You’ve done everything right. You rested when it first happened. You saw your GP. You went to physio and did the exercises. Maybe you’ve had scans, injections, or seen specialists.
And yet, here you are. Still in pain.
If your back pain hasn’t healed despite your best efforts, it’s not because you’ve failed. It’s because something has been missed. This post explores the hidden reasons back pain persists — and why your back might not be the real problem at all.
The Uncomfortable Truth About Back Pain
Here’s something that might surprise you: research consistently shows that findings on MRI scans often don’t correlate with pain.
Studies of people with no back pain at all have found that significant numbers have disc bulges, degenerative changes, and other “abnormalities” on imaging — yet they feel absolutely fine. Meanwhile, people in severe pain sometimes have scans that look relatively normal.
This disconnect tells us something important. The structural findings that get blamed for back pain — the disc bulges, the wear and tear, the degeneration — often aren’t the real cause. They’re incidental findings that get labelled as the problem because they show up on the scan.
If your treatment has been based on what showed up on your MRI, and that treatment hasn’t worked, this might be why. The scan might be showing you something that isn’t actually causing your pain.
Your Back Is Usually the Victim, Not the Cause
Your back sits in the middle of your body. It has to respond to everything that happens above and below it. When something goes wrong in your hips, your pelvis, your feet, or even your shoulders and neck, your back often pays the price.
Think of your spine as the conductor of an orchestra. If the string section is playing out of tune, the conductor has to work harder to keep things together. The conductor isn’t the problem — but the conductor is where the stress shows up.
Here are some of the hidden causes of back pain I see regularly:
Dysfunction in the Feet
Your feet are your foundation. Every step you take, your feet send information up the chain about the surface you’re walking on and how you need to balance.
When receptors in your feet aren’t working properly — sometimes from an old ankle sprain, sometimes from the wrong footwear, sometimes from an injury that healed structurally but not neurologically — your whole body compensates. The muscles of your hips and back have to work differently to keep you upright and moving.
Over time, this compensation becomes strain. Your back feels tight, achy, or painful — but the feet are driving the problem. No amount of back treatment will fix this because the treatment is aimed at the wrong area.
Hip Dysfunction
Your hips are designed to be mobile. When they lose range of motion — whether from sitting too much, from old injuries, or from neurological dysfunction — your lower back picks up the slack.
Every time you should be rotating through your hips, your spine rotates instead. Every time your hips should be absorbing load, your back takes the impact. The back becomes overworked because the hips aren’t doing their job.
This is why people with back pain often find their hips are restricted when properly assessed. The hip restriction might not cause any hip symptoms, but it’s directly contributing to the back pain.
Pelvic Imbalance
Your pelvis is the base that your spine sits on. When the pelvis is out of balance — tilted, rotated, or unable to move symmetrically — the spine has to compensate constantly.
Pelvic imbalance can come from many sources. Compensation for an old injury. Dysfunction in the muscles that control the pelvis. Issues with the sacroiliac joints. Sometimes it traces back to something as seemingly unrelated as an abdominal scar or dysfunction in the internal organs.
When the foundation is uneven, everything above it has to adapt. The back takes the strain because it has no choice.
The Opposite Side of the Body
Pain on one side of your back might actually originate from the other side of your body — sometimes even the other end.
I’ve seen cases where right-sided back pain traced back to dysfunction in the left ankle. Where lower back pain originated from the opposite shoulder. The body is interconnected in ways that don’t match our intuitive understanding of anatomy.
These contralateral patterns are why treatments focused only on the painful area often fail. The pain is real, but the cause is elsewhere.
Why Conventional Treatment Often Falls Short
Conventional back pain treatment typically focuses on the back itself. Mobilise the spine. Strengthen the core. Stretch the tight muscles. Decompress the discs.
These approaches aren’t wrong — but they’re often incomplete. They treat the area that hurts without asking why it hurts.
If your back pain is caused by dysfunction in your feet, strengthening your core won’t fix it. The core exercises might help you compensate more effectively, but they won’t address the underlying cause. As soon as you stop the exercises, the pain returns.
If your back is overworking because your hips don’t move properly, mobilising your spine won’t solve the problem. The spine will just return to its overworked state because the hips still aren’t functioning.
This is why so many people end up in a cycle of ongoing treatment. Regular physio, regular massage, regular chiropractic adjustments — indefinitely. The treatment provides relief, but the problem never actually resolves because the cause hasn’t been addressed.
What Needs to Happen Instead
Resolving persistent back pain requires looking beyond the back. The assessment needs to examine the whole body to find what’s actually driving the problem.
This means testing the function of your feet, ankles, knees, hips, and pelvis — not just your spine. It means assessing your nervous system’s control of your muscles, not just the muscles themselves. It means looking for causes, not just symptoms.
When the real cause is identified, treatment can be targeted accurately. Sometimes the back does need direct treatment. But often, addressing a hip restriction, resetting dysfunctional receptors in the feet, or correcting pelvic imbalance resolves the back pain without ever treating the back directly.
This approach takes longer in assessment but leads to faster resolution overall. Finding the right target first time is more efficient than treating the wrong thing repeatedly.
Signs Your Back Isn’t the Real Problem
How do you know if your back pain is actually being caused by something else? Here are some clues:
Your back pain came on gradually without any obvious cause. When there’s no clear incident that started the pain, it often indicates a compensation pattern that built up over time. Something elsewhere in the body was dysfunctional, and the back eventually couldn’t cope with the extra load.
Treatment to your back helps temporarily but doesn’t last. This is a classic sign that the back is the victim rather than the cause. The treatment provides relief because it reduces strain on the back, but the relief doesn’t last because the source of that strain still exists.
Your pain is worse at certain times of day or during specific activities. These patterns often point to functional causes. The back hurts when something else in the body isn’t working properly during that activity or posture.
You’ve been told you have “non-specific” back pain. This diagnosis essentially means they can’t find a clear structural cause. Which is accurate — but it doesn’t mean there’s no cause. It means the cause isn’t structural. It’s often neurological.
Other areas feel tight or restricted but don’t necessarily hurt. Your body might be telling you where the real problem is, but since those areas don’t hurt, they get ignored. The hips that feel stiff, the ankle that’s not quite right, the shoulder that doesn’t move as well as it should — these could be relevant clues.
Finding the Root Cause
If you’ve been stuck in the cycle of back pain that never fully resolves, it might be time for a different approach. Not another treatment aimed at your back, but a thorough assessment that looks for what’s really causing the problem.
This is exactly what we do at Breakthrough Pain & Performance. We don’t assume your back is the problem just because that’s where it hurts. We test your whole body to find the true source of dysfunction. Then we treat that — which often resolves the back pain far more effectively than treating the back ever did.