Why Your Back Pain Keeps Coming Back (And What You Can Do About It)
Medically reviewed by Devanshi Modi, PT, Cert. MDT, CMP — licensed physical therapist with over 15 years of clinical experience.
If you've done physical therapy before, felt better for a while, and then watched your back pain return, you're not alone — and it's not your fault. In one study of 250 people who had recently recovered from an episode of low back pain, 69% had it come back within 12 months, and 40% had a recurrence that limited their activities[1]. Most people recover from a new episode fairly quickly, but recurrence is common[2].
One of the most common frustrations we hear from patients at our East Brunswick clinic is some version of: "I've tried PT already, and it just came back." Pain coming back is common, so on its own it doesn't mean your earlier physical therapy failed. For nearly everyone with low back pain, it isn't possible to pinpoint the specific source of the pain[2]. What we can look at are the movements, positions, and habits that make your pain better or worse.
Short-Term Relief vs. a Longer-Term Plan
Some treatments mainly aim to ease pain in the moment. Superficial heat, for example, is among the non-drug treatments the American College of Physicians recommends for acute or subacute low back pain[3], while current evidence does not support therapeutic ultrasound for chronic low back pain[4]. Relief is worth having — it just isn't the whole plan. Some factors are linked with back pain returning: in people who had recently recovered from an episode, frequent awkward postures, sitting more than 5 hours a day, and having had more than two previous episodes all predicted a recurrence within a year[1].
Our approach asks a practical question: which movements, positions, and daily habits make your pain better or worse — and what can you change, and practice, to manage them?
How the McKenzie Method Guides Treatment
At Spineck Physical Therapy, we use the McKenzie Method (Mechanical Diagnosis and Therapy). We systematically test how your symptoms respond to specific repeated movements and positions. Many people have what's called a directional preference — a particular direction of movement that reduces their pain — and often their pain centralizes, retreating back toward the spine and away from the leg. In studies of people with spinal pain, about two-thirds showed centralization or a directional preference and about a third showed neither, and these responses are linked with a better outlook in low back pain[5].
If we find a pattern like this, two things follow:
- We build your plan around the movements that ease your symptoms. The 2021 physical therapy clinical practice guideline for low back pain lists the McKenzie approach (Mechanical Diagnosis and Therapy) as an option physical therapists may use to reduce pain and disability, based on moderate evidence for chronic low back pain and weaker evidence for acute low back pain[6].
- We teach you how to manage a flare-up on your own. The same guideline supports active, one-on-one education in self-management techniques — such as staying active and pacing — for acute low back pain, although in trials the benefits were mainly short-term improvements in disability and function[6].
Why Self-Management Matters
What you keep doing between and after your visits matters. In a review of 21 randomized trials, exercise combined with education lowered the risk of an episode of low back pain by about 45% (moderate-quality evidence), while education on its own did not appear to prevent back pain[7]. Understanding your own back — what aggravates it, what settles it, and which movements help — gives you a plan for the next flare-up. It isn't a guarantee, though: in a randomized trial of 262 adults who had recently recovered from low back pain, a two-session McKenzie-based self-management program did not meaningfully reduce recurrences over the following year; it may have reduced recurrences that led people to seek care, but that result was uncertain[8].
We emphasize staying active and keeping up your exercises, and it helps to know what to expect: for chronic low back pain, two of three published systematic reviews supported the McKenzie Method for reducing pain and disability, but several trials found only short-term improvements of small to moderate size and did not show differences at longer-term follow-up[6].
The One-on-One Difference
A thorough movement assessment takes time and attention. At Spineck, every session is one-on-one with Devanshi Modi, PT, Cert. MDT — the same therapist every visit, never an aide, never split across multiple patients. Seeing the same therapist every visit means you don't have to re-explain your history, and your plan can be adjusted as you progress.
If your back pain keeps coming back, a one-on-one movement assessment can help you understand your pattern and build a plan to manage it. Call us at 551-208-3234 to schedule a one-on-one evaluation in East Brunswick.
References
- da Silva T, Mills K, Brown BT, et al. Recurrence of low back pain is common: a prospective inception cohort study. J Physiother. 2019;65(3):159-165. doi:10.1016/j.jphys.2019.04.010 · PubMed
- Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356-2367. doi:10.1016/S0140-6736(18)30480-X · PubMed
- Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. doi:10.7326/M16-2367 · PubMed
- Ebadi S, Henschke N, Forogh B, et al. Therapeutic ultrasound for chronic low back pain. Cochrane Database Syst Rev. 2020;7(7):CD009169. doi:10.1002/14651858.CD009169.pub3 · PubMed
- May S, Runge N, Aina A. Centralization and directional preference: an updated systematic review with synthesis of previous evidence. Musculoskelet Sci Pract. 2018;38:53-62. doi:10.1016/j.msksp.2018.09.006 · PubMed
- George SZ, Fritz JM, Silfies SP, et al. Interventions for the management of acute and chronic low back pain: revision 2021. J Orthop Sports Phys Ther. 2021;51(11):CPG1-CPG60. doi:10.2519/jospt.2021.0304 · PubMed
- Steffens D, Maher CG, Pereira LS, et al. Prevention of low back pain: a systematic review and meta-analysis. JAMA Intern Med. 2016;176(2):199-208. doi:10.1001/jamainternmed.2015.7431 · PubMed
- de Campos TF, Pocovi NC, Maher CG, et al. An individualised self-management exercise and education program did not prevent recurrence of low back pain but may reduce care seeking: a randomised trial. J Physiother. 2020;66(3):166-173. doi:10.1016/j.jphys.2020.06.006 · PubMed
This article is for general education and is not a substitute for an individual evaluation by a licensed clinician.
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This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a licensed healthcare provider about your specific condition.