Why Your Back Pain Keeps Coming Back - And What Rehab-to-Performance Actually Means
Do this ONE stretch and your back pain will go away!
…and the hopeless part of you says it will. So yes, for a brief moment you feel pain relief. That micro dose of hope is powerful.
It’s not that it’s a bad stretch — it usually feels good in the moment — but repeating it endlessly doesn’t make it a long-term fix. It’s like putting a bandage over a leaky pipe; it slows the dripping, but doesn’t fix the source.
Though I’m in the realm of treating back pain, that doesn’t mean I’m immune to it myself. I absolutely experience it from time to time. The difference is that I’ve learned how to get to the root cause — both for myself and for my patients — rather than chasing temporary relief.
Why "It Depends" Is Actually the Right Answer
If you’ve ever asked a clinician, “Why does my back hurt?” and gotten the dreaded, “Well, it depends…”—I understand the frustration. But it’s not a cop-out answer. It’s the truth.
Your back pain could come from tight hips, poor posture, stress, poor sleep, or an old ankle injury that never fully healed. Your body works like one big kinetic chain — when one link isn’t functioning properly, something else has to compensate. That “something else” is often your low back.
Before we can even talk about solutions, let’s look at the structure we’re asking to cooperate: your spine.
The Joint-by-Joint Approach: The Blueprint to Movement
If you’ve ever been in my office, you’ve heard me mention Gray Cook and Michael Boyle’s Joint-by-Joint (JBJ) approach. This framework describes a predictable pattern of alternating stable and mobile joints throughout the body.
In short:
The ankle needs mobility.
The knee thrives on stability.
The hip needs mobility.
The lumbar spine thrives on stability.
The thoracic spine should stay mobile.
The neck (cervical spine) remains stable.
See the pattern? It alternates — one mobile, one stable, all the way up. When one of these joints stops doing its job, the next one up or down the chain tries to pick up the slack.
Now let’s visualize what’s happening. The mid-back (thoracic spine) needs a lot of freedom to rotate and extend because of how it connects with your ribs and assists in breathing. But the low back (lumbar spine) isn’t built the same way. Its joints mainly move forward and backward, which is great for bending and extending — not so great if you start asking it to twist and rotate constantly. That’s when irritation happens.
So, if your hips and mid-back lose mobility, your low back becomes the victim — trying to move more than it’s designed to. And when that happens over days, weeks, or months… it starts hurting.
The Real Culprit: The Hips Don’t Lie
Despite walking every day, most of us barely use our hips through their full range of motion. Think about it: walking primarily uses a small, repetitive range — forward and backward. But your hip joint is a beautiful ball-and-socket structure that can move up, down, sideways, and rotate all around.
When we spend most of our day seated — at desks, in cars, at dinner — those same hip muscles tighten up and “forget” how to move fully. When they stop moving, your body doesn’t just quit moving altogether. Instead, the low back starts taking extra movement to make up the difference. And that’s how pain cycles begin.
A great way to restore hip health is through intentional mobility training. Mobility isn’t the same thing as flexibility — it’s not just how far your joint can move when relaxed. Mobility is the active control you have through a range of motion, especially under load. It’s the difference between being able to bend backward in yoga and being able to control that motion when you pick up your child or swing a golf club.
If you’d like to explore this concept practically, try my YouTube routine:
It’s one of my go-to drills to open up and strengthen the hip capsule.
The Misunderstood Word: “Rehab”
When most people hear the word rehab, their minds jump to something dull or clinical — maybe repetitive exercises in a sterile room or endless stretching routines that feel like chores. But real rehab isn’t about “stretching yourself to death,” and it isn’t about putting you through a cookie-cutter workout plan.
Rehab means restoration. It’s about identifying deficiencies in movement, retraining patterns, and progressively reintegrating strength, power, and confidence back into your body. It’s not just about feeling better; it’s about moving better.
Here’s the mistake most people make: they stop their recovery journey when the pain disappears. They go from the “painful phase” to the “pain-free” phase — and stop there. But that’s like patching a hole in your roof without reinforcing the structure underneath it. The goal isn’t to reach no pain; the goal is to reach resilience.
From Rehab to Performance: The Bridge Most People Miss
So what is “rehab-to-performance”? Think of it as a bridge. On one side, you have pain, injury, and restriction. On the other, you have powerful, confident, pain-free movement. Most systems stop once you cross the halfway point — you’re no longer in pain, so you get discharged or told to “keep it up at home.”
The rehab-to-performance model continues the journey. It moves beyond pain management and into performance optimization. It’s not about training you like an athlete (unless you are one), but about bringing your movement quality and strength to a level that prevents you from returning to old pain cycles.
In my practice, I call this the Resilience Movement Screening process. It has two major phases:
During Pain: We uncover which joints are underperforming and which ones are overworking.
After Pain: We rebuild better mechanics — not just “back to normal,” but above your baseline.
This process highlights an important shift in mindset. Healing isn’t just recovery — it’s development. You’re not simply “getting back to where you were”; you’re becoming stronger, more coordinated, and more body-aware than before.
A Story That Says It All
I once worked with a patient who was an avid weekend golfer. Every few months, his low back would flare up, and every time he’d return saying, “I think I just need another round of stretching.”
But when we dug deeper, it wasn’t his back at all — it was his hips and thoracic spine that weren’t rotating efficiently. His lumbar spine had been over-rotating to make up for the loss. We started integrating hip mobility, thoracic rotation work, and core stability drills instead of passive stretching.
The result? His back pain vanished — and his golf drive added nearly 20 yards within a month. That’s the perfect example of going beyond rehab into performance. Fixing the root cause not only relieves pain but also unlocks better function in daily life (and yes, your golf game too).
The Hamburger Analogy
It’s the day after Thanksgiving and you go to a restaurant and order a hamburger with fries, and the waiter/waitress doesn’t ask a single question. A few moments later (fast service, huh!) they give you a meatball between two slices of bread and some mashed potatoes. I mean, it’s kind of what you asked for, but you know it’s either leftovers from the previous day’s meal (copy and paste), or they really have no idea what they’re doing and it’s sub-par service. Yes, it keeps your hunger at bay, but you were looking at the bigger goal of getting what you wanted since you paid for it. Now, if they ended up asking how you wanted your hamburger done, if you wanted the buns toasted, what toppings you wanted, and the style of fries? That, my friends, is dang good service–they went above and beyond for what you truly want.
True rehab-to-performance asks the right questions:
What movements does your body really need to get back to?
What demands will your job, hobby, or sport place on your spine?
And what customized exercises will get you there safely and effectively?
That attention to detail — the equivalent of asking how you like your burger cooked and what kind of fries you want — separates a good rehab plan from a transformative one.
The Bigger Picture: Movement Is Medicine
Here’s something I wish everyone knew: your body wants to move. Pain doesn’t always mean damage; often, it’s a signal of dysfunction or compensation. When a joint isn’t doing its job, your brain senses instability and interprets it as danger. Movement retraining literally reprograms that signal.
You can’t stretch your way out of a stability problem. You can’t strengthen your way out of a mobility restriction. Each area needs what it’s designed for. When you restore that balance — hips mobile, lumbar stable — your back often thanks you by staying quiet.
The Mind-Body Connection
There’s also an emotional side to back pain that we don’t talk about enough. Chronic pain is stressful, and stress itself tightens muscles, decreases recovery, and can sensitize your nervous system. That’s why approaches like breathwork, mindfulness, and even sleep optimization complement physical rehab so well.
When I work with patients, I often see that those who learn to breathe better—actually engage the diaphragm and ribs fully—notice faster improvements in pain and posture. Breathing connects not just the physical structure of your mid-back and core, but also your body’s stress response. You can’t separate the two.
Final Thoughts
So, why does your back pain keep coming back?
Because most systems stop too early. Because you’re treating symptoms instead of systems. Because your body’s incredible design deserves more than quick fixes.
The rehab-to-performance model is about closing that gap. It’s about restoring mobility, building stability, then layering strength, control, and confidence on top of it. It’s about giving your body the long-term support it needs to thrive.
I’ll leave you with this: the best-known secrets are overused, and the best-kept secrets are undervalued.
Keep your health journey close. Listen to your body when it whispers — before it has to scream.
