Back pain is a symptom. The question is where it comes from.
Low back pain has four common mechanical sources: muscular strain, facet joint dysfunction, sacroiliac joint dysfunction, and disc irritation. They look alike at first glance and respond to different techniques. The exam is how we tell them apart.
Which back pain is this?
A careful exam usually pinpoints the source within minutes. Here is what each looks like when a patient describes it in the intake.
Muscular strain
Localized aching or burning in the low-back muscles, worse after sustained postures or a recent lift. No radiating leg symptoms. Usually the first episode resolves in 1 to 3 weeks with adjustment, soft-tissue work, and specific exercise.
Facet joint dysfunction
Sharp, catching pain on one side of the spine, worse with extension (leaning back) and rotation. Responds well to specific adjustment and mobility work.
Sacroiliac (SI) joint
Pain localized to a dimple above the buttock, often one-sided. Worse with sitting and standing up, transferring load, or rolling in bed. Responds to specific SI adjustment and hip mobility.
Disc irritation
Deep, dull pain that intensifies with flexion (bending forward) or sitting. May radiate into the buttock or leg in a defined pattern. Often responds to Cox flexion-distraction rather than high-velocity adjustment.
Exam, then treatment.
Movement screen
We watch you bend, extend, rotate, and side-bend. The pattern tells us which structures are irritated.
Orthopedic tests
Straight-leg raise, Kemp's test, SI provocation, and specific disc-loading tests to isolate the source.
Neurologic screen
Reflexes, sensation, and motor testing. If a leg is weak or numb, that changes the plan.
Matched technique
Manual adjustment, Activator, drop-table, or Cox flexion-distraction, chosen to match what we found.
Certain symptoms mean you should be evaluated by a physician first, not a chiropractor. These include severe pain after major trauma, progressive leg weakness, loss of bowel or bladder control, numbness in the saddle region, unexplained weight loss with back pain, or fever. Dr. Augello screens for these on every first visit and refers immediately when they are present.
Back pain questions.
When should I see a chiropractor for back pain?
If your back pain has lasted more than a few days, is interfering with work or sleep, or keeps recurring, it is worth having evaluated. Chiropractic is a reasonable first step for most mechanical low-back pain. Red flags that warrant urgent medical evaluation first include severe pain after major trauma, progressive leg weakness, loss of bowel or bladder control, unexplained weight loss, or fever.
What causes most low back pain?
Most non-traumatic low back pain comes from four sources: muscular strain, facet joint dysfunction, sacroiliac joint dysfunction, and lumbar disc irritation. A proper examination can usually distinguish these, which is important because they respond to different techniques.
How long will it take to feel better?
For a first episode of mechanical low back pain without nerve involvement, most patients notice meaningful change within the first two to four visits. Chronic pain patterns that have been present for years typically need a longer corrective course, often 8 to 12 weeks, followed by periodic maintenance. Dr. Augello provides a specific written timeline after your exam.
Is it safe to adjust a herniated disc?
It depends on the disc and the technique. Many disc cases respond well to specific flexion-distraction treatment (the Cox technique) which gently distracts the disc space. High-velocity manual adjustment is often not appropriate for acute disc protrusion. Imaging and a careful exam determine which approach fits.
What if chiropractic does not help?
If you are not making progress after a reasonable trial, Dr. Augello will say so and refer appropriately, whether that means orthopedic consultation, physical therapy, or pain management. The job is to help you get better, not to keep you on the schedule.
Related reading: When to see a chiropractor · Sitting posture for desk workers · How our adjustments work
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