Clinicians Are Usually Wrong When Identifying Lumbar Tissue Pain Generators

Many patients have been told by their health care provider that a specific lumbar tissue is the cause of their low back pain.

Some common examples include:

  • Lumbar facet joint
  • Degenerative disc disease
  • Osteoarthritis
  • Multifidus
  • Lumbar paraspinal
  • QL
  • SI Joint
  • Lumbar ligaments

What if I told you that most health care providers were most likely incorrect about the low back pain generator?

Evidences based clinical guidelines for management of acute low back pain suggest that 85% of the time the clinician is wrong about identifying the structure that is causing pain. 1

For this reason it is important for patients to seek providers that assess what movements that provoke or improve your low back pain rather chasing a specific tissue.

Movement based practitioners will view low back pain through a different lens and are generally very effective. This is due to the directional preference of low back pain. Directional preference are specific exercises in either lumbar flexion, extension, lateral flexion, and/or rotation that improves a patient’s symptoms

A randomized control study by Long et al in 20042, demonstrated that patient outcomes improved significantly when given exercises that match the directional preference as opposed to the opposite direction or given generic exercise.

At the end of the day, if your low back pain decreases through movement, does it really matter what tissue is the pain generator?

This is the way everybody.


  1. Bogduk N. Evidence-based clinical guidelines for the management of acute low back pain. Submitted for endorsement by the NH&MRC. November 1999.
  2. Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine. 2004;29:2593-2602.

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