Low Back Pain That Keeps Coming Back — What an Assessment Actually Looks At

Written and clinically reviewed by Dr. Ashley Aguero, DC — September 1, 2026

Low back pain that settles down and then returns may follow a recognizable pattern. The episodes can look similar each time — the same side, the same movement, or the same point in a session. When symptoms keep returning, an assessment can help identify factors that may be contributing.

Why does low back pain keep coming back?

Because the location of pain does not always tell you everything about why symptoms are recurring.

Several factors may contribute. Hip or thoracic mobility, trunk strength and control, fatigue, recovery, and changes in training volume can all influence movement and how load is distributed during sport and training. A movement strategy that feels fine early in a session may also change as fatigue builds.

None of these findings automatically identifies the cause of low back pain, which is why they need to be interpreted alongside symptoms, training demands, strength, and movement.

What does an assessment actually look at?

Four things, in roughly this order.

How you move, not just where you are sore. Hinging, squatting, rotating, standing on one leg. When appropriate, looking at movement under load can add useful information because it more closely resembles the tasks that provoke symptoms during training.

The hips and the mid-back. These regions sit on either side of the low back, and restrictions or movement differences may influence how an athlete distributes motion and load through the trunk. That is why an assessment for low back symptoms may also include areas beyond the low back itself.

How you load and brace under fatigue. Position on rep one is not always position on rep eight. Watching what changes as a set goes on can provide information that a single repetition may not capture.

What your week actually looks like. Training volume, what changed in the month before symptoms started, hours at a desk, sleep, how much running went into the legs. Looking at the broader training and recovery context can help identify changes that may be relevant to when symptoms started or why they continue to recur.

What happens in the appointment itself?

An initial appointment at ELATE runs a full hour. That covers a history, the movement assessment above, and a neuromusculoskeletal examination looking at the wider chain rather than the symptomatic segment on its own.

Treatment in the same session may include chiropractic manipulation and soft-tissue techniques such as Myofascial Release Technique, cupping, or IASTM, depending on the examination findings and clinical indication. These approaches may be used for short-term symptom modulation or changes in mobility, alongside movement, exercise and load-management strategies.

When appropriate, you also leave with movement or rehab recommendations for between sessions so the plan extends beyond what happens in the clinic.

What if you are mid-training-cycle and just deciding whether to train?

That is a different question with a different answer, and it has its own article. If your low back is talking right now and you are trying to work out whether to modify the session, stop, or carry on, start with our piece on whether to train through it — it covers what usually tolerates modified training and what warrants pulling back.

This article is about the recurring pattern: when the same complaint has come and gone multiple times and you want to better understand what may be contributing.

When low back pain needs something other than an assessment

Some presentations warrant medical evaluation or additional diagnostic workup rather than routine conservative care. These may include new or progressive weakness, changes in bowel or bladder function, saddle numbness, significant trauma, fever or other signs of systemic illness, unexplained weight loss, or symptoms that raise concern for infection, fracture or other serious pathology. Radiating leg pain, numbness or tingling also warrant appropriate neurological assessment, particularly when symptoms are progressive or accompanied by weakness.

None of that is a reason to panic, and it is not a description of most low back pain. It is a short list worth knowing, because the right first step in those situations is a medical evaluation. Part of working within a sports medicine framework is recognizing when to refer, and we do.

Frequently Asked Questions

How long should low back pain last before I get it assessed?

There is no fixed number, but two patterns are worth paying attention to: symptoms that have not settled after a couple of weeks and symptoms that repeatedly return in a similar way. Recurring symptoms can be a reasonable reason to have the pattern assessed rather than continuing to manage each episode on its own.

Do I need imaging before an assessment?

Imaging is usually not the first step for uncomplicated low back pain when there are no concerning clinical findings. An examination can help determine whether imaging or referral for additional medical evaluation is appropriate. Where there are symptoms that warrant it, we refer.

Will I have to stop training?

Not necessarily. It depends on what the assessment finds. When appropriate, training may be modified rather than stopped completely while symptoms, capacity and contributing factors are addressed. That decision is individualized rather than made in advance.

Is this different from seeing a general chiropractor?

The license is the same — every chiropractor in California is a Doctor of Chiropractic. The difference is the emphasis: a sports chiropractic appointment is built around what your body is being asked to perform, which is why the initial appointment is a full hour and includes a movement assessment.

What if my low back pain is only after heavy training days?

That is closer to the question of whether to train through it, which our article for lifters covers in detail. If it happens after most heavy days and has been building over weeks, it is worth assessing the pattern rather than managing each episode.

A Note on What This Article Is Not

This isn’t a diagnosis for your specific low back, and sports chiropractic isn’t a replacement for medical evaluation. Certain presentations — including significant trauma, substantial weakness or loss of function, persistent night pain, or findings that raise concern for structural injury — may warrant additional medical evaluation, imaging, or referral to an appropriate specialist.

Getting it looked at in San Diego

ELATE Chiropractic & Sports Medicine is in North Park, working with lifters, runners, CrossFit athletes, beach volleyball players and active adults across San Diego. The practice is cash-based, accepts HSA and FSA payments, and can provide a superbill for potential reimbursement.

If the same low back complaint has now appeared more than once, that is a reasonable point to have it assessed rather than waiting for it to become the reason you stop training. Everything we offer is on the services page, and the 60-minute initial appointment is where an assessment starts.

Dr. Ashley Aguero, DC, is a Doctor of Chiropractic with a Sports Medicine emphasis, practicing in North Park, San Diego. She is a CrossFit athlete with sideline experience in high school football, rugby and cycling.