Lower back pain is one of the most common reasons patients come to my clinic in Saket. It is also one of the most mismanaged conditions in physiotherapy in Delhi.
Not because it is complicated. Because most clinics skip the step that matters most: finding out which of the many possible causes is actually responsible for this particular patient’s pain.
Lower back pain is not one condition
This is the first thing I tell every patient who comes to me with back pain that has not responded to previous treatment. Lower back pain is a symptom, not a diagnosis. And it has a long list of possible causes.
The pain could be coming from weak back muscles. Or tight back muscles. Or prolonged sitting that has shortened the hip flexors and changed how the lumbar spine loads. It could be radiating pain from the hip. A postural issue. A structural problem. It could be coming from thoracic or cervical restriction transferring load downward. It could even be coming from the foot: a pronated foot changing the entire kinetic chain upward through the ankle, knee, hip, and into the lower back.
All of these present as lower back pain. They require completely different treatment approaches. Treating them all the same way is why back pain keeps returning.
Unless you identify the root cause, you cannot plan the rehabilitation. You can manage the symptom temporarily. You cannot resolve the problem.
The case of the young athlete with restricted hips
A patient came to me in his late twenties. He was a competitive athlete and had been dealing with lower back pain for a long time. He had tried treatment before with no lasting result.
When I assessed him properly, the root cause was not in his back at all. It was in his hips. He had significantly restricted hip extension and rotation on one side. Because the hip could not move through its full range, the lumbar spine was compensating with every step, every sprint, every change of direction. The back was doing the work the hip was supposed to do. Over months and months of training, that compensation had loaded the lumbar spine beyond what it could sustain.
We focused the rehabilitation on restoring hip mobility and strengthening the hip muscles through the available range. Once the hip started moving properly, the stress on the lower back reduced automatically. His pain resolved and he returned to playing with better movement quality than before the injury.
Nobody had looked at his hip. Everyone had treated his back.
What most physiotherapy clinics miss in the assessment
The majority of back pain patients I see who have been failed by previous treatment share one common experience: the assessment was too narrow.
A proper assessment for lower back pain starts with a thorough history. Not a quick intake form. A real conversation about when the pain started, what makes it worse, what positions relieve it, what the patient was doing in the weeks before it began, and what previous treatment felt like even if it did not last.
From the history alone, a good clinician should have a working hypothesis about the likely cause before any physical examination begins. The physical examination then confirms or challenges that hypothesis.
What I look for in the physical examination goes well beyond the lumbar spine. I check the hip range of motion in all directions. I assess the thoracic spine mobility. I look at how the patient stands, how they move, how their foot contacts the ground. I check core activation patterns and whether the glutes are firing correctly during basic movements.
This takes time. But it is the only way to find the actual cause rather than just treating the location of the pain.
Why chronic lower back pain needs a different approach
Chronic lower back pain is not just acute back pain that has lasted longer. It is a different clinical picture entirely.
In chronic cases, the muscles surrounding the back stop firing properly. The body has been in pain for so long that the normal muscle recruitment patterns have changed. The glutes inhibit. The core stops activating automatically. The surrounding structures compensate. By the time a patient has had back pain for six months or more, the problem has spread well beyond the original cause.
This is why treating chronic lower back pain with back exercises alone almost never works. The back muscles are not the only muscles that need attention. The glutes, the core, the thoracic extensors, the hip flexors, the entire posterior chain. All of these need to be assessed and addressed.
My rehabilitation programme for chronic lower back pain works on the entire chain. Not just the back. We strengthen the glutes because weak glutes are one of the most consistent findings in chronic back pain patients. We activate the core because a core that has stopped firing automatically cannot protect the lumbar spine under load. We restore thoracic mobility because a stiff thoracic spine forces the lumbar spine to compensate for every rotational movement. We look at the structures above and the structures below.
The principle is the same one I apply to every chronic condition: the area that hurts is rarely the area that needs to be treated. Fix the chain, and the back stops hurting. Treat only the back, and the pain keeps coming back.
The question to ask if your back pain keeps returning
If your lower back pain improves for a few weeks and then comes back, ask your physiotherapist one question: what do you think is causing the pain?
Not where is the pain. What is causing it.
If the answer is vague: “tight muscles,” “poor posture,” “weak core” without specifics. The root cause probably has not been found yet. A clear answer should name a specific structure, a specific movement pattern, or a specific compensation that the assessment revealed.
Chronic lower back pain is treatable. But it requires finding the actual source, not just managing the location of the symptom.
I see patients with chronic lower back pain in Saket, South Delhi. If your back pain has not responded to previous treatment, WhatsApp me at +91 92893 03555. The first session is an assessment and a conversation about what the history reveals.
If your physiotherapy has not been finding the root cause, this may explain why: Why Physiotherapy Stopped Working for You and What I Look for Instead
Dr. Manvi Dhyani, PT holds an MPT in Sports Physiotherapy from Jamia Millia Islamia and is a registered physiotherapist with the Delhi Council for Physiotherapy and Occupational Therapy (Reg. TPR-2666). She has worked as a team physiotherapist with the Central Reserve Police Force, completed international field postings with ProHealth Asia across four countries, and served as physiotherapist for India’s national archery team at the 2021 World Archery Youth Championships in Wroclaw, Poland. She practices in Saket, New Delhi.
Dr. Manvi Dhyani is a qualified physiotherapist (MPT Sports Physiotherapy, Jamia Millia Islamia; Registered Physiotherapist, Delhi Council for Physiotherapy and Occupational Therapy, Reg. TPR-2666). The title Dr. is used in accordance with her doctoral-level physiotherapy qualification and does not denote a registered medical practitioner under the NMC Act, 2020.