Low Back Pain

Common Symptoms

• Dull, aching, or sharp pain anywhere from the lower ribs to the top of the pelvis
• Pain that's worse with certain positions or movements (sitting, bending, twisting)
• Muscle tightness or spasm in the low back
• Pain that may or may not radiate into the buttock or leg
• Stiffness that's often worse first thing in the morning or after prolonged sitting

Why It Happens

Low back pain can originate from several different structures — muscles and fascia, the small facet joints of the spine, the intervertebral discs, or, less commonly, a compressed nerve root. Identifying which structure (or combination) is involved is central to appropriate treatment, since the underlying cause of a strained low-back muscle is very different from a herniated disc irritating a nerve.

Why It Can Become Persistent

The low back is involved in nearly all upright posture and movement, so it's difficult to fully offload, and the underlying cause is sometimes never clearly identified — which can lead to generic treatment that doesn't target the actual pain generator. Deconditioning, prolonged sitting, and fear of movement can also contribute to pain lasting longer than expected for a simple strain.

Who Commonly Gets It

Low back pain is extremely common and affects most adults at some point. Risk factors include prolonged sitting, physically demanding work, prior back injury, deconditioning, and simply the cumulative effects of aging on the spine.

How It Is Usually Diagnosed

A provider takes a detailed history and physical exam, including screening for "red flag" symptoms (such as significant weakness, loss of bowel/bladder control, unexplained weight loss, or fever) that would need urgent evaluation. For most low back pain without red flags, a focused exam — checking movement patterns, muscle tenderness, and neurological signs — guides initial treatment; imaging is not always needed early on and is reserved for specific situations.

Traditional Treatment Options

• Activity modification and continued movement: Current guidelines generally favor staying as active as tolerated over prolonged rest.
• Physical therapy: Targeted exercise addressing strength, mobility, and movement patterns is a well-supported first-line approach for most non-specific low back pain.
• NSAIDs: Sometimes used short-term for symptom control.
• Heat/manual therapy: Can provide short-term symptom relief for some patients as part of a broader plan.
• Injection or specialist referral: Reserved for specific diagnoses (such as nerve-related pain) identified on evaluation, not a first-line approach for general low back pain.

Why Someone Might Start Looking for Another Option

Because low back pain has so many possible causes, generic treatment that isn't matched to the actual source of pain often falls short — which is a major reason an accurate diagnosis, rather than jumping straight to a specific therapy, matters more here than for many other conditions on this site.

Where Shockwave Therapy May Fit

The evidence for shockwave therapy in low back pain is limited and preliminary compared with the other conditions on this site. It has been explored specifically for soft-tissue and myofascial sources of low back pain — not disc-related or nerve-related pain — and only in early-stage, non-peer-reviewed research so far. We are transparent that this is not an established, well-studied use of shockwave therapy the way plantar fasciitis or tennis elbow are.

How Shockwave Treatment Works for This Area

If your evaluation identifies a soft-tissue or myofascial source of low back pain where shockwave therapy may reasonably apply, acoustic pressure waves would be directed at the specific tender area identified on exam. This is not appropriate for disc-related, nerve-related, or joint-related low back pain, which require different treatment approaches entirely.

What the Treatment Feels Like

Most patients describe a firm tapping or pressure sensation at the treatment site, with some tenderness directly over a sore spot. Your provider will explain whether this applies to your specific presentation before any treatment is considered.

What Happens During Your First Visit

Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.

Who May Not Be Appropriate

• Anyone with "red flag" symptoms — significant weakness, numbness, loss of bowel/bladder control, fever, or unexplained weight loss — who needs urgent medical evaluation, not shockwave therapy
• Suspected disc herniation, nerve compression (sciatica), or spinal stenosis, which need their own diagnostic workup and treatment approach
• People who have not yet had a medical evaluation to identify the actual source of their low back pain
• Active infection, open wounds, or certain bone/spine conditions at the treatment site
• Pregnancy, in the treatment area, unless specifically cleared by your provider

This list is not exhaustive. Your provider will screen for contraindications during your evaluation.