Why does my lower back still hurt when tests show no clear cause?

If your back keeps hurting but you are told that an X-ray or MRI shows no serious abnormality, you may wonder, “Then why does it hurt?”

Lower back pain that cannot be explained by a single clear cause, such as fracture, infection, tumor, or severe nerve compression, is also referred to as 'non-specific low back pain.'

The term 'non-specific' does not mean that the pain is fake or a psychological issue. This means that various factors such as movement of the lumbar spine and pelvis, muscle tension and strength, activity level, sleep, and stress can all influence pain.

The lower back does not move solely with the vertebrae and discs.

• Spine and Joints
• Muscle and fascia
• ligament
• Pelvis and hip joint
• Nerve
• Trunk and buttock muscles
• Breathing and posture
• Daily activities and sleep

All these elements move together.

Therefore, in many cases, the pain cannot be fully explained by a single disc seen on an MRI. Conversely, even if imaging studies show no significant abnormalities, restricted joint movement and inability of muscles to function properly can lead to actual pain and functional impairment.

• Pain in the center of the lower back or on one side that occurs repeatedly
• Pain worsens when sitting or standing for a long time.
• Stiffness when bending, straightening, or rotating
• Dull pain extending to the surrounding area of the buttocks
• Pain recurs when feeling fatigued or when physical activity increases.
• The examination showed no major abnormalities, but daily life is still inconvenient.
• Avoidance of exercise and activity due to fear of pain.
• It may be fine during treatment, but it can easily hurt again.

If leg strength decreases or sensation becomes significantly dull, and bowel or bladder function changes, do not consider it merely non-specific low back pain; nerve issues must be checked first.

For non-specific low back pain, it is more important to carefully examine current movement and function than imaging.

repetitive movements causing pain

We check which movement among sitting for a long time, bending down, standing up, walking, or lifting objects causes pain.

Movement of the lumbar spine and pelvis

We check which directions the lower back and hip do not move well in, and whether one area moves excessively to compensate for another.

Muscle tension and strength

We check whether the muscles around the lower back remain tense and whether the torso and buttock muscles generate adequate force at the required moments.

Nerve function

If there is leg pain and numbness, we examine muscle strength, sensation, reflexes, and gait to distinguish it from other conditions.

Daily Function

We check how long you can sit, how far you can walk, and what limitations exist regarding sleep, work, and exercise.

Factors hindering recovery

We also examine whether sleep deprivation, sudden changes in activity level, fear of pain, prolonged static postures, and stress contribute to the persistence of pain.

That is incorrect.

MRI is useful for visualizing structures such as discs, nerves, and the spinal canal, but it does not show all of the following details.

• How exactly the lower back is moved
• In which movement does pain occur?
• whether the muscles are exerting force appropriately
• How is your ability to sit for long periods and walk?
• What effects do sleep and activity levels have on pain?

Conversely, even if degenerative changes or disc protrusion are visible on an MRI, they may not be directly related to the current pain.

Imaging findings should be interpreted together with current symptoms, physical examination, and nerve function.

The fact that pain persists for a long time does not always mean that tissue damage is continuing to progress.

Avoiding movement due to pain can cause joints to become stiffer and may reduce muscle strength and endurance. If sleep deprivation and stress overlap, you may become more sensitive to pain.

Therefore, in cases of chronic lower back pain, the process of restoring the following is just as important as continuing to search for the damaged area.

• Range of motion for comfortable movement
• Walking and Sitting Time
• Function of trunk and buttock muscles
• Sleep and daily activities
• Confidence that one can self-regulate even when experiencing pain

Description of current condition

We begin by understanding why pain recurs and which movements are safe. The presence of pain does not necessarily mean that all movements are causing damage.

Chuna manual therapy

We can evaluate the movement of the lumbar spine, pelvis, and hip joint, and manage restricted joints and overly tense muscles.

Chuna manual therapy is not merely a treatment to align the shape of bones, but is performed in a direction that confirms movements related to current pain and aids actual functional recovery.

After treatment, we recheck the range of motion of the lower back, ability to sit and stand, gait, and pain response.

Acupuncture treatment and pharmacopuncture treatment

Considering pain around the lower back and buttocks, muscle tension, and the patient's condition, this may be performed selectively.

Recovery from exercise and activity

Walking, mobility exercises, and core and gluteal muscle exercises are progressed stepwise according to current function.

One exercise does not suit everyone. Assess and adjust based on pain response after exercise and daily function.

Pain relievers and injection therapy

Much non-specific low back pain can be treated with the Chuna manual therapy, acupuncture, pharmacopuncture, and exercise described above. In periods when pain is severe, analgesics are sometimes used alongside them.

However, in chronic low back pain, the longer pain relievers are taken, the greater the burden on the stomach, kidneys, and cardiovascular system becomes, while the pain reduction effect is often not substantial. Injections also merely reduce pain temporarily and differ from long-term functional recovery. If pain returns every time medications are stopped, it is advisable to re-examine movement, muscle function, and daily loading, and to continue recovery through Korean medicine treatment.

• Has the pain decreased?
• Has the range of motion for moving your lower back increased?
• Has the time you can sit for long periods or walk increased?
• Whether sleep and work have become easier
• Has the recovery time become shorter even with pain?
• Has the range increased for conditions that can be managed on their own without treatment?

If there is no change even after a certain period of treatment, you should re-evaluate and revise the plan rather than repeating the same treatment.