Your back’s been hurting on and off for months. Maybe years. It settles for a while — then you reach for something the wrong way and it’s back. You’ve been told to stretch more, sit straight, do core exercises. None of it has actually fixed it.
If that’s the pattern, you’re not unlucky. You’re stuck in a loop most physio isn’t built to break.
What “comes and goes” actually means
A flare-up isn’t your back failing. It’s the same underlying problem reaching threshold again. Tight tissue, a restricted joint, a movement pattern your body has been compensating around — none of it ever resolved, so it keeps tipping over the line every few weeks or months.
Stretching when it flares up takes the edge off. Core exercises help your body cope with the load. But neither of them is treating the structure that keeps starting the fire.
That’s why “rest, stretch, see if it settles” works for a while, then the pain comes back the next time you load the area. The pain pattern hasn’t been resolved — it’s been managed around.
Three reasons most physio doesn’t fix recurrent back pain
1. The treatment is exercise-only
Most clinics today run on a high-volume model: quick assessment, a printout of band exercises, a follow-up in two weeks. Exercise has a role — but as homework, not as the appointment itself. If nobody’s actually got hands on the tight, restricted tissue causing the pain, the exercise sheet is asking the body to load through a structure that hasn’t been freed up.
For a fresh injury, exercise-only sometimes works. For pain that’s been around for months or years, it almost never does on its own.
2. The advice is generic
“Sit up straight.” “Don’t lift heavy.” “Lose some weight if you can.”None of it is wrong on principle. But it’s not specific to your back, your job, or your week.
If you spend nine hours a day twisting under a sink, carrying gear up scaffolds, or holding a kid on your left hip, that’s the load profile your treatment plan needs to be built around — not a slide deck.
3. The treatment site isn’t the cause
Back pain doesn’t always live where it starts. Lower back pain often traces back to hip mobility, glute strength, thoracic stiffness, or a foot biomechanics issue. If treatment only goes where the pain is, you’re chasing a symptom — and the cause keeps reigniting it.
A proper assessment looks past the painful spot. Hands-on testing of how the joints move, how the tissue feels, how the body loads under fatigue. That’s where the real driver shows up.
What hands-on treatment does differently
In my clinic, the appointment is hands-on first. Manual therapy, dry needling, soft tissue release, joint mobilisation — physically reducing the restriction and tissue load that’s keeping the pain pattern alive.
Then, and only then, exercise. Targeted, short, specific to what your body actually needs to load — not a wall of generic core work.
The point of the difference is simple: each session has to do something. You leave knowing what was treated, why, and what to expect for the week. Not just a printout.
For most people with recurrent back pain, the goal is sustained relief — and that’s what most achieve. Some get full resolution. A smaller group get significant improvement that they then maintain with the right ongoing strategy. More on how I treat chronic pain →
When to see someone — and when to wait
Acute back pain (hours to a few days old) often does settle with rest and gentle movement. If yours is fresh and improving day by day, give it a week.
But if any of these apply, it’s worth booking in:
- Pain that’s been there for more than three weeks
- A pattern where it flares every few weeks or months and never fully resolves
- Pain that changes your sleep, your work, or how you move through the day
- Anything you’ve already tried — stretches, exercises, generic physio — that hasn’t shifted it within 4–6 sessions
The longer a pain pattern is left, the more entrenched it gets. Hands-on treatment works at any stage, but the earlier you address the cause, the fewer sessions you’ll need.
Red flags — when it’s not just back pain
Most back pain is musculoskeletal and resolves with the right treatment. A small minority needs different attention. See your GP urgently — not just a physio — if you have:
- Numbness or weakness in the legs
- Loss of bowel or bladder control
- Unexplained weight loss alongside the pain
- A history of cancer, recent significant trauma, or fever with the pain
These are uncommon — but worth ruling out. For everything else, hands-on physio is usually the right next step.
Working in the trades, training hard, or just dealing with pain that won’t go away? Read more about chronic pain treatment →