6 Common Causes of Low Back Pain — A Toronto Chiropractor's Clinical Guide

By Dr. Matthew Hannikainen DC — The Well Adjusted Chiropractic Centre, Toronto

Low back pain is one of the most common reasons people seek chiropractic care in Toronto. It's also one of the most mismanaged — not because the treatments don't work, but because most treatment focuses on the pain rather than the structural reason the pain exists in the first place.

At our downtown Toronto clinic, we see a consistent set of underlying causes behind low back pain. Understanding which one is driving your symptoms matters — because the approach to correction is different for each. This article walks through the six most common presentations we see clinically, how we identify them, and what a structural approach to chiropractic care can do about them.

1. Vertebral subluxation

In clinical terms, a vertebral subluxation is a spinal segment that has lost its normal position or movement — creating pressure or irritation on the adjacent nerve roots. In practice, it's the most common finding we encounter in Toronto low back pain patients.

What makes subluxations clinically significant is that they don't always cause pain directly at the site of the problem. Nerve irritation from a lumbar subluxation can produce symptoms in the buttocks, hip, or leg — which is why low back pain patients often present with a more complex symptom picture than simple local pain.

Chiropractic adjustments address subluxations by restoring proper segmental motion and alignment. In our CBP-based approach, we don't simply adjust based on where it hurts — we use X-ray analysis to identify the specific structural pattern and direct care accordingly.

2. Herniated disc

A lumbar disc herniation occurs when the nucleus pulposus — the gel-like centre of the disc — pushes through a tear in the annular fibres and contacts the adjacent nerve root. The result is typically a combination of local low back pain and referred symptoms into the leg: pain, numbness, tingling, or weakness following the path of the affected nerve.

What we consistently find in Toronto patients with disc herniation is that the herniation didn't occur randomly — it occurred in the context of a spine that had lost its normal lumbar lordosis, creating uneven disc loading over time. Addressing that underlying structural environment is what separates lasting recovery from repeated episodes.

From a CBP perspective, restoring lumbar lordosis through mirror-image traction and corrective adjustments reduces the mechanical stress on the affected disc — not just the symptoms it's producing. We document the structural change on comparative X-rays at the end of a correction program.

For a detailed breakdown of disc herniation types, symptoms, and the specific home exercise program we use clinically, see our full article on lumbar disc herniation and chiropractic care.

3. Sciatica

Sciatica refers specifically to pain that travels along the path of the sciatic nerve — from the lower back through the buttock and down the leg, sometimes as far as the foot. It's a symptom, not a diagnosis. The clinical question is always: what is compressing or irritating the sciatic nerve?

The two most common causes we see in our Toronto clinic are lumbar disc herniation (nucleus material pressing on the nerve root) and piriformis syndrome (the piriformis muscle compressing the sciatic nerve as it passes through the gluteal region). These two presentations can produce almost identical symptoms but require different approaches to treatment — which is why a proper structural assessment matters before beginning care.

Chiropractic adjustments aimed at restoring lumbar alignment reduce nerve root compression. For piriformis-related sciatica, soft tissue work and specific stretching protocols address the muscular component. Most patients see significant improvement within the first 4-6 weeks of consistent care.

4. Spinal stenosis

Lumbar spinal stenosis involves narrowing of the spinal canal or the foraminal openings through which nerve roots exit — creating pressure on the spinal cord or nerve roots. The classic presentation is neurogenic claudication: leg pain, heaviness, or weakness that worsens with walking and improves with sitting or forward flexion.

What we've found clinically at our Toronto clinic is that the degree of stenosis visible on imaging doesn't always correlate directly with symptom severity. A spine with good segmental alignment and maintained lumbar lordosis tolerates stenosis far better than one that has lost its curve and collapsed into extension-loading. Restoring the lordotic curve through CBP-based care reduces the functional compression even when the structural narrowing remains.

This is best assessed on a lateral lumbar X-ray — the curve measurement tells us both the degree of structural compromise and the target for correction.

5. Spondylolisthesis

Spondylolisthesis occurs when a vertebra slips forward relative to the one below it — most commonly at L5-S1. It ranges from a minor slip (Grade 1) to a significant displacement (Grade 4), and it's graded on a lateral X-ray. Many Toronto patients present with spondylolisthesis that has been present for years without their knowledge — it's often discovered incidentally during a routine spinal assessment.

Symptoms range from chronic low back ache to severe nerve compression with leg symptoms, depending on the degree of slip and the structural compensation that has developed around it.

At our clinic we've found that a very specific chiropractic adjustment protocol — combined with lumbar stabilization exercises — produces consistent results in Grade 1 and Grade 2 spondylolisthesis. The goal isn't to reverse the slip entirely but to stabilize the segment, restore as much normal alignment as possible, and reduce the nerve irritation it's creating. Grade 3 and 4 presentations require co-management with a spine specialist.

6. Muscle strain and ligament sprain

Acute muscle strains and ligament sprains are the most common cause of sudden onset low back pain — the kind that strikes after a heavy lift, a sudden awkward movement, or a long day of physical work. They're typically the easiest low back pain presentations to resolve acutely, but they become a problem when they're recurrent or when they develop into chronic pain patterns.

Recurrent low back strains are rarely just bad luck. In our clinical experience, they consistently occur in the context of underlying structural vulnerability — a spine that has lost its normal curve, weak stabilizing musculature, or poor ergonomic loading patterns. The strain is the event; the structural weakness is the environment that allowed it to happen.

Chiropractic care for acute strains addresses the immediate segmental dysfunction. For recurrent strains, we look at the underlying structural picture and address what's making the spine vulnerable to repeated injury.

The structural assessment that changes everything

Regardless of which of the above is driving your low back pain, the starting point at The Well Adjusted Chiropractic Centre is the same: a thorough structural assessment.

Every new patient receives a comprehensive examination including postural analysis, range of motion testing, and orthopedic assessment. Where clinically indicated we refer for weight-bearing X-rays — specifically a lateral lumbar view that allows us to measure your lumbar curve, identify the structural cause of your pain, and set a measurable correction goal.

This is the foundation of Chiropractic BioPhysics (CBP) — the technique we practice at our downtown Toronto clinic. Rather than adjusting based on symptoms alone, we identify the specific structural deviation causing your pain, correct it progressively over a structured care plan, and verify the result with comparative assessments. The outcome is documented, not just felt.

Home exercises for low back pain

Clinical note: Exercise prescriptions at our clinic are individualized based on examination findings and diagnosis. The exercises below represent movements commonly used in our low back pain rehabilitation protocols — they are not a substitute for a personalized assessment. If you have a confirmed disc herniation, spondylolisthesis, or stenosis, consult a chiropractor before beginning any exercise program.

For patients with low back pain related to postural loading and muscle imbalance, the following exercises from our clinical protocol are commonly prescribed:

Prone lumbar extension — lying face down, perform a sloppy push-up keeping the pelvis on the floor and letting the spine sag. 12 reps, 10-second hold, performed hourly. This is the primary exercise for restoring lumbar lordosis and centralizing disc pressure.

Hip flexor stretch (high lunge) — step into a lunge, keep the pelvis square and upper body upright, straighten the back knee to stretch the front of the hip. 2 reps of 20 seconds, twice daily. Tight hip flexors are a consistent contributor to lumbar pain in Toronto desk workers.

Single knee to chest — lying on your back, hug one knee toward the chest holding under the knee joint. 2 reps of 20 seconds, twice daily. Releases the gluteal and piriformis muscles that commonly tighten with low back problems.

Abdominal hollow / leg drag — lying on your back with knees bent, draw the navel gently toward the spine and slowly straighten one leg along the floor. 2 sets of 15-20 reps with a 4-second hold, daily. Low-load lumbar stabilization that activates the deep core without spinal flexion.

Cat / camel — on hands and knees, alternate between letting the spine sag (camel) and arching it toward the ceiling (cat). 2 sets of 15-20 reps, daily. Improves segmental mobility and drives nutrient exchange into the discs.

These exercises are most effective when combined with in-clinic structural correction — they support and reinforce the changes made during adjustments rather than replacing them.

Why low back pain keeps coming back

If you've had low back pain that resolves and returns — resolves and returns — the cycle is telling you something. Temporary relief without structural correction leaves the underlying mechanical environment unchanged. The same stresses keep producing the same problem.

This is the distinction between symptom management and structural correction. At our Toronto clinic we aim for the latter — identifying the structural cause, correcting it progressively over a defined care plan, and verifying the change with comparative assessments. Patients who complete a full correction program consistently report not just less pain but fewer episodes and better long-term spinal health.

Book a low back pain assessment in downtown Toronto

If you're dealing with low back pain — whether it's a recent onset or a problem you've been managing for years — a structural assessment is the starting point for understanding what's actually driving it.

At The Well Adjusted Chiropractic Centre, 69 Yonge Street Suite 301, we see low back pain patients every week and have for over 19 years. No referral is needed and same-week appointments are typically available.

Call or text: 416-504-8880 Book online: getadjusted.ca/online-booking

Dr. Matthew Hannikainen DC is a chiropractor in downtown Toronto practicing Chiropractic BioPhysics (CBP). He trained at Life West Chiropractic College where CBP was a core technique, and has been in clinical practice for over 19 years. He is a member of the Ontario Chiropractic Association and the Canadian Chiropractic Association.