Recurring low back pain: what can an osteopath do?

In short

Low back pain often comes back: two in three people have pain again within a year of recovering.^[1] Does your back pain keep returning, even after physiotherapy or another treatment? At the osteopath, we take a broad view to find what triggers your back pain. Just like a physiotherapist, we look at your muscles, joints and nerves. Depending on your complaint, we also look at other structures that may explain the pain. A good example is pain that radiates from the kidneys to the lower back. The osteopath examines whether such structures are involved and treats them where possible. We always use safe, non-invasive manual techniques and give you explanation and exercises, whether or not together with one of the physiotherapists in our team. The lasting effect mainly comes from that combination: moving, varying your posture, understanding what is going on, and treatment.^[2]^[3] If it turns out to be something we cannot treat (for example kidney stones), we refer you for further tests.

Do you recognise any of these symptoms?

Your low back pain keeps coming back, sometimes every few months.
Your back is stiff in the morning, or hurts after sitting for a long time.
The pain spreads to your buttock, pelvis, groin or hip, sometimes on both sides.
Your back or pelvis feels "stuck".
Your back pain mainly occurs, or gets worse, during your period.
Your back pain comes with bowel problems, such as constipation, bloating or cramps.
Your belly, diaphragm or pelvic floor feels tense, and you tend to breathe high and shallow.
You have lasting pelvic or back pain after a fall on your tailbone.

When should you see an osteopath?

At Magnus, we find that a visit to the osteopath makes sense when:

your low back pain keeps coming back;
you have already had physiotherapy or another treatment for these complaints, but are no longer making progress;
other complaints play a role, such as bowel, bladder or cycle problems, that were not yet known or not part of your treatment plan.

At Magnus, we combine physiotherapy and osteopathy, with consultation between colleagues and you. The choice is always yours.

Where can low back pain come from?

Low back pain rarely has a single cause. This is what the osteopath looks at, and what may play a role:

A blocked vertebra. The vertebrae move less freely in one place. This can also cause pain that radiates in the back or towards the legs.
The spine as a whole. If it moves less well in one place, other parts of the spine compensate.
Long periods in the same position (for example a lot of sitting or cycling) can cause excessive tension or shortening of structures, so the vertebrae cannot move freely.
The abdominal organs. Digestive, bladder or cycle problems can go together with pain radiating to the lower back.
Foot, knee and hip. We check whether the mobility and movement pattern of those joints can affect your back pain. A difference in leg length or a knee that does not fully straighten may play a role, but does not have to.
Pressure on a nerve. A herniated disc, for example, can press on a nerve in the back. This can cause local back pain, sometimes with pain radiating to the pelvis or legs (for example tingling, numbness or even loss of strength).
An oversensitive nervous system. Sometimes there is back pain without damage, or more pain than the damage explains. The nervous system has then become oversensitive. This is also called chronic or persistent pain.

Some factors are regularly overlooked in examination and treatment. By looking at your complaints from different angles, we map out the full picture: which factors all contribute to your back pain? A correct diagnosis is essential for a complete and effective treatment plan.

Who is more at risk of a new episode?

In a large study, these people in particular had back pain again within a year:^[1]

people who often work in awkward postures;
people who sit for more than five hours a day;
people who had back pain more than twice before.

There is no proof that one "wrong" posture causes back pain.^[4] Staying in the same position for a long time does play a role. Varying your posture is therefore more important than "sitting up straight".

When should you see your GP or go to A&E straight away?

Go to your GP or the emergency department straight away if you:

have pain that keeps getting worse and spreads further and further;
feel numb around your anus, genitals or the inside of your thighs;
suddenly can no longer properly hold your urine or stools, or cannot pass urine;
suddenly have clear loss of strength in one or both legs or feet;
have back pain with fever, or lose weight without explanation;
ever had cancer and develop new back pain;
have back pain after a fall or accident, especially if you have osteoporosis;
have constant pain at night that does not improve in any position.

Can you see an osteopath without a referral?

Yes. You do not need a referral and can book an appointment with the osteopath directly. Osteopathy is not covered by compulsory health insurance, but most health insurance funds (mutualities) reimburse part of it through their supplementary insurance. Read more about reimbursement of osteopathy.

What does an osteopath do for back pain?

1. Examination

A conversation about the course of your complaints: when they get worse or better, and which treatments you have already had.
Your posture when sitting and standing, and how you move in daily life in different settings (work, hobbies, home …).
The mobility of your lower back and the joints around it (upper back, hips and pelvis): what can you do yourself, and how does it move when the osteopath moves it?
The neighbouring joints (foot, knee, hip): how they move, how you walk or stand, and whether that can affect your back pain.
Tension in soft tissues such as muscles and connective tissue (for example ligaments or joint capsule) that may explain your back pain or keep it going.
Neurological tests, if needed: sensation, strength and reflexes. This tells us whether a nerve is irritated.
Examination of other structures that can radiate to the lower back, such as the kidneys, the large intestine and the lower pelvis, using various tests.

If the osteopath sees signs that a doctor should look at, we refer you.

2. Explanation

You get an explanation of:

what pain is: pain does not always mean damage, and a painful back is usually not a broken back;
where the problem is and what triggers it;
the importance of movement and posture: which movements may cause you trouble and why, and which movements are pain-free and help you regain mobility.

Understanding where your pain comes from is essential. Explanation about pain combined with exercises has been shown to work better than exercises alone.^[5]

3. Treatment

Treatment techniques largely overlap with those in physiotherapy. The focus is sometimes a little more on manual techniques, where you are somewhat more passive at first. The aim is still to build up movement again as soon as possible.

Joints: mobilisations, muscle energy techniques (you lightly tense against the osteopath's hand) and, where appropriate, manipulations (a short, quick movement).
Muscles and connective tissue: massage and stretching techniques, including for the psoas (deep hip flexor), the quadratus lumborum (a deep muscle in your flank), the sheet of connective tissue in your lower back (thoracolumbar fascia) and your diaphragm.
Abdomen (visceral): gentle mobilisations of the abdominal organs, aimed at mobility and tension in the abdomen.
Craniosacral and relaxation: gentle techniques aimed at relaxation and the overall muscle tension in your body.

4. Getting started yourself

It is important that you gain control over your complaint yourself and master it step by step. That is why you always get some "homework" to speed up your recovery. Part of it may be familiar from your physiotherapist, combined with what matters for you personally:

exercises you do at home, tailored to what the examination showed;
varying your posture, especially if you sit a lot;
general lifestyle tips, for example about exercise, sleep and nutrition;
advice or a referral for complaints that contribute to your back pain, for example constipation or complaints linked to your cycle.

5. A broader view of persistent pain

With complex pain that persists, we look at more than just your back. In osteopathy, we try to reduce the total load on your body. That is why we also discuss sleep, stress and nutrition, and with digestive complaints possible intolerances (in consultation with your doctor or a dietitian). That long-lasting pain is more than a physical problem is well supported: an approach that also addresses stress and thoughts about pain helps in the long term.^[10] Knowing which factors raise your overall stress level helps you get the pain under better control.

What works for low back pain? (treatment with evidence)

Treatment	What does the research say?	Evidence
Exercise therapy	Reduces pain and limitations in long-lasting low back pain.^[2]	Strong evidence
Exercise and explanation to prevent recurrence	An exercise programme, or exercise together with explanation, reduces the risk of new pain and limitations later.^[3]	Strong evidence
Explanation about pain, on top of exercises	Reduces pain and limitations more than exercises alone.^[5]	Strong evidence
Manual therapy on top of exercises	Works better than exercises alone in the short term.^[6]	Limited evidence
Manipulations	Small effect on pain and a moderate effect on function in the short term, but the evidence is very uncertain.^[7]	Limited evidence
Muscle energy techniques	Small effect on pain, no effect on limitations.^[8]	Limited evidence
Walking, running	A small effect on pain compared with doing nothing.^[9]	Strong evidence
Cognitive behavioural therapy and mindfulness	Reduce pain and limitations, also in the long term.^[10] This therapy is given by a psychologist; the osteopath refers you.	Strong evidence

Our osteopaths at Magnus are also physiotherapists, so they have all the treatment techniques above at hand. Their focus is a little broader, which lets them tailor the treatment even more closely to some patients.

Popular treatments, but little evidence

Craniosacral therapy. A review from 2019 found less pain in long-lasting pain, including in the neck and back.^[11] A larger analysis from 2024 found no reliable effect.^[12] It is a gentle, safe technique. With us it is always an addition: we can use it to relieve symptoms, but it is never the core of the treatment. No evidence
Techniques on the abdominal organs (visceral therapy) have been studied very little. A review found little evidence for these techniques. One study saw less back pain in the long term when they were used together with physiotherapy.^[13] Limited evidence
Learning a "correct posture". There is no proof that one particular posture causes back pain.^[4] Varying your posture and keeping moving are more important. No evidence
Supplements for back pain. We found no good research on this; the topic has also been studied very little. No evidence
Nutrition and intolerances as a cause of back pain. There is little research on this. We look at them as part of the bigger picture, especially if you also have digestive complaints. No evidence

No evidence does not mean that something is harmful or helps no one. It means we do not know for sure. That is why we always combine these techniques with what is well studied: exercise, explanation and keeping moving. It is important that the approach stays non-invasive. If there are serious complaints, or your history points to something that needs further tests (for example a possible small fracture in a vertebra), we refer you.

What can you expect?

In the short term: less pain and muscle tension, and you move more easily. Sometimes your abdomen also feels less tense.
In the long term (months): the lasting effect mainly comes from the combination of movement, varying your posture, explanation, lifestyle and manual treatment.^[2]^[3]

Just like your physiotherapist or any other healthcare provider, your osteopath should be able to give you a realistic picture of what to expect, so that you can check it yourself. If that is not the case and you are not making progress, something is not right.

How quickly will you notice results, and how often do you need to go?

That depends on how long you have had complaints and what triggers them. If a joint moves less freely in one place, you sometimes notice a clear difference after one treatment. If the cause is more complex, a few treatments are needed. After the first two or three treatments, you usually notice whether things are going in the right direction. We usually review together after three to four treatments. After that, the appointments are spaced further apart, so you can continue with your exercises yourself. The goal is that you no longer need us.

Have you been treated before? Feel free to bring reports from doctors or physiotherapists to your first consultation. That way we have the full picture straight away.

Which is better for back pain: osteopath or physiotherapist?

There is no winner. As mentioned above, our osteopaths are physiotherapists with additional training in osteopathy. You can expect them to make sure you make progress. What helps most is a combination of manual treatment where useful, exercise and explanation.^[2]^[6] The osteopath also looks at elements that fall a little outside the physiotherapist's field, such as the function of certain structures and organs that can explain or worsen back pain. At Magnus, they work under one roof and consult each other. We find that extremely important, because research also shows how important physiotherapy is. Both therapies can strengthen each other.

Your osteopath for low back pain

Steve Dierckxsens
Osteopath D.O., Leuven (Naamsepoort)

Eefje Coomans
Osteopath D.O., Antwerp (Eilandje)

To book, use the gold "Book an appointment" button at the top right. Not sure whether the osteopath can help you? Send us a message via WhatsApp: Leuven or Antwerp.

Read more about our osteopaths and practices on Osteopath Leuven and Osteopath Antwerp. Eefje can also help you with menstrual and cycle problems.

Frequently asked questions

Why does my back pain not go away, or keep coming back?
That is very common: two in three people have back pain again within a year.^[1] Sitting a lot, often working in awkward postures and previous episodes increase the risk. An exercise programme, together with explanation, reduces that risk.^[3] If your back pain persists despite treatment, we look further together with your GP.

Is a manipulation (a "crack") dangerous?
For the lower back, the risks of a manipulation are small. Side effects are usually mild and short-lived, such as some soreness or stiffness.^[14] The osteopath examines you first and does not manipulate if there is a reason not to. If you do not want a manipulation, or we judge that it may not be suitable for you, there are always gentler techniques such as mobilisations. They work just as well, though sometimes a little more slowly. Both osteopaths and manual therapists (a recognised specialisation within physiotherapy) can perform manipulations safely and correctly.

Is pain after a visit to the osteopath normal?
It can be, depending on the technique used and how sensitive your body is. The osteopaths at Magnus always tell you what to expect. Your back may be a little sensitive or stiff for a day or two, like after a hard workout. That goes away by itself.^[14] If the pain gets worse instead of better after two to three days, or you get a warning sign (see above), contact us. If you have questions, feel free to ask them during your consultation. You have the right to go home well informed.

How many days of rest do you need after the osteopath?
None. Just like with the physiotherapist, keeping moving is crucial. Being active, such as walking, always helps more than resting.^[9] On the day itself, it is better to take it a little easier with heavy exertion.

How many times can you go to an osteopath?
There is no maximum. We agree together how many treatments make sense, and review after three to four sessions. Health insurance funds only reimburse a limited number of treatments per year; check this with your fund.

Can an osteopath free a trapped nerve?
Not literally, but we can take pressure off the nerve. With pain radiating into your leg, a nerve is often irritated by a bulging disc (herniated disc) or a narrowing of the spinal canal. Techniques such as traction (gently stretching your spine) and movements in flexion (bending forward) can give the nerve more space and reduce the irritation. Which direction helps you, we find out during the examination. If the strength in your leg or foot decreases, or you feel numb in your seat area, see your doctor straight away.

Can a trapped nerve in the back go away by itself?
Often, yes. Larger herniated discs in particular often shrink by themselves in the following months.^[15] That can take a few weeks to months.

Do I need a scan or X-ray?
Usually not. About 90% of back complaints are non-specific: no clear cause can be seen on a scan, and imaging is then not needed. Imaging can only be useful when there are red flags. A good physiotherapist or osteopath recognises them during the conversation and examination. So do not expect quick fixes or quick diagnoses from your osteopath, but a thorough conversation and examination first. Without warning signs, a scan changes little about the treatment. If there are warning signs, we refer you to your doctor.

Can back pain be related to my bowels or my cycle?
Bowel problems and pelvic pain around your period sometimes go together with low back pain. The osteopath also examines that area. Read more about menstrual and cycle problems.

Can I move with back pain?
Yes. Keeping moving, such as walking, helps more than resting.^[9] It is important to know which movements can help get your complaints under control, and what you can do if the pain does come up.

Is osteopathy reimbursed?
Not by compulsory health insurance. Most health insurance funds give a contribution through their supplementary insurance. Read more about reimbursement of osteopathy.

Last updated: November 2026.

What do the evidence labels mean?

We base ourselves on reviews and guidelines published in 2019 or later. Click a label in the text to see its explanation.

Strong evidence

Several good studies or reviews reach the same conclusion.

Limited evidence

There are few or small studies, or the results contradict each other. It may help, but it is not certain.

No evidence

Good studies find no effect larger than a placebo, or there are no good studies yet. No evidence does not mean that something is harmful.

Glossary

Difficult words on this page, explained in plain language. The explanations are written in our own words, based on the source given.

Cognitive behavioural therapy

a form of psychological help in which you learn to deal differently with thoughts, feelings and behaviour around your pain.

Source: Jenkins HJ, et al. (2025)

Craniosacral therapy

a gentle technique in which the osteopath works with light pressure around your head, spine and pelvis.

Source: Haller H, et al. (2019)

Episode (flare-up)

a period in which you have back pain. If the pain returns after a period without complaints, we speak of a new episode or recurrence.

Source: da Silva T, et al. (2019)

Exercise therapy

supervised exercises, tailored to your complaints, to make your back stronger, more flexible and less sensitive.

Source: Hayden JA, et al. (2021)

Herniated disc (hernia)

the soft core of an intervertebral disc bulges out and can press on a nerve. A herniated disc often shrinks by itself.

Source: Rashed S, et al. (2023)

Manipulation (HVLA)

a short, quick movement of a joint, sometimes with an audible "crack". HVLA stands for high velocity, low amplitude: fast, with a small range.

Source: de Zoete A, et al. (2026)

Manual therapy

treatment with the hands, such as mobilisations, manipulations and massage.

Source: Narenthiran P, et al. (2025)

Mindfulness

attention training in which you learn to notice what you feel and think, consciously and without judgement.

Source: Jenkins HJ, et al. (2025)

Mobilisation

moving a joint calmly and repeatedly, within a comfortable range, to help it move more freely.

Source: Narenthiran P, et al. (2025)

Muscle energy technique

a technique in which you lightly tense against the osteopath's hand and then relax. This lets the joint move further.

Source: Santos GK, et al. (2022)

Non-specific low back pain

back pain for which no clear cause can be found, such as a fracture, an inflammation or a trapped nerve. It is the most common form of low back pain. That no cause can be seen on a scan does not mean the pain is not real.