Blog · Symptoms & recovery

Pain is not always where the cause is

By Remko Opdam · 5 June 2026 · 3 min read

In short

The place that hurts is often not the place where the problem sits.
In low back pain, reduced glute activation is a known and researched factor.
Massaging the painful spot eases the consequence, not the cause.

Someone in one of my sessions recently had trouble with her lower back. Mainly when squatting, and in exercises where she extended her back. A familiar story: she had been training around it for a while, because "it comes with the territory at my age".

During the session I spent two minutes releasing her glutes. Not her back, her glutes. She squatted again and felt the difference immediately.

Around the same time someone else had neck and shoulder pain while training. There I briefly released the muscles between neck and shoulder blade, a minute at most. She felt an improvement straight away too.

Why the glutes, when it is the back that hurts?

This is the principle most people do not know: the place that hurts is often not the place where the problem sits.

Your lower back usually complains not because it is weak, but because it is taking over work from muscles that are not engaging.

When you squat, your glutes should be doing the heavy work. If they are not, your lower back takes over. It is not built for that, and after a few weeks or months it starts to protest. The same goes for neck and shoulder pain: often it is not "stress" or "sleeping badly", but a muscle becoming overloaded because it is compensating constantly.

Massage the painful spot and it feels good for a while, but you are treating the consequence. It does not resolve the cause.

An honest note: some of it came back

With the second woman some of the tension came back later in the session once she started loading again. That is part of it, and I think it matters to say so.

One or two minutes of release is not a treatment. It is a test. What those two minutes tell you is that this can be influenced. The complaint is not age and not bad luck, there is something to improve. But improving it structurally means addressing the cause: teaching the right muscles to engage again, building up what they can handle step by step, and reducing the compensation.

That, in short, is the approach I work with: Mylogenics. First test where the problem actually sits, then release and activate deliberately, and then build so it stays away.

What you can do with this yourself

Do not train through recurring pain. Pain in the same exercise, in the same place, week after week, is information. Ignoring it makes the pattern stronger.
Check your glutes when you squat. Do you feel a squat mainly in your lower back rather than in your glutes and thighs? Then you are probably compensating.
Do not put complaints down to your age automatically. "It comes with the territory" is rarely true. Usually what comes with it is a different approach.

And if your back or neck has been part of this story for a while, have someone look at it properly. Not at where it hurts, but at why.

Frequently asked questions

Why does my lower back hurt if my glutes are the problem?

Your lower back hurts because it is taking over work from glutes that are not pulling their weight, not because the back itself is necessarily weak. In movements like the squat your glutes should be doing the heavy work. If they are not properly activated, the lower back compensates, and it is not built for that. Over time it starts to protest. This lines up with research into the role of the gluteus medius in low back pain. A systematic review found that people with low back pain more often show reduced strength and trigger points in that muscle than people without complaints. It concluded that strengthening the muscle can be part of a broader approach. So a good approach looks at why the glutes are not engaging, not only at the place that hurts. In practice a few minutes of targeted activation often makes a noticeable difference within the same session.
Source: systematic review on glute function & low back pain (PMC) →

Does massaging the painful spot really help back pain?

Massaging the painful spot can bring temporary relief, but it usually treats the consequence rather than the cause. If your lower back hurts because it is compensating for glutes that are not engaging, that underlying cause does not disappear by releasing the back itself. As soon as you move the same way again, the overload returns. It is more effective to activate and train the muscles that should be doing the work, so the lower back no longer has to compensate. That is why at Infinite Health we look at movement patterns before working on the complaint itself. Recovery is often shorter that way, because you remove not only the symptom but the reason it keeps coming back. Massage can happily sit alongside it as a moment of relaxation, as long as you do not expect it to solve the complaint long term.

When should I see a doctor about back pain instead of a trainer?

See your GP, the Dutch family doctor, if the pain radiates into your leg, if you have tingling, numbness or loss of strength, if it followed a fall or an accident, if it wakes you at night and does not ease when you change position, or if back pain comes with fever, unexplained weight loss or problems passing urine or stool. Those are signals asking for a medical assessment, not for a training plan. The same applies if the pain came on suddenly and severely with no clear trigger. Where training does fit: a nagging, recurring complaint tied to certain movements, one that has been around a while and where a doctor found no medical cause. If you are unsure, the order is simple: the doctor first, the gym after. I would rather refer someone too early than too late.

Pain is not always where the cause is

Why the glutes, when it is the back that hurts?

An honest note: some of it came back

What you can do with this yourself

Frequently asked questions

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Sources