, and isn't something they have to accept.
When I release a restriction that's been creating referred pain, the change is immediate and measurable. The pull releases. The compensation pattern shifts. The pain reduces or eliminates.
Most people achieve pain-free outcomes within four to eight sessions. Each session produces clear, measurable change in symptoms because we're addressing mechanism, not just managing sensation.
The Question Everyone Asks
During initial consultations, three questions come up consistently.
First: "What is fascia?" It's the connective tissue network running throughout your body, surrounding and connecting muscles, organs, and structures. When it gets restricted or adhered, it creates tension and pulls that you experience as pain.
Second: "Can I actually become pain-free?" Yes. We unwind the fascial restrictions and take you back through the different postural compensations, working backwards towards your original pain-free state.
Third: "How long will it take?" Most people achieve pain-free outcomes in four to eight sessions, with clear measurable change in each session.
The confidence in those answers comes from understanding mechanism. When you know what's causing the pain and you have systematic methods to address it, outcomes become predictable.
Why This Approach Remains Rare
The combination of factors that makes this work effective also makes it difficult to replicate within standard healthcare models.
Manual palpation expertise takes decades to develop. You can't learn tactile discrimination from textbooks or weekend courses. It requires thousands of hours with hands on tissue, learning to feel the subtle differences between restriction types.
The two-hour session format doesn't fit economic optimisation models. Most practices need high client throughput to remain viable. Extended sessions reduce capacity and revenue.
Working outside institutional consensus when evidence supports it requires willingness to operate independently. Many practitioners remain constrained by what their credential system sanctions, even when research has moved beyond those boundaries.
Integrating education into treatment adds complexity. It's faster to perform technique than to explain mechanism whilst you work. But without that educational component, clients don't develop understanding of their own physiological causality.
These aren't criticisms. They're structural realities that explain why approaches like this remain uncommon despite their effectiveness.
What This Means for Your Back Pain Journey
If you've been treating your back pain by focusing only on your back, you may be missing the actual source of the problem.
The pain is real. The location is accurate. But the restriction creating that pain might be in your hip flexors, your ribcage, your shoulder girdle, or anywhere along the fascial chains that run through your body.
Traditional approaches aren't wrong — they're working with incomplete anatomical models. The practitioners are skilled and well-intentioned. The system just hasn't caught up with what research now shows about fascial networks and whole-body compensation patterns.
Understanding this changes how you approach resolution. Instead of accepting that nothing works, you recognise that nothing has yet addressed the mechanism. Instead of believing your pain is permanent, you understand it's the result of restrictions that can be systematically released.
The research supports this. The clinical outcomes demonstrate it. The gap exists between what's knowable and what's currently being delivered in standard practice.
To Recap
Pain location doesn't always indicate restriction source. Your body compensates for fascial restrictions by creating tension patterns along interconnected chains, and you feel that compensation as pain in areas distant from the actual restriction.
Traditional approaches focus on the pain site because that's where symptoms present, but this misses the underlying mechanism. Scans don't show fascial restrictions effectively, and standard assessment methods don't include the systematic whole-body evaluation needed to trace compensation patterns.
Resolution requires hands-on assessment that can feel different restriction types, systematic unwinding that respects how the body has organised itself, adequate time for nervous system trust, and educational transfer so you understand what's happening.
The research exists. The methods work. The gap between current knowledge and standard practice creates the space where people with chronic pain continue searching for answers that should already be available to them.
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