5 Signs Your Back Pain Is Actually Coming From Somewhere Else | Physical Therapy in Sioux Falls Can Help

You've tried the stretches. You've done the exercises. You've rested, iced, and maybe even gone through a round of physical therapy — and your back still isn't right.

Here's something that might change everything: what if your back isn't actually the problem?

At True North Physical Therapy in Sioux Falls, one of the most common things we see is people who have been treating the wrong place for months — sometimes years. Their back hurts, so everyone focuses on the back. But the back is just where the pain shows up. The real issue? It's usually somewhere else entirely.

Your body moves as a connected system. When one part isn't doing its job — usually the hips, glutes, or ankles — another part compensates. And that compensating part? It eventually breaks down. For most active adults, that breakdown shows up as back pain.

So before you book another massage or do another set of cat-cow stretches, check yourself against these five patterns. If any of them sound familiar, your back pain is almost certainly a system problem — and that's actually great news, because system problems have clear solutions.

Sign #1: Your Back Pain Always Comes Back When You Increase Activity

You dial things back, take it easy, and the pain fades. You feel good. You start training again — running, lifting, hiking, whatever it is for you — and within a few weeks, it's back.

This is one of the clearest signs that your back is being asked to do too much because something else isn't pulling its weight.

True back injuries do improve with rest. But pain that returns predictably every time you push harder isn't a back injury — it's a load tolerance problem. Your back is absorbing forces it was never designed to handle alone, because the system around it is weak or restricted.

The most common culprit: hip extension. If your glutes aren't firing well during running, hiking, or lifting, your lower back takes over. Every step, every rep, your lumbar spine is compensating for a hip that isn't doing its job. That tissue gets irritated and inflamed — and no amount of rest fixes a compensation pattern.

If your back pain disappears with rest and returns with activity on a predictable cycle, the root cause isn't in your back.

Sign #2: You Have Pain in Multiple Spots

Back pain. And hip tightness. And maybe some sciatic-type discomfort down the back of your leg. Or your back hurts and your knee has been achy too.

When pain shows up in more than one place, people often assume they just have a lot of problems. But multiple pain points are usually a sign of one systemic problem — the body is breaking down at every point where compensation is occurring.

Think of it like a leaking roof. One bad shingle causes water to show up in the ceiling, the wall, the floor. You don't have three separate problems — you have one source creating multiple symptoms.

In the body, restricted hip mobility is a perfect example. If your hip can't move well through its full range, your lower back compensates every time you bend, squat, or walk. So does your knee. You get back pain and knee pain — and treating either one in isolation doesn't fix the hip.

If you have pain in multiple locations, a movement assessment that looks at how your whole body moves is essential. That's exactly what we do at True North before we ever touch a treatment plan.

Sign #3: Your Pain Changes With Your Footwear

This one surprises people. Put on different shoes — or go barefoot for a few days — and your back pain noticeably shifts. Sometimes better, sometimes worse.

Foot mechanics influence everything above them. Your arches, ankles, and calves are the foundation of every movement you make. When that foundation changes, the entire chain above it changes too.

Overpronation (ankles collapsing inward) causes internal tibial rotation, which drives the knee inward, which disrupts hip mechanics, which loads the lower back differently. Rigid, high-heeled shoes shorten the calf complex and change how load transfers through the Achilles and into the pelvis. Orthotics can temporarily mask these mechanics — but they don't fix the underlying mobility and strength issues.

If your back symptoms are sensitive to what you put on your feet, your movement foundation is the story — and fixing it means working from the ground up, not just treating the back.

Your feet are the foundation. When the foundation shifts, everything above it shifts too — including your lower back.

Sign #4: You've Been Told It's 'Just Arthritis' or 'Normal Wear and Tear'

This is one of the most frustrating things we hear from patients at True North. Someone gets an MRI, the radiologist notes some degenerative changes, and suddenly they're told their pain is just age-related and there's not much to be done.

Here's the truth: imaging findings and pain don't always match. Research consistently shows that many people with significant degenerative changes on MRI have zero pain — and many people with significant pain have relatively clean imaging. Structural changes show up in almost everyone over 35. That doesn't mean they're causing your symptoms.

What does cause symptoms? Load distribution. If your hips are weak and immobile, your lumbar spine absorbs disproportionate force. That tissue gets irritated regardless of what the MRI shows.

We regularly work with patients in their 40s, 50s, and 60s who have been told to just live with their back pain — and who leave True North moving and feeling better than they have in years. Degenerative changes are often a finding, not a sentence.

Sign #5: Stretching Only Helps for About 20 Minutes

You stretch your hip flexors, roll out your lower back, do a few minutes of yoga — and you feel better. For about 20 minutes. Then it all comes back.

Stretching is not a fix for a strength problem.

When muscle tightness is protective — meaning your body is bracing an unstable area — stretching can temporarily reduce the tension, but the brain immediately re-activates the protective guarding because the underlying instability hasn't changed.

The most common example in back pain: the hip flexor. When your glutes are weak, your hip flexors compensate by pulling your pelvis into an anterior tilt, which compresses the lower lumbar spine. That's why stretching your hip flexors feels temporarily amazing — you're releasing the compensation. But until the glutes are strong enough to stop relying on the hip flexors for stabilization, the pattern just re-establishes itself.

If you've been stretching the same spots for months without lasting change, you're managing symptoms — not solving the problem. The fix requires progressive strengthening, not more passive work.

Temporary relief from stretching is a clue, not a solution. Your body is telling you there's a stability problem underneath.

Try This at Home: The Hip Mobility Self-Test

Before your next appointment, try this simple test to check your hip mobility — one of the most common contributors to back pain we see in Sioux Falls active adults:

90/90 Hip Internal Rotation Test:

•     Sit on the floor with both knees bent at 90 degrees — one leg in front, one to the side.

•     Keeping your spine tall, try to bring the back leg's knee toward the floor on the outside (internal rotation of the back hip).

•     If you can't get within 4–6 inches of the floor without your whole pelvis tilting or your spine rounding, you have restricted hip internal rotation.

•     Compare both sides. Significant asymmetry (one side much better than the other) is especially telling.

Restricted hip internal rotation is one of the most reliable predictors of lower back and knee pain in active adults. If you noticed a difference in this test, your hips — not your back — are likely the primary driver of your symptoms.

What to Do Next | Physical Therapy in Sioux Falls

If you recognized yourself in any of these five signs, the good news is that a system-level approach works. We see it every week at True North.

The process looks like this: first, we do a full movement assessment to identify exactly where the system is breaking down — not just where it hurts. Then we calm down the irritated tissue while simultaneously addressing the root cause. And then we build strength and capacity so the problem doesn't come back.

This is the foundation of the RESET Method — our approach to rebuilding your body from the ground up, not just managing symptoms until the next flare-up.

Back pain that keeps coming back is almost never bad luck or inevitable aging. It's a solvable problem. You just need someone to look at the whole system.

→  Ready to find out where your back pain is actually coming from?

Schedule a Movement Assessment at True North Physical Therapy in Sioux Falls.

www.sdtruenorthpt.com  |  605-681-6082  |  3801 W Technology Cir, Sioux Falls SD 57106