If you’ve pulled a muscle, tweaked your back, or you’re
wondering whether that pain running down your leg is a pinched nerve —
you’ve probably already watched the videos. Some of them are
genuinely decent: gentle stretches, follow-along routines, “is it nerve,
muscle or joint?” checklists. This page will not tell you those
exercises are dangerous, because for most back pain they aren’t. It will
tell you honestly what they can do, what they can’t, and how to know
which situation you’re in.
At Somalynk in Ixelles, near Place du Luxembourg and the EU
quarter, low back pain is treated by Philippe Tadger — a
musculoskeletal physiotherapist and manual therapist who is also a
Statistical Editor at Cochrane and a PhD
researcher in chronic pain (VUB). The person who treats your
back is the same person who reads the studies behind every claim on this
page. Consultations in English, French and Spanish.
Trust strip: MSc Orthopaedic Manual Therapy
(Zaragoza, honours) · Statistical Editor at Cochrane · PhD candidate in
chronic pain, Vrije Universiteit Brussel · INAMI-conventionné
n°5/58395/34/527
👉 Book a consultation
— or keep reading: Is it a nerve, a
muscle or a joint? · What’s safe to
do at home · When back pain needs more
than exercises
“Is it a nerve, a muscle or a joint?” — the
right question, and why it’s hard to answer alone
It’s the most-asked question about back pain online, and it’s a
good question — where your pain comes from genuinely changes
what treatment should look like. Pain that stays low in the back, pain
at that small bony spot at the back of the pelvis, and pain that runs
down the buttock or the back of the thigh are not the same problem.
Here’s the honest part: the self-tests you find online can’t
reliably settle it. Tests like the straight-leg raise or the
slump test exist in clinical practice — but no single test is conclusive
on its own. Clinicians use them in combination, alongside your
history, how your symptoms behave when you move, strength and nerve
function, and, where useful, imaging. A test performed once, on
yourself, on the living-room floor, tells you very little — and a
“positive” result can send you down entirely the wrong path.
This is exactly what a functional and movement
diagnosis is for, and it is the core of how we work:
- No automatic protocols. Two people with “low back
pain” can leave with completely different plans, because the diagnosis —
not a recipe — drives the treatment. - Even if you bring an MRI or a medical diagnosis, we still
make our own functional and movement diagnosis. Imaging
informs; it doesn’t replace watching how your spine actually moves and
what reproduces your pain. (More on scary MRI words below.) - In an acute flare-up, reproducible mechanical signs guide
us — we find the movements that switch your pain on and off,
and use them to steer treatment session by session.
Worried your stretches are making it
worse?
You may have seen the warning that the stretches you’ve been doing
could be making your back worse. It’s a powerful hook — fear
usually is. Here’s the calmer, evidence-based version:
- For common (non-specific) low back pain, gentle movement and
exercise are safe and recommended. UK national guidance (NICE
NG59) and the Belgian KCE guideline both put staying active and
exercising at the centre of care. The bigger risk for most people is not
the wrong stretch — it’s stopping moving out of fear. - The best advice in those videos is real: gentle beats
aggressive. A slighter stretch sustained for longer does more
good than an all-or-nothing, go-big-or-go-home approach. If a stretch
sharply increases your pain or sends symptoms further down your leg,
that specific movement isn’t your friend right now — stop that one,
don’t stop moving altogether. - Where the fear has a kernel of truth: if your pain
radiates below the knee, if you have numbness or tingling, or if certain
directions of movement consistently worsen things, then generic routines
genuinely can be a poor match — not because stretching is dangerous, but
because your back may need a specific direction, dose or
progression. That’s a diagnosis question, not a YouTube question.
What you can safely do at home — honestly
No gatekeeping: for a common episode of low back pain (“pulled a
muscle”, “tweaked it lifting something”, woke up stiff),
evidence-consistent self-care looks like this:
- Keep moving, gently. Short, frequent walks are one
of the best-supported things you can do. Motion is not the enemy;
guidelines explicitly recommend staying as active as you can (NICE
NG59). - Skip the bed rest. Lying still for days makes most
backs stiffer and recovery slower. Rest positions are fine for minutes,
not for days. - Gentle mobility work, in pain-free ranges. The
classics you’ve seen — knees-to-chest, dropping bent knees side to side
(lumbar rotation), pelvic tilts, glute bridges — are reasonable,
low-risk movements for general back stiffness. Do them gently and
sustained, not forced. - Heat can ease symptoms short-term. A warm shower or
heat pack won’t fix anything structural, but it can make moving easier —
and moving is the point. - Watch the trend, not the hour. Back pain
fluctuates. What matters is the direction over days: most simple
episodes clearly improve within one to two weeks.
And the honest boundary: if you’re not clearly
improving after about two weeks of sensible self-care, if pain runs
below the knee, if you get numbness, tingling or weakness, or if this is
the third or fourth episode this year — that’s the point where
self-treatment should hand over to assessment. Not because you did
anything wrong, but because generic advice has done what it can.
What the videos don’t tell you: red flags and when to
seek care
The most-viewed back pain videos — tens of millions of views between
them — contain no screening for serious causes and no boundary
for when self-treatment should stop. That’s the single biggest
gap between a follow-along video and professional care, so here it is
plainly.
See a doctor promptly (not a physio, not a video) if back
pain comes with any of these:
- Numbness in the saddle area (groin, inner thighs),
new difficulty controlling bladder or bowel, or
numbness when wiping — possible cauda equina compression, a medical
emergency. - Progressive weakness in a leg or foot (tripping,
foot slapping, can’t rise onto tiptoes). - Fever, chills or feeling systemically unwell with
back pain. - Unexplained weight loss, a history of
cancer, or unrelenting pain at night that doesn’t ease in any
position. - A significant trauma (fall, accident) — or a minor
one if you have osteoporosis or long-term corticosteroid use.
These are uncommon. The overwhelming majority of low back pain is
not dangerous. But screening for them is the first thing any
competent assessment does — and part of a physiotherapist’s job is
recognising them and referring you on. It’s also why “not a specific
diagnosis needed, safe for everyone” is a promise no responsible
clinician can actually make.
Myth-check: discs, pops and being “out of place”
Correcting these accurately matters more than being polite about
them. No channels named; the ideas are what we’re after.
- “This exercise puts the disc back where it should
be.” No exercise repositions a disc. What is real:
some backs feel clearly better moving in one direction than another
(clinicians call it directional preference), and exercises can
absolutely reduce pain and improve movement. The relief is real — the
disc-pushing mechanism is not. Evidence points to changes in pain
sensitivity and movement, not to discs sliding back into position. - “My MRI says disc bulge — so that’s why it hurts.”
Maybe; often not. Disc bulges and degeneration are common in
people with no pain at all, and get more common with age
(systematic-review evidence, Brinjikji 2015). This is why guidelines
don’t recommend routine imaging for most back pain — and why we make a
functional diagnosis even when you bring an MRI. - “I need something to pop for it to work.” The pop
(cavitation) is gas releasing in joint fluid — a side effect, not a fix.
Relief without a pop is just as valid; a louder crack is not a better
result. And your SI joint has not “gone out of place” — it is one of the
most stable joints in the body. It can hurt, and that pain is treatable
— without any relocation story. - “Rest until it passes.” Covered above, but worth
repeating: days of bed rest is one of the few genuinely
counterproductive things you can do for a simple back episode.
Relief is not recovery: beyond
stretching
Here’s the structural limitation of even the best follow-along
routines: they end at stretching and floor-level
stabilisation. That can genuinely ease a flare-up. It does very
little to stop the next one.
What lasting recovery adds:
- Progressive loading. Your back gets robust the way
any tissue does — by being loaded a bit more than it’s used to,
gradually, over weeks. That means progressing from floor exercises to
loaded, functional movement matched to your life: lifting your child, a
day at a desk in the EU quarter, getting back to running or the
gym. - Motor control work where the diagnosis calls for
it. Specific exercise targeting how you move, not just
how flexible you are. - A relapse-prevention logic. When your condition is
stable, our assessment deliberately shifts from pain to
function — finding the deficits that predict the next
episode and training them. That’s the difference between “my back feels
looser today” and “I stopped having episodes.”
This combination — manual therapy to settle pain and restore
movement, plus specific exercise to build capacity — is exactly what
guidelines recommend: hands-on treatment as part of a package
with exercise, never as a standalone passive fix (NICE NG59).
It’s also how every plan here is built.
Your first consultation: we diagnose, we test, we
adapt
No mystery, no commitment to an endless programme:
- History and your goals. How it started, what
switches it on and off, what you need your back to do — desk marathon,
deadlifts, grandchildren. - Functional and movement diagnosis. Movement
analysis, strength, nerve tests where indicated — the proper version of
the “is it nerve, muscle or joint” question. Red-flag screening is built
in. If you have imaging or a prescription, bring it; we’ll use it
alongside the functional picture, not instead of it. - A test treatment, same session. We don’t just
assess — we probe our first hypothesis with treatment and see how your
back responds. That response steers the next session. We diagnose,
we test, we adapt.
Depending on what we find, the path differs: an
acute episode gets a more intensive short arc guided by
your mechanical signs; a recurring or stable problem
gets a function-first plan aimed at cutting relapse risk. In both cases
the recommended path combines manual therapy (integrated with
osteopathic techniques) + specific exercise + evidence-based
practice in each session — and aims at a defined endpoint, not
dependency.
When back pain has become chronic
If your back has hurt for more than three months, the honest news is
that it’s rarely just a tissue problem anymore. Persistent pain involves
a sensitised nervous system, and it’s shaped by sleep, stress, activity
levels, and what you believe about your back. That’s not “it’s in your
head” — it’s how pain biology works, and it’s precisely
Philippe’s research field (PhD in chronic pain and
lifestyle interventions, VUB).
Chronic low back pain here is treated with the full toolkit: hands-on
treatment to reduce sensitivity, graded activity to rebuild capacity and
confidence, and attention to the cognitive and emotional
factors that can quietly maintain a chronic situation. Few
clinics can offer a manual therapist who actively researches this.
Practical info: prescription, reimbursement,
location
- Prescription. Bring a medical prescription — it’s
legally required for reimbursement, and treatment must start within 2
months of the prescription date. You can consult without one, but the
session is then fully at your charge. - Reimbursement. As a conventioned practice, fees
follow the official INAMI schedule with no supplements: a standard
session costs €31.64, of which your mutuality reimburses €25.39 — you
pay a fixed co-payment of €6.25 (€2.50 with preferential status/BIM),
and the one-time intake at your first session is reimbursed in full. If
you’re an expat with international cover: invoices from this
conventioned Belgian practice are accepted by insurers such as Allianz
Care, Cigna Global, Aetna and BUPA. Full details and the current
official tariffs: pricing &
insurance · INAMI sources: tariff
schedule (PDF), fixed
co-payments. - Cost. Philippe is INAMI-conventionné
(n°5/58395/34/527) — he works at the official conventioned
tariffs. Ask at booking for the current amount and what reimbursement
leaves you to pay. - Location. Ixelles, near Place du
Luxembourg (Philippe practises at ESP) — in the EU quarter,
minutes from Bruxelles-Luxembourg station. If your back pain is fed by
ten-hour desk days, you’re in the right neighbourhood. - Languages. English, French, Spanish (native).
About Philippe Tadger
Musculoskeletal physiotherapist and manual therapist, 15+ years
across Venezuela, Colombia, Spain, France and Belgium. MSc
Orthopaedic Manual Therapy (Zaragoza, honours) ·
Statistical Editor at Cochrane · MSc Statistics, MSc
Quantitative Epidemiology · PhD candidate in chronic
pain (VUB) · postgraduate osteopathy in progress (Collège Belge
d’Ostéopathie). Hands-on training: Maitland, Mulligan, Kinetic Control,
Clinical Neurodynamics, myofascial pain (Travell & Simons),
diagnostic ultrasound, contemporary pain science.
Frequently asked questions
Is my back pain a nerve, a muscle or a joint — how can I
tell? You usually can’t, reliably, on your own — and that’s not
a knock on you. The self-tests circulating online exist in clinical
practice, but no single test is conclusive; clinicians combine them with
your history, movement analysis and nerve function. Sorting this out is
exactly what the first consultation is for.
I think I pulled a muscle in my back — what should I do right
now? Keep moving gently, walk often and short, use heat if it
helps, do easy mobility work in comfortable ranges, and avoid bed rest.
Most simple episodes clearly improve within one to two weeks. If yours
doesn’t — or pain runs below the knee, or you get numbness or weakness —
get assessed.
Are the stretches I found online making my back
worse? For common low back pain, almost certainly not — gentle
exercise is safe and recommended. But if a specific stretch sharply
worsens your pain or pushes symptoms further down your leg, drop that
one and get assessed: your back may need a specific direction and dose,
which is a diagnosis question.
My scan says “disc bulge” — is that why it hurts?
Not necessarily. Disc bulges and degeneration are common in pain-free
people and increase with age, which is why guidelines don’t recommend
routine imaging for most back pain. We make our own functional and
movement diagnosis even when you bring an MRI — imaging informs it, but
doesn’t replace it.
Is it sciatica? The pain goes down my buttock and
thigh. Pain radiating down the leg can be
nerve-related — especially below the knee, or with tingling or numbness
— but buttock and thigh pain can also come from joints and muscles. The
distinction changes the treatment, and it takes a combination of
clinical tests to make properly.
Is my SI joint out of place? Should something pop?
No — the SI joint is one of the most stable joints in the body, and it
doesn’t slip out of position. It can absolutely be a source of pain, and
that pain is treatable. The “pop” some techniques produce is gas in the
joint fluid — a side effect, never the goal.
Should I rest in bed until it passes? No. Days of
bed rest slow recovery for most back pain. Relative rest for a day,
fine; after that, gentle movement is the treatment.
When is back pain serious? See a doctor promptly if
it comes with saddle numbness, new bladder or bowel problems,
progressive leg weakness, fever, unexplained weight loss, a cancer
history, unrelenting night pain, or follows significant trauma. These
are uncommon — most back pain is not dangerous — but they must be ruled
out first, and screening for them is part of any assessment here.
How long should I try home exercises before seeing
someone? As a rule of thumb: about two weeks of sensible
self-care. Come sooner if symptoms radiate below the knee, you have
numbness or weakness, pain is severe and unmanageable, or this is a
repeat episode — recurring back pain is a pattern worth diagnosing, not
just re-stretching.
What happens in the first consultation? Three steps:
your history and goals; a functional and movement diagnosis (with
red-flag screening built in); and a test treatment in the same session,
so we can see how your back responds and adapt the plan. Bring your
prescription and any imaging.
How many sessions will I need? It depends on the
diagnosis — an acute episode and a ten-year recurring pattern are
different projects. What’s constant: the plan has a defined endpoint and
combines hands-on treatment with exercise you’ll own yourself. There is
no physiological dependency on treatment.
Do I need a prescription, and will my insurer reimburse
me? Bring a medical prescription — it’s required for
reimbursement; you can consult without one, but the session is then
fully at your charge. Fees follow the official INAMI schedule: a
standard session costs €31.64, your mutuality reimburses €25.39, and you
pay a fixed co-payment of €6.25 (€2.50 with preferential status/BIM) —
the first-session intake is reimbursed in full. International insurers
(Allianz Care, Cigna Global, Aetna, BUPA) accept our invoices too; full
details on the pricing & insurance
page.
Can I be treated in English or Spanish? Where are
you? Yes — English, French and Spanish (Philippe’s native
language). The clinic is in Ixelles near Place du Luxembourg, in the EU
quarter, minutes from Bruxelles-Luxembourg station.
My back pain keeps coming back — why? Usually
because each episode was treated (or self-treated) only until the pain
settled, and the underlying functional deficits — strength, movement
control, load tolerance — were never addressed. When your condition is
stable, our assessment deliberately targets function to cut the risk of
the next episode. Relief is not recovery.
👉 Ready for a diagnosis instead of another routine? Book a consultation in EN, FR or
ES.
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References
- NICE Guideline NG59 — Low back pain and sciatica in over 16s:
assessment and management. Self-management, exercise first-line; manual
therapy only within a package including exercise; no routine imaging. https://www.nice.org.uk/guidance/ng59 - Hartvigsen J et al. (2018), Lancet 391:2356-2367.
doi:10.1016/S0140-6736(18)30480-X — Lancet Low Back Pain Series: most
low back pain is non-specific; guidelines converge on staying active and
avoiding bed rest and routine imaging. - KCE Report 287 (2017), Belgian Health Care Knowledge Centre —
Belgian clinical guideline on low back pain and radicular pain. https://kce.fgov.be - Brinjikji W et al. (2015), AJNR 36(4):811-816 (PMID 25430861) —
systematic review: imaging findings of disc degeneration/bulge are
common in asymptomatic people and increase with age.
Internal links: Manual Therapy in Ixelles
(sibling service page — safety numbers and technique detail live there)
· Chronic & persistent pain (research specialism) · About Philippe
Tadger · Book an appointment / contact.