Low back pain: why it keeps coming back, and how McKenzie therapy finds the mechanical cause

Have you ever bent down to tie a shoelace and felt your lower back lock up without warning? For many people, that ordinary movement is the moment they finally decide to get help.

Low back pain rarely comes from one dramatic event. It usually builds from a movement pattern that overloads one part of the spine more than the rest. Once that pattern is identified, however, targeted physiotherapy can resolve it for good.

In this guide, you will find:

• The most common causes of low back pain
• What is actually happening in the disc and spinal joints, with a deeper-dive option
• How we diagnose the root cause at Physio Flora
• Our physiotherapy treatment options for low back pain
• Three physiotherapist-approved exercises to start today
• Answers to the questions our patients ask most

What is mechanical low back pain?

Most low back pain is classed as mechanical. This means the pain relates to how the spine moves and how load passes through it, rather than to a single structural diagnosis.

The lumbar spine relies on a stack of vertebrae, discs, facet joints, and supporting muscles working together. As a result, pain can arise from any of these structures, or from a combination of them. In addition, the same postural habit repeated for years, such as sitting in a flexed position, can gradually shift stress onto one specific structure.

This is different from serious spinal pathology, which is far less common. Because of this distinction, an accurate assessment matters more than a quick diagnosis pulled from a scan.

Deep dive

Go deeper: the tissue science

This section goes deeper into the physiology for readers who want it. Skip ahead to "Common causes of low back pain" if you would rather get straight to the practical guidance.

The lumbar spine is built from vertebrae separated by intervertebral discs. Each disc has a tough outer ring called the annulus fibrosus and a soft, gel-like centre called the nucleus pulposus. Behind each disc sit two facet joints, small structures that guide and limit spinal movement.

Repeated flexed postures, such as prolonged sitting or bending, can gradually push the nucleus toward the back of the disc. This can irritate the outer annulus and, in some cases, nearby nerve tissue. Facet joints, on the other hand, tend to become irritated by excessive extension or rotation, particularly under load.

Surrounding muscles often respond to this irritation by tightening protectively. This muscle guarding is a genuine physical response, not simply a psychological one, and it frequently becomes a secondary source of pain in its own right.

Healing follows a fairly predictable pattern. The inflammatory phase runs for roughly the first five days. The proliferative or repair phase follows, lasting from around five days to six weeks for muscle and ligament tissue. Discs, however, have a limited blood supply, so their repair and remodelling phase extends much further, often six weeks to several months, and sometimes longer for a significant disc injury.

Chronic low back pain behaves differently from an acute flare-up. Tissue sensitivity can persist even after the original injury has healed, which is why movement-based reassessment, rather than rest, is central to recovery. We look at that pattern in more detail in our guide to recurring lower back pain.

Common causes of low back pain

Several patterns show up again and again in the clinic:

• Prolonged flexed postures. Long hours at a desk, driving, or leaning over a laptop keep the lumbar discs under sustained load. This overlaps closely with postural neck and back pain.
• Repetitive bending and lifting. Gardening, home renovation, or lifting children repeatedly stresses the same tissues without adequate recovery time.
• Sudden rotational loading. A fast golf swing, a twisting tennis serve, or a reaching padel shot can overload the spine in a single movement.
• Weak deep stabilising muscles. When the deep core and lumbar stabilisers underperform, larger muscles compensate and fatigue quickly.
• Incomplete recovery from a previous episode. A back that was never fully rehabilitated after an earlier injury is far more likely to flare up again.

Because each of these causes loads the spine differently, the right treatment depends entirely on identifying which pattern applies to you.

How we diagnose the root cause at Physio Flora

Flora is a trained McKenzie therapist, also known as Mechanical Diagnosis and Therapy, or MDT. This is a specific assessment method built for exactly this kind of problem.

During assessment, we use repeated movement testing to identify what is known as a directional preference. In practice, this means finding the specific direction of movement, often flexion or extension, that consistently reduces or centralises your pain.

This matters because it removes the guesswork. Rather than prescribing a generic set of back exercises, the assessment tells us precisely which movements help your spine and which ones aggravate it. As a result, treatment can be tailored from the very first session instead of adjusted through trial and error over several weeks.

This approach is particularly effective for disc-related pain, where the wrong exercise can genuinely slow progress. However, it also helps identify facet-related and muscular causes, since each responds to a different loading strategy.

Physiotherapy treatment options for low back pain

Treatment is built around the directional preference identified during assessment, then broadened as symptoms improve.

• McKenzie method exercises. A structured, progressive programme based on your specific directional preference, used to centralise and then eliminate pain.
• Manual therapy and joint mobilisation. Hands-on techniques to restore movement in stiff segments of the spine and surrounding joints.
• Dry needling. Targets the protective muscle guarding that often develops around an irritated segment, helping to reduce pain and restore normal movement.
• Sports performance coaching. For golfers, tennis and padel players, and cyclists, we address the swing, stroke, or position that originally overloaded the spine, so the problem does not simply return once you are back on court or course.
• Progressive loading programme. A gradual return to lifting, bending, and sport-specific movement, building tolerance rather than avoiding load altogether.

Most patients notice a meaningful reduction in pain within the first two to three sessions, once the correct directional exercise is identified and applied consistently. If you would rather start from home, our online spine health programme follows the same structure by video.

Three physiotherapist-approved exercises to start today

These general starting points are safe for most non-specific low back pain. However, a proper directional preference assessment ensures you are doing the version that actually helps your particular pattern.

• Prone lying, progressing to gentle press-ups. Lie face down for a few minutes, then, if comfortable, prop up onto your forearms and gradually onto extended arms. Stop if pain moves further down the leg.
• Cat-cow mobility. On hands and knees, move slowly between arching and rounding your back. Keep the movement controlled and pain-free throughout its range.
• Glute bridge. Lying on your back with knees bent, lift your hips while keeping your core gently engaged. This builds the deep stabilising strength that protects the spine during daily activity.

If any exercise increases pain below the knee, stop and book an assessment rather than pushing through it.

Answers to the questions our patients ask most

Is bed rest good for low back pain?

No. Prolonged rest is now known to slow recovery. Gentle, guided movement almost always produces better outcomes than staying still.

When should I worry about low back pain?

Seek immediate medical attention if you experience numbness in the groin or inner thighs, sudden bladder or bowel changes, or progressive weakness in the legs. These are rare but require urgent assessment.

Can I keep exercising with low back pain?

In most cases, yes, with modifications. Complete avoidance of activity often slows recovery and can lead to deconditioning.

How long does it take to recover from low back pain?

Many patients see significant improvement within two to six weeks of starting a directional exercise programme, though disc-related pain can take longer given slower tissue healing.

What is McKenzie therapy, and how is it different?

McKenzie therapy, or Mechanical Diagnosis and Therapy, uses repeated movement testing to find the direction that reduces your pain. Instead of a generic back exercise sheet, you get the specific movement your spine responds to, which is why progress is usually faster.

Ready to fix the cause, not just the symptom?

Low back pain does not have to become a recurring part of your life.

At Physio Flora, we combine thorough clinical assessment with evidence-based treatment and a genuine understanding of an active lifestyle, wherever it is lived. We treat back pain from Calahonda & Mijas Costa Clinic, Marbella, Fuengirola and across the Costa del Sol.

No referral needed. Consultations in English, Dutch, German and Spanish. Same-week appointments available.

Your back carries every movement you make. Give it a plan that actually fixes the cause.

Book a low back pain assessment