---
title: "Lower Back Pain"
---
## You're Tired of Living With This
Most patients we see for lower back pain have been managing it for years. They have tried physical therapy at least once, used over-the-counter and sometimes prescription medications, and adjusted how they sleep, sit, and exercise. Some have seen chiropractors. Some have been told it is stress, or weight, or just part of getting older.
If the pain is still there, you do not need another reason to manage it. You need someone to figure out where it is actually coming from and treat that specific source. That is what we do.
## What Lower Back Pain Usually Means
The lower back is a complex area. Five lumbar vertebrae stack on top of each other, separated by discs and connected by small facet joints, all sitting on the sacrum and pelvis, with nerves traveling through to your legs. Pain can come from any of these structures, and identifying which one is the actual source is the most important step. See which pattern sounds most like yours.
#### Pain that is worse with standing, bending backward, or twisting
If your pain worsens when you stand, bend backward, or twist, and eases when you sit forward or lie down with knees bent, this often points to the facet joints. Facet pain is one of the most common and most under-recognized causes of chronic lower back pain, tends to develop with age, and often feels deep, achy, or stiff, worse late in the day.
#### Deep, aching pain that worsens with sitting
If your pain is worse when you sit, especially for long periods, and better when you stand or walk, the source may involve your spinal discs. Disc-related pain often builds during sitting and may flare with bending, lifting, or rolling over in bed. It can come from disc degeneration, disc inflammation, or vertebrogenic pain originating in the bony endplate.
#### Pain in the lower back and buttock that is hard to localize
If your pain extends into the buttock and has resisted years of general back-pain treatment, the sacroiliac joints may be the source. SI joint pain is frequently mislabeled because the symptoms do not fit a typical lumbar pattern, and it often worsens with prolonged sitting, standing, stair climbing, or rolling over in bed.
#### Pain that radiates down your leg
If your pain travels down the buttock and leg, sometimes to the foot, this is radiating pain or sciatica, often from a herniated disc or spinal stenosis irritating a spinal nerve. We address this on our Sciatica and Herniated Disc pages.
#### Sudden severe pain after a minor activity
Sudden severe lower back pain after a minor strain, fall, or bend, particularly if you are over 60 or have osteoporosis, can indicate a vertebral compression fracture and warrants prompt evaluation.
## When to Stop Managing It and Get It Evaluated
Acute lower back pain (less than six weeks) often improves with rest, gentle movement, and over-the-counter anti-inflammatories. Consider professional evaluation when:
- Your pain has lasted more than six weeks without significant improvement
- The pain interferes with sleep, work, or daily activities
- You have had recurring episodes over months or years
- Conservative treatments have not provided lasting relief
- You are tired of relying on medication to function
- You want to identify the actual source rather than continue managing symptoms
The earlier the source is identified, the more options you typically have, because some treatments work better in earlier stages of certain conditions.
## How PHI Approaches Lower Back Pain
Our approach starts with identifying the source. Many patients arrive having been told they have "general" or "non-specific" low back pain, labels that do not point to a treatment. The actual source does.
Your physician evaluates your specific pain pattern, reviews any prior imaging, and sometimes uses diagnostic injections to confirm the source. Once the source is clear, the options narrow to the ones likely to actually help. For facet-mediated pain, facet joint injections often help, with radiofrequency ablation for longer-lasting relief. For disc-related pain, epidural steroid injections reduce inflammation, and for vertebrogenic pain the Intracept Procedure is a single-treatment option. For sacroiliac joint pain, SI joint injections both diagnose and treat. Regenerative options including PRP, A2M, and stem cell therapy may address the underlying disc tissue.
Most patients leave their first consultation with a specific diagnosis and a clear plan, which is often more clarity than they have had in years.
## Why PHI for Lower Back Pain
## Frequently Asked Questions
**Q: I've had lower back pain for years. Is it too late to find an answer?**
No. Patients with chronic lower back pain often have more diagnostic clarity than they realize, because the pattern of how the pain has changed over time is itself useful information. Many patients with years of unsuccessful prior treatment find meaningful relief once the actual source is identified.
**Q: Will I need surgery?**
Most patients with chronic lower back pain do not need surgery. The vast majority find meaningful relief through non-surgical approaches including injections, radiofrequency ablation, the Intracept Procedure, and regenerative medicine. Surgery is reserved for specific situations where it is the right answer.
**Q: I've had MRIs that showed problems but treatment didn't help. What now?**
This is common. MRI findings do not always correlate with the actual source of pain, and many patients have multiple findings, only one of which is causing symptoms. Identifying which finding is the source often requires diagnostic injections rather than imaging alone, which changes treatment recommendations for many patients.
**Q: Should I keep doing physical therapy?**
In most cases yes, often alongside other treatments. Physical therapy works best when paired with treatment of the underlying source. Patients who have done PT for months without improvement often benefit from interventional treatment that addresses inflammation or joint dysfunction that PT alone cannot reach.
**Q: How long until I feel better?**
This varies by treatment. Many injections produce relief within days to weeks. Radiofrequency ablation produces gradual improvement over several weeks. The Intracept Procedure produces durable relief that develops over weeks. Regenerative options work over several months. Your physician will set specific expectations.
**Q: What if injections don't work for me?**
If targeted injections do not produce meaningful relief, that result is itself diagnostic. It tells your physician the source may not be what was initially thought, and the next step is reconsidering the diagnosis. This is why we use diagnostic injections rather than empirically trying treatments.
**Q: How is this different from going to a chiropractor?**
Chiropractic care can help specific patients, particularly for muscle-related pain and minor mechanical issues. PHI's approach is medical and interventional. We diagnose the source through imaging, examination, and sometimes diagnostic injections, then deliver treatments targeting that specific source. PHI works with chiropractic care but does not offer it in-house.
**Q: Do you take insurance?**
Insurance coverage and payment options may vary. We provide documentation for you to seek reimbursement through your out-of-network benefits, which may apply to certain services. All pricing is disclosed at consultation.
**Q: Do you accept international patients?**
Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations.
## Treatments We Offer for Lower Back Pain
PHI offers the full range of evidence-based treatments for lower back pain. Your physician will recommend the right option, or combination, based on the source of your pain, your imaging, and your treatment history.
- Epidural Steroid Injections, for disc-related and radiating nerve pain
- Facet Joint Injections, for facet-mediated pain
- Radiofrequency Ablation, for longer-lasting facet relief
- Intracept Procedure, a single-treatment option for vertebrogenic pain
- Sacroiliac Joint Injections, to diagnose and treat SI joint pain
- PRP Therapy
- Stem Cell Therapy
- A2M Therapy
- Exosome Therapy
> Epidural steroids for cervical and lumbar radicular pain and spinal stenosis: systematic review summary. Peer-reviewed via PubMed, 2025.
— [American Academy of Neurology Guidelines Subcommittee](https://pubmed.ncbi.nlm.nih.gov/39938000/)
> Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Peer-reviewed via PMC, 2020.
— [Cohen SP, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC7362874/)
## Schedule Your Lower Back Pain Consultation
A 60-minute consultation will identify the specific source of your pain, walk through the treatment options that match it, and give you a clear plan. Call (310) 856-9488 or book online now.
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