Back Pain Therapy for Persistent Pain
Back pain is extremely common — and in most cases, it is not serious.
Many episodes of low back pain settle without the need for specific treatment. The back, hips, and pelvis are strong, adaptable parts of the body.
When back pain persists, keeps returning, or begins to feel limiting or unreliable, the impact can be significant. Some people also experience pain spreading into the buttock, hip, or leg — often described as sciatica.
This page is for people with persistent or long-standing back pain or sciatica who want a clearer understanding of what’s going on and whether this approach is right for them.
When back pain doesn’t settle
Persistent back pain doesn’t always feel the same from day to day. Many people notice stiffness, guarding, or flare-ups rather than constant pain.
Pain may come and go, feel unpredictable, or spread into the buttock, hip, or leg. For some, symptoms are more noticeable after being still for a while, or when the body struggles to transition between activity and rest.
Importantly, ongoing back pain and sciatica are rarely a sign of serious damage. More often, they reflect how the body has adapted over time.
Why back pain and sciatica can persist
When the back has been painful or irritated, the body often responds protectively. This can involve increased sensitivity in the nervous system, muscle guarding, and a reduced sense of confidence in movement.
Over time, protective tension can build around the hips, pelvis, and lower back, limiting how easily these areas move and share load. In practice, many people’s back pain or leg symptoms are influenced by these patterns rather than by the spine itself.
When these protective responses persist, the back and hips may begin to feel stiff, reactive, or unreliable — even in the absence of ongoing tissue damage.
What this means for treatment
When back pain or sciatica becomes persistent, treatment often needs to address more than the painful spot alone.
The aim is to:
- Calm protective nervous system responses
- Reduce unnecessary guarding in the hips and pelvis
- Support the back to move with greater ease and confidence
Rather than being forceful or aggressive, the focus is on helping movement feel safe and manageable again, allowing change to happen gradually.
What this approach involves
Work with persistent back pain usually combines hands-on treatment, guided movement, and clear explanation, adapted to how your body is responding.
In addition to working directly with the back, hands-on work often focuses on the hips and surrounding pelvic tissues, as these areas commonly influence both low back pain and sciatica. The back itself is also addressed, but not in isolation.
Where appropriate, heat may be used to help soften protective tissue responses and make movement more comfortable.
Movement, walking, and self-care
Backs generally respond well to safe movement. Walking is one of the most helpful activities for back pain and sciatica — it encourages natural movement, reduces stiffness from sitting, and helps calm the nervous system.
Self-care is kept simple. This usually involves gentle movement, awareness, and practical guidance around sitting habits and daily patterns, without turning recovery into another task to manage.
What people often notice over time
Progress varies, but many people notice gradual changes such as:
- Less guarding through the hips and lower back
- Easier movement after sitting
- Sciatic symptoms that are less intense or less frequent
- Flare-ups that settle more quickly
- Increased confidence using their back again
For some, the first shift is understanding rather than symptom change — knowing what’s happening and how to respond can be deeply reassuring.
Experiences of treatment for back pain
“Steven has been a huge help with my jaw pain/TMJ and sciatic pain in the lower back.
The therapeutic massage is excellent but the really great thing has been how much he’s helped me understand how to self manage the pain by sharing so many techniques and exercises that I can use at home.”
Sarah M.
“I was struggling with an episode of bad lower back pain.
Steven gave me a thorough and careful assessment, clearly explaining what he thought was happening and how he was going to treat it.
A couple of sessions of treatment really calmed the pain down.”
Jennifer W.
“I had a massage with Steven to address my lower-back pain.
He made a thorough assessment of my problem and gave me a rehabilitation regime.
He was very reassuring and helped alleviate my lower-back pain.”
Nikos
Is this approach right for you?
This approach is usually most helpful when back pain or sciatica has been present for a while or keeps returning.
If your symptoms are very recent and already settling, you may find that reassurance, time, and gentle movement are enough at this stage.
Next steps
If you’re dealing with persistent or long-standing back pain or sciatica — and this approach feels appropriate — you can book a treatment session.
An initial session focuses on:
- Understanding how your back and hips are currently moving and responding
- Identifying key areas of restriction or overload
- Beginning hands-on treatment in a way your system can tolerate
You don’t need a firm diagnosis or referral. Treatment can be adapted as your back and hips respond over time.
Frequently asked questions
These are questions that often come up for people with persistent or long-standing back pain or sciatica who are considering hands-on treatment. If something isn’t covered here, you’re always welcome to ask.
No. You don’t need a firm diagnosis or a referral to book a session.
Many people come without a clear label for their pain, or with scans or diagnoses that haven’t fully explained their symptoms. Treatment focuses on how your back and hips are currently moving and responding, and can adapt as things change.
That’s very common.
Many people I work with have already tried physiotherapy, exercises, or other hands-on approaches. This work often feels different because it focuses on reducing protective tension, improving comfort with movement, and helping you better understand what’s contributing to your symptoms — rather than following a fixed protocol.
There isn’t a fixed number, but most people notice clear, meaningful improvement within the first few sessions.
As a general guide, many people find that around 5–6 sessions is enough to make significant progress, particularly when back pain has been present for some time. Often, changes in comfort or movement are noticeable within the first 3–4 sessions, which helps guide next steps.
Treatment is reviewed as you go, based on how your back responds, rather than following an open-ended or indefinite plan.
Yes. This approach is commonly used with persistent or recurrent back pain, including pain that spreads into the hip or leg and is often described as sciatica.
The focus is on helping the system feel safer to move again, rather than trying to force change or target one structure in isolation.
If this doesn’t quite fit
If your symptoms overlap, change over time, or don’t fit neatly into one category, this page explains the main pain issues I work with and may help you decide where to begin.
