BACK PAIN PHYSIOTHERAPY • HOBART
Back Pain &
Lower Back
PHYSIOTHERAPY
Hobart
The reason it keeps coming back is usually the same, the
pattern that's driving it was never addressed.
Most people who come to us with back pain have had it before. They've tried massage, stretching, maybe a round of physio. It helped for a bit. Then it came back.
WHATS ACTUALLY GOING ON
Quick Facts: Back Pain
Most Common Presentation
Acute pain on a background of chronic pain. It's rarely the first time.
Typical Recovery Arc
Sharp pain, then dull ache, then stiffness, then back to lifting. Most people feel the difference within days.
What We Look For
Movement pattern, coordination, and what's actually loading your back. Not just where it hurts.
Referral
No referral needed. Book directly online or call 0483 947 716.
No referral needed • All major health funds
YOUR BACK
PROBABLY
ISN’T WEAK.
Most people come in believing their back is weak. That's what they've been told. And sometimes it's true, but more often, the real problem is the opposite.
What we see most is an extension bias. The back is overworking - the erector spinae are doing everything because the muscles that should be sharing the load (glutes, deep core, hamstrings) aren't doing their job. The back isn't weak. It's exhausted from doing everyone else's work.
That's why generic "core strengthening" often doesn't fix it. If you're just adding more load to a system that's already out of balance, you get more of the same.
The Pattern We See Most
People avoid flexion, move with an extension bias, and load the facet joints and back extensors repeatedly. Previous physio often made this worse: more extension-based exercises, no one looking at the actual movement sequence. The answer isn't more extension. It's offloading the back by reloading the hamstrings and glutes, then reintroducing lumbar flexion and extension in the right order.
Very Common
Extension Bias & Facet Loading
The back is doing too much work. Glutes, hamstrings, and deep core aren't sharing the load, so the facet joints and erectors cop everything. Feels like stiffness, fatigue, and that jamming sensation with certain movements.
Common
Disc-Related Pain
Disc bulges, herniations, degenerative changes. Can refer into the glutes or legs. Often sounds scarier than it is. Most disc presentations respond well to the right loading approach. The scan doesn't tell the full story.
Common
SIJ Dysfunction
One-sided lower back or buttock pain. Frequently misdiagnosed. Often confused with disc pain or neural symptoms. Responds well to targeted strengthening and correcting the loading imbalance driving it.
Common
Muscular & Coordination Issues
Poor movement sequencing: the right muscles aren't firing in the right order. The body still gets the job done, but the wrong structures take the load. Sort the pattern, and the pain usually follows.
WHATS ACTUALLY
DRIVING IT.
WHY IT HAPPENS
Think of a square being pulled from all four corners equally, that's a healthy, balanced joint. If you've had pain or avoided certain movements, one corner stops pulling. The other three overwork, the joint loads unevenly, and that's where the wear happens.
Back pain is rarely one thing. It's usually a combination of load, capacity, coordination and often the psychological weight of having had it before.
01
Flexion Avoidance
Bending with a stiff spine, lunging instead of hinging, never loading through the hamstrings. Over time the back extensors do everything and eventually they can't keep up.
02
Muscle Inhibition
Glutes, deep core, and hamstrings that aren't switching on properly. The back compensates. You get stronger in the wrong places and weaker where it matters.
03
Exceeded Capacity
A sudden increase in load: moving house, a new training program, a long day at work. Your back wasn't conditioned for what it was asked to do. One or two reps past your limit is all it takes.
04
Incomplete Rehabilitation
The last episode settled. Treatment stopped. But the pattern that drove it was never sorted, so when load comes back, so does the pain. The most common reason backs keep flaring.
05
The Biopsychosocial Load
Pain isn't only physical. Stress, sleep, nutrition, social isolation. All of these amplify pain perception. The more you focus on an area, the more the nerve pathway reinforces it. We address all of it.
06
Fear & Pain Memory
Having had back pain before changes how you move. You protect. You avoid. The avoidance patterns become the problem. Getting back to normal movement, in a way you don't even notice, is part of the treatment.
SYMPTOMS
SOUND FAMILIAR?
Stiff in the morning, eases after moving around, then builds again through the day
Sharp catch when bending, lifting, or rolling over in bed
Aching that builds with sitting, especially driving or long flights
Pain or referral into one or both buttocks. You think it might be the disc
Can't stand up straight after sitting. Takes a few steps to get going
Scared of bending with straight legs. You bend your knees for everything
It's come back again and this time you want to actually sort it
Back pain stopping you from hiking, lifting, playing with your kids, or doing what you love
HOW WE TREAT IT
THE By design
approach
to back pain.
The subjective tells us most of what we need to know before you've even moved. The way you sit down, the movements you avoid, what you've tried, it all points somewhere. The objective assessment confirms it and shows you we already know what's going on.
We don't have a back pain protocol. We have a process for finding your pattern, and that determines everything else.
Step 01
Find the Pattern
Lumbar flexion, extension, rotation. Squat, lunge, single leg. Glute bridge, core activation. We're looking for the coordination gap: the movement sequence that's putting your back in the wrong position under load.
Step 02
One or Two Exercises
Not a list of ten. The one or two things that will make the biggest difference right now. Usually pelvic tilts, basic glute activation, or a hinge pattern, whatever your reassessment shows is moving the needle. We send it with video so you can't get it wrong.
Step 03
Explain What's Happening
We walk you through the anatomy on the iPad. Link the scan to what we found in the assessment. Show you why your back has been doing what it's been doing. Most people have never had it explained this way before.
Step 04
Hands-On When Needed
Joint mobilisation, manual therapy, dry needling where appropriate. Not as an end in itself, but to reduce pain enough that you can start loading the right structures. For most people this comes in session two, after the basic activation work has started.
Step 05
Progressive Loading
Once you can hinge and pelvic tilt and brace, we head into the gym and start adding load. Cable crunches, Pallof presses, RDLs, wood chops. Building the capacity your back needs to handle real life, not just a pain-free resting state.
Step 06
Graded Exposure
The movement that scared you most: we get you back to it without you realising. Three to four weeks in, you're doing the pattern that used to hurt. That's the moment it
Phase 01
Calm the Pain
Basic lumbopelvic control. Move without fear. Sharp pain turns to an ache.
Phase 02
Sort the Pattern
Hinge, J-curl, pelvic tilt in standing. Core bracing. Glute control. The ache turns to stiffness.
Phase 03
Build the Capacity
Into the gym. Add load. Build the strength your back needs to handle whatever life throws at it.
Phase 04
Keep It That Way
Stagger out to fortnightly, monthly, then a check-in. You know what to do if it flares. It usually doesn't.
WHY BY DESIGN
WHAT MAKES US
DIFFERENT
01
We Look at How You Move
Not just where it hurts. The movement sequence, the coordination, the pattern you've been avoiding. That's where the answer is.
02
Strength Is the Treatment
Pain relief is the start. Getting the right muscles loading in the right order and building capacity around that is what stops it coming back.
03
We Explain the Why
You leave every session knowing more about your back than when you arrived. Understanding what's happening is part of the treatment itself.
04
Graded Exposure
The movement that scared you: we get you back to it without you realising. Three weeks in, you're doing it. That's when it actually sticks.
05
Experienced Physios Only
Every physio on our team is highly experienced and held to a high standard. No juniors. No compromise on clinical quality.
06
400+ Five-Star Reviews
Hobart's highest-rated physiotherapy clinic. The results speak for themselves.
COMMON QUESTIONS
ABOUT BACK PAIN.
My scan shows a disc bulge. Does that mean I need surgery?
Almost certainly not. Scans often look worse than the clinical picture. Many people with significant findings on imaging have no pain at all. What matters is what your scan shows in the context of how you're actually moving and what's loading your back. A disc bulge on a scan doesn't automatically mean disc pain. We'll walk you through exactly what yours means for your situation.
I've been told my back is weak and my core needs strengthening. Is that right?
Sometimes. But more often, the back is actually overworking, not underworking. The problem is usually that the glutes, hamstrings, and deep core aren't doing their share, so the back extensors cop everything. Generic core strengthening without sorting that pattern often makes things worse. We look at the actual movement sequence first.
Should I rest or keep moving?
Keep moving, within your tolerance. Complete rest makes back pain worse over time, not better. The key is finding the right type and amount of movement for your specific presentation. Usually that means starting with basic pelvic tilts and controlled movement, not aggressive exercise.
I've had physio before and it didn't last. Why would this be different?
The most common reason back pain keeps coming back is that treatment stopped when the pain settled, before the movement pattern was sorted and the capacity was built. We don't discharge you when you feel better. We discharge you when your back is strong enough that it won't keep happening.
Do I need a referral?
No. You can book directly without a GP referral. If you have a chronic disease management plan (CDM/EPC) through your GP, we accept those. Medicare covers part of the cost for up to five sessions per year.
READY TO SORT
YOUR BACK
FOR GOOD?
No referral needed • All major health funds • North Hobart
Or call 0483 947 716 • hello@bydesignphysio.com
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