Back pain is one of the most common reasons people seek physical therapy. Yet many people spend months or even years trying stretches, exercises, or treatment plans that never address the actual source of their pain.
At Cohen Health and Performance, we see this every day in our back pain rehab McLean and Bethesda clinics. Many of our patients have already seen multiple providers before they arrive. They have completed physical therapy, rested, modified their workouts, or tried injections, but their symptoms continue.
The reason is often simple. Back pain is not one condition. Different diagnoses require different treatment strategies. There is no one size fits all approach.
If the treatment does not match the diagnosis, progress is often slow or nonexistent. In some cases, the wrong exercises can even make symptoms worse.
Here are two of the most common causes of back pain that we treat and why each requires a completely different rehabilitation approach.
Spinal stenosis
Spinal stenosis occurs when the space around the spinal cord becomes narrower, creating compression within the spine. It is most common as we get older but can affect active adults who still want to hike, golf, travel, lift weights, or keep up with their grandchildren.
People with spinal stenosis often experience:
- Pain, numbness, or tingling into both legs
- Difficulty standing upright for long periods
- Increased symptoms with walking or standing
- Relief when sitting or leaning forward
The goal of conservative treatment is to reduce the positions that increase compression while improving the body’s ability to move efficiently.
In our clinics, treatment often focuses on:
- Learning to stack the pelvis underneath the hips instead of standing in excessive lumbar extension
- Improving control of intra-abdominal pressure to better support the spine
- Increasing hip mobility so movement comes from the hips instead of the lower back
- Building strength that allows patients to return to daily activities with less pain
One of the first exercises we teach many patients with spinal stenosis addresses these exact goals.
Below is a video demonstrating one of the exercises we frequently use early in the rehabilitation process.
Disc bulge or herniation
A lumbar disc bulge or herniation occurs when disc material pushes beyond its normal position. Many people have disc bulges without ever knowing it. Problems occur when that disc places pressure on one of the nerve roots leaving the spine.
Unlike spinal stenosis, symptoms usually travel down one leg rather than both. Many people notice increased pain with bending forward, although every person’s movement preferences are slightly different.
Treatment focuses on reducing stress on the irritated nerve so inflammation can settle and symptoms begin to improve.
Once symptoms calm down, rehabilitation shifts toward answering the bigger question.
Why did the injury happen in the first place?
Sometimes the answer is poor hip mobility. Sometimes it is weakness, movement mechanics, training volume, or recovery habits. Identifying and correcting the underlying cause is one of the most important parts of preventing future flare ups.
Why an accurate diagnosis matters
These are only two examples of low back pain. Other conditions, including muscle strains, spondylolisthesis, facet joint irritation, and sacroiliac joint dysfunction, all require different treatment strategies.
That is why an individualized evaluation matters.
At Cohen Health and Performance, we don’t hand every patient the same sheet of exercises. We identify the source of your pain, understand how your body moves, and build a rehabilitation plan that fits your goals, whether you want to return to lifting, running, golf, or simply live without constant back pain.
If you are searching for back pain rehab in McLean or back pain rehab in Bethesda, our team specializes in helping active adults and athletes get lasting results by treating the cause of the problem, not just the symptoms.
Ready to stop guessing and start making progress? Schedule an evaluation with our team and let’s build a plan that is specific to your back, your goals, and your lifestyle.
