“Why does it hurt again?”

Have you ever had an injury that you thought was resolved, but then one day you realize it’s beginning to hurt again? Did you think that you would have to live with this pain for the rest of your life?

If you are dealing with persistent pain and would like to know how we can help, call or text Carter Physiotherapy at (512) 693-8849.

Many of our patients tell us similar stories about a pain/injury that would resurface now and again, sometimes completely debilitating them—or at least keeping them from being able to exercise for a while. And unfortunately, many of them thought they would “just have to live with it.” They assumed they’d even be occasionally laid up by it … until they found us.

If it’s starting to hurt again, does that mean it will never heal?

It is not uncommon for some symptoms to return after you think your issue is resolved. In fact, now and again, some symptoms may return in our patients even after we have completed a successful course of therapy and the patient left the clinic pain-free and highly active.

If symptoms return after treatment has concluded, it doesn’t mean that you have had a big setback. Moreover, it doesn’t mean that PT wasn’t the full answer to the problem.

If you achieved pain-free status in PT before, it can be done again!

However, it is important to address the return of pain as soon as possible so it doesn’t become a bigger issue that takes multiple treatments to resolve.

For example, I experienced exactly this situation when I was a young therapist. I had been traveling for work, and when I returned I was having some intense low back pain. I knew that with a few treatments and some modification in movement that I would feel better fairly quickly. And that is exactly what happened. In 4-5 days, I was feeling much better after some much-needed treatment. 

What would make it hurt again?

So what did I do after a week of feeling really good? I decided it was a good idea to go hit some golf balls at the driving range.

My symptoms came back even though I had been feeling great. I had no complaints of pain with any movement, but I decided hitting 30 golf balls would be alright. Just that little strain of hitting a few chips brought my pain back.

I should’ve known better being a physical therapist. But I was feeling so good it was hard not to get out and test it a bit. The great thing was that I had access to great manual therapists who could fix me right up. I was back on the golf course the following week with no restrictions at all.

You do not have to live with the pain

The take-home point is this: Don’t let a little return of symptoms keep you from the things you love. If it was fixed before, it can be fixed again.

Sometimes a fire is not always out just because there aren’t flames. Fortunately, if you can address your symptoms quickly, they should resolve quickly.

Request a call with one of our Austin-area physical therapists if your injury has started to hurt again. We can get you back you to doing the things you love.

3 Beginner Core Exercises for Low Back Pain

3 Beginner Core Exercises for Low Back Pain

There are three very simple core exercises we teach to a lot of our patients who are experiencing chronic or acute low back pain.

If you are dealing with back pain and would like to know if we can help, call or text us at (512) 693-8849.

These exercises will activate some of the core muscles that tend to get weak after dealing with a back injury or chronic back pain.

Despite what you might think, it’s very important to move and exercise as normally as possible when you have back pain—as long as it doesn’t cause an increase in your pain.

3 Beginner Core Exercises for Low Back Pain


If it’s after hours and you’d like to schedule a phone call with one of our doctors of physical therapy, Click Here.

Or you’d rather not speak on the phone, you can click here to send us an email.

Finally, if you’re dealing with low back pain and would like more information on what else you can do to help yourself, CLICK THE LINK BELOW to get our Popular FREE Report:

7 Secrets to Heal Your Back & Stay Pain-Free Without Ever Needing Pain Medications, Injections, or Surgery … Again!

Video Transcription

(please excuse grammatical errors and the conversational nature of the transcription):

“There are three very simple core exercises that I teach to a lot of my patients when they have chronic or acute back pain.

It’s also very important that you try to move and exercise as normally as possible when you have a pain or long-term issue in your back as long as those movements and those exercises don’t cause an increase in your pain.

These simple exercises will activate some of the core muscles that tend to get weak after dealing with a bit of a back injury or back pain overtime.

First, we activate a muscle called the transverse abdominis by drawing the belly button in towards the spine. So if you place the belly button on your spine correctly, you feel just inside the hip bones here, you’ll feel the muscle push a little bit into your finger.

If you don’t feel the muscle pushing, don’t worry and just think about drawing the belly button into the spine and firming up your abs just slightly with that in place. You’re going to lift one foot just where it’s unweighted and keep your hips as level as possible. The idea here is that you are simply drawing the belly button to the spine activating the core muscles and then balancing on one leg for about five seconds at a time.

As you lift the other way, you go back and forth from side to side to make sure that you’re keeping your hips level. Make sure that you’re not lifting a leg and dropping it back to the side and dropping the unweighted side down.

You want to activate the core, lift the foot and keep the hips nice and level. You’re going to go back and forth five seconds on each side for a minute or two at a time a few times a day.

The second one is a very simple bridge exercise. A lot of people start out bridges and simply push straight up and go into an arching and go back. That’s not what we are going to do.

First things first, again activate the core belly button towards the spine then you’re going to tilt the hips a little bit trying to flatten out the low back and then keeping that core activated and keeping the hips tilted back. You’re going to lift up until your torso and legs are in one line.

You don’t need to go past that because we’re trying to avoid arching the low back. So the belly button to spine, tilt the hips flat in the lower back, and lift up keeping the low back nice and flat. When you’re coming back, you would repeat that until you get a little bit of a fatigue.

In terms of numbers, you would want to reach out to your healthcare practitioner to confirm these things. This is just something to get started in terms of activating your core muscles and not getting into a habit of moving too carefully ending up with a lot more weakness that you need to be dealing with.

The last of these three exercises, You’re going to get off work and lot of people teach this bird dog exercise when you come way out with the arms. I don’t really like that because if you’re getting way back with the leg some of the large muscles at the back get more active and I prefer the little tiny core muscles all along the spine to be the ones that are doing most of the work.

So you want to have a nice flat back again belly button to spine, activate the core, and then you’re just going to slide one leg back until it’s just unweighted. That’s all you need to do and then come back in slide the other leg out until it’s just unweighted. When you come back in, you will notice as I do this I’m not dropping. My hips are moving my back that much with staying pretty still and my belly button is staying way back on the spine activating my core.

You can also add raising the opposite hand once you get to a point where you can do that without much problems and without losing your balance.

To wrap it up, do these three quick exercises to activate the core and try to avoid weakness from developing while you’re having back pain, because this is commonly associated with longer term chronic issues.”

Here’s One Way We Fix Sciatica

Here’s One Way We Fix Sciatica

There are a variety of different types of back pain, and every one of them can be incredibly debilitating. Luckily, many types respond very well to hands-on manual therapy techniques. In this post, we discuss a treatment technique that can be highly effective for sciatica.

If you are dealing with back pain and would like to know if we can help, call or text us at (512) 693-8849.

We make a ton of training videos for our staff as well as other PTs around the world. Occasionally we post them on our blog so those out there suffering needlessly can get an idea of our approach to hands-on physical therapy, and see how we help others to get back to living the active lifestyle they want and deserve.

Below is one such video showing an example of treatment techniques for sciatica back pain.

Positional Release Technique to Fix Sciatica


If it’s after hours and you’d like to schedule a phone call with one of our doctors of physical therapy, Click Here.

Or you’d rather not speak on the phone, you can click here to send us an email.

Video Transcription

(please excuse grammatical errors and the conversational nature of the transcription):


“We have determined that the strain has spasm going on in the piriformis, hitting the sciatic nerve (this condition is known as sciatica), and it’s not affected  in any way by lumbar movements. I did a piriformis test so it  seems like that’s at least part of what we’re dealing with.

What we’re going to do rather is perform a Positional Release Technique for the piriformis.  One of the companies that made this famous may refer to this as “Jones Strain Counterstrain”.

First, ask the patient to just relax and follow instructions.  Find the tender spot by asking the patient to identify it. Then hold that spot throughout the technique while moving the patient’s leg into a position where hopefully the pain diminishes. The idea here is to put the patient in a position where the pain is nonexistent and the patient only feels the pressure of the thumb. Let the patient give way to the leg and establish a pain scale. From now on, the patient should just let the leg hang left. So I have my hand just above the patella on the inside using my forearm and torso to support and lower the leg.

Then we’re going to raise the leg up a little bit because I know we’re going to be bringing this down and I have to hold this for 90 seconds. I want to make sure I’m in a right position to move and fold the leg.

I am in a position over at the edge of the table to start with this technique. So, you get the leg off and let me know if it’s making an effect to the pain underneath. I’m going to bring it further up in the flexion of the hip.  Then, I’m going to start some hip rotation and bring the patient to more flexion.

Now, recheck with the patient on the pain scale. If the patient says it feels better, you proceed to moving the leg while just trying to find a point in which it feels least painful; preferably no pain all.  When we get to that point, we have to hold it for 90 seconds and it puts the muscle into a relaxed shorten position.

I’m not sure how physiologically this works but with certain patients and certain situations like this, I’ve seen it make a huge difference right away in any kind of spasming muscle.

Once you reach this point, you just let the patient or have cue in them, make sure there is no tension building up under your arm or under your hands or anything and letting them know to relax by giving you the dead weight of their leg.

The way you support their leg is very important in this situation because if you don’t give them the feeling that you’re completely supporting the leg really comfortably then you’re not going to be able to let go of the leg and this technique will not work if these muscles are active in any way.

Going on, I’m going to bring the leg back up in super slow motion. As I do that, you need to think ahead in terms of where you’re taking the person’s limb, how you’re going to get there because as I move I’ve got to make sure that I’m moving very slowly for this technique to work.

Remember that the movement back to the starting position has to be super slow motion. You can’t move them quickly because the technique won’t work as well.

So I’m going to get my hand reset here and giving nice support against my belly as well. While the patient is relaxed, I’m holding the leg against my belly to give extra support, and she can fully relax.

So in the situation that the patient is not able to let her leg hang fully relaxed, I have the patient activate the antagonist muscle to try to decrease the activity of the muscle I’m really trying to keep relaxed.

Then let the patient almost work lightly against you trying to lift the leg up. The patient should keep slight tension in that direction as you move her limb.

The patient continues pushing down, a little bit down towards the table. You have to do this in situations where people just can’t let go and fully relax, which is not uncommon especially if there’s pain in the area.

After completing the technique,  we get them up and retest and the tests or motions that were painful before.”

What To Do About Your Back Pain – Part 3

What To Do About Your Back Pain – Part 3

What to do about your back pain 3In the Part 2 of this series, we discussed how between 60-70% of people will have an episode of low back pain in their life. [1] The real problem becomes what do you do about it. Do you take it easy for a few days and hope it gets better? This is strategy that works for some people. But what do you do if doesn’t get better in a few days?

Call or text us now to see if we can help heal the back pain that’s holding you back from enjoying the kind of life you deserve, 512-693-8849.

Treatment options for back pain

Back pain that isn’t improving within a week of the original injury needs to be looked at by a professional. Unfortunately, when you go to your physician, they are most likely to just give you pain meds and muscle relaxers and tell you to rest. While those can be helpful in certain circumstances, it is also contributing to the epidemic of pain medication dependency and addiction in this country. Further, there are usually safer options that are equally effective [2].

Some patients look for a spine surgeon to start exploring options. This is also unfortunate, as research has shown that physical therapy is every bit as effective as spine surgery for treating certain types of back pain. [3]

It seems quite risky to have spinal surgery if the average outcomes are about the same as getting conservative treatment. I know I wouldn’t want anyone cutting on my spine if I wasn’t confident that the outcomes were very favored towards surgery.

If you are lucky and find a surgeon who only uses surgery as a last resort, he/she will likely give you a prescription for physical therapy. But what if he/she owns the physical therapy clinic next door that they are sending you to? How do you know you will get the best care possible? It’s not to say that those aren’t great physical therapists, but most of them are required to see multiple patients per hour and much of the care is given by PT assistants and techs that have very little training compared to a Doctor of Physical Therapy.

How we treat back pain at Carter Physiotherapy

Here at Carter Physiotherapy we don’t recommend addictive medications that only affect symptoms rather than the causes of the symptoms. We aren’t owned by a physician group, and all of our treatment sessions are a full hour spent one-on-one with our patients. We are not limited by insurance companies telling us how to treat patients. You are the customer and all of our attention is focused on what is absolutely best for you.

In what ways is your back pain limiting you? What does it keep you from doing (or doing as much as you’d like to)? Are you able to exercise, work, and spend quality time with your family without being disrupted or sidelined by back pain? It doesn’t have to be that way! There are safe, natural, hands-on solutions for what you are dealing with.

[RELATED REPORT] 7 Secrets to Heal Your Back & Stay Pain-Free Without Ever Needing Pain Medications, Injections, or Surgery … Again!


  1. Duthey, Beatrice. Priority Medicines for Europe and the World “A Public Health Approach to Innovation” https://www.who.int/medicines/areas/priority_medicines/BP6_24LBP.pdf. 15 March 2013
  2. Huber, E., Robinson, R. C., Noe, C. E., & Van Ness, O. (2016). Who Benefits from Chronic Opioid Therapy? Rethinking the Question of Opioid Misuse Risk. Healthcare, 4(2), 29. https://doi.org/10.3390/healthcare4020029
  3. Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, et al. Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis: A Randomized Trial. Ann Intern Med. 2015;162:465-473. doi: 10.7326/M14-1420
What To Do About Your Back Pain – Part 2

What To Do About Your Back Pain – Part 2

What to do about your back pain 2In Part one of this series, we talked about how back pain is one of the most common reasons people visit their doctor. This time, I’d like to start by asking you a question: Have you ever worked in the yard or picked up something the wrong way, and before you know it, you are on the ground writhing in pain?

If you are suffering from back pain and wondering if we can help, call or text us at 512-693-8849.

If you haven’t had such an experience, consider yourself lucky! Studies show that most people will have an episode of significant back pain at some point in their life. [1]

How back pain gets started

I can recall one very distinct story when my back “went out.” I was 24 years old, helping my brother move to Dallas and unfortunately he was moving to the 3rd story of an apartment. We had driven several hours to get there and arrived late in the evening.

Everything was going well until I moved this one small lamp. As I set it down I had a feeling I was about to be in a lot of pain, and sure enough, I was right. This was pain like I had not experienced before. I was incapacitated.

What I had done was injure a “disc” in my back. The intervertebral discs are the spacers between the bones in your back. They function like shock absorbers to help forces distribute through your body. But your discs don’t like a lot of prolonged compression or heavy loads, both of which my spine had experienced a lot of that day.

I’d been sitting for 4 hours in a bumpy truck and then attempted to carry heavy furniture up 3 flights of stairs. This was a bad combination. I had a very difficult time standing up straight and couldn’t get comfortable in bed at all.

Managing the symptoms of back pain

You might reach for a heating pad or ice pack, take a hot bath, or even try some Advil. But the reality is that you are really only addressing the symptoms with those things. And that is completely fine at the moment. There is nothing wrong with addressing symptoms, as long as you also address the causes of your back pain.

You may have to see your doctor. He or she may prescribe some pain medcation to help ease your pain. And in small doses, that can be perfectly fine. But you really want to be careful not to rely on pain medication to get you through your day for very long.

We have an epidemic in this country of people abusing pain medication. The problem with opioid abuse has risen to such dangerous levels that the FDA required a new label warning patients of the potential harms of these very powerful medications. [3]

Understanding the causes of back pain

There are many reasons why people experience back pain. Below are some of the most common causes (or aggravating factors) for the patients we help in our Austin-area physical therapy clinic.

  • Improper lifting:  we often see people who sustained a back injury when working in their yard or lifting heavy at the gym and not using proper lifting/bending mechanics while doing so.
  • Prolonged sitting: sitting puts a lot of pressure on the discs in our back and also allows certain muscles of the back to become tight because they are held in a shortened position. This can occur even if we are sitting with “good posture.”
  • Improper sleeping positions: a common cause of neck and back pain is not using proper pillows, mattress, and the sleeping position that is best for you, your body type, and the kind of back issue you’re dealing with.

It can be quite quick and easy to identify problems in any of these areas and determine if you need to make changes in how you lift things, your desk/chair set up, or your sleeping arrangement.

Treating the causes of back pain

Sometimes these problems can be revealed in a quick free consultation in our clinic. Call or text us at 512-693-8849 and ask about a free consultation. Within 20-30 minutes with one of our Physical Therapists, you can have the relief of knowing exactly what’s causing your back pain and the best path to get rid of it.

My story ended well. I was better in several weeks but the reality is if I addressed it immediately I would have been better much faster (If only I was already a Doctor of Physical Therapy at that time!)

If you have a back pain story or any questions about the information above, please share them in the comments below.

CLICK HERE FOR THE POPULAR RELATED REPORT: 7 Secrets to Heal Your Back & Stay Pain-Free Without Ever Needing Pain Medications, Injections, or Surgery … Again!


  1. Duthey, Beatrice. Priority Medicines for Europe and the World “A Public Health Approach to Innovation” https://www.who.int/medicines/areas/priority_medicines/BP6_24LBP.pdf. 15 March 2013
  2. Fritz JM, Magel JS, McFadden M, Asche C, Thackeray A, Meier W, Brennan G. Early Physical Therapy vs Usual Care in Patients With Recent-Onset Low Back PainA Randomized Clinical Trial. JAMA. 2015;314(14):1459-1467. doi:10.1001/jama.2015.11648
  3. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm518697.htm
What to do About Your Back Pain – Part 1

What to do About Your Back Pain – Part 1

What to do about your back pain 1Low back pain is the third most-common reason why people visit their doctor! [1] Think about that. The number one reason people visit their doctor is for cold and flu symptoms.

Suffering from low back pain? Call of text us at 512-693-8849 for a free consultation to find out if we can help.

Back pain is an epidemic in this country and is THE LEADING CAUSE of activity limitation and work absence throughout much of the world. [2]

You have all heard the stories about someone lifting too heavy of a weight or working in the yard and someone’s back going out. That experience can be very painful and debilitating. You find yourself in bed with a heating pad unable to move. You call in sick the next day hope that it will go away soon.

The reality is that most of us will have a low back episode at one point in our lives. [2] And if you are lucky enough it will go away quickly. If you aren’t lucky, it will become more of an issue. The great thing about low back pain (if there is such a thing) is that if you treat it quickly it typically gets better much faster.

Dealing with your low back pain

It is in human nature to hope that unpleasant things will simply go away. We ignore the rattling noises of our car. We put off going to the dentist thinking that toothache will go away. Why not take the car to the mechanic and get that noise cleared up? Why not get into the dentist and solve that toothache that has been bothering you for two weeks?

Those who get physical therapy earlier, within 14 days, have better outcomes. It makes sense… the earlier you address an issue, the easier it tends to be to fix it. [3]

While treating the problem quickly is the ideal, we have had people in our clinic who suffered from back pain for over 30 years, and they still did extremely well with our treatment. It just takes longer to get relief for those patients than for our clients who sought treatment much earlier.

Treatment options for low back pain

When we compare outcomes from conservative treatment versus surgical intervention, physical therapy performs as well as surgical interventions in the long run. [4] Think about that for a bit. You will do just as well with physical therapy as if you through a risky and costly back surgery. [5]

So the take home points of this first article in our 3-part series:

  1. Low back problems are extremely common, so you are not alone.
  2. The sooner you identify and address the root causes of your pain, the easier and quicker it tends to be to fix the problem. BUT we find most low back pain very treatable—even if it has been going on for decade or more.

Don’t let back pain hold you back

Don’t let your low back pain get in the way of putting on your pants in the morning, picking up your young child, or sitting comfortably in your car or at work. It is likely something that can be vastly improved with the right treatment. If you haven’t already read it, click below for some free information on what you can do right now to ease your back pain:

CLICK HERE FOR THE POPULAR RELATED REPORT: 7 Secrets to Heal Your Back & Stay Pain-Free Without Ever Needing Pain Medications, Injections, or Surgery … Again!


  1. St. Sauver JL, Warner DO, Yawn BP, et al. Why do patients visit their doctors? Assessing the most prevalent conditions in a defined US population. Mayo Clinic proceedings Mayo Clinic. 2013;88(1):56-67. doi:10.1016/j.mayocp.2012.08.020.
  2. Andersson GBJ. The Epidemiology of Spinal Disorders. In Frymoyer JW (ed.) The Adult Spine: Principles and Practice. Philadelphia, Lippincott-Raven, 1997, pp. 93–141
  3. Childs JD, Fritz JM, Wu SS, et al. Erratum to: Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Health Services Research. 2016;16(1):444. doi:10.1186/s12913-016-1681-2.
  4. Froholdt, A., Reikeraas, O., Holm, I. et al, No difference in 9-year outcome in CLBP patients randomized to lumbar fusion versus cognitive intervention and exercises. Eur Spine J. 2012;21:2531–2538.
  5. Hedlund, Rune et al. The long-term outcome of lumbar fusion in the Swedish lumbar spine study. The Spine Journal , Volume 16 , Issue 5 , 579 – 587

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