Back Pain that Won’t Resolve
You've done the rounds. Two physical therapists, maybe a chiropractor. Possibly a cortisone shot, maybe a course of muscle relaxers. The pain comes back, or it never quite leaves.
You're starting to wonder if anyone is going to figure this out.
I'll give you a hint. It's not because you're old. It's not because you have a 'bad back' — no matter what your imaging says.
“By the end of the initial visit, I walked without pain.”
Why It Keeps Coming Back
Back pain that won't resolve usually isn't a back problem. It's a movement problem that shows up as back pain — because your back is bearing load that should be shared by your hips, your ribcage, your feet, your breath.
Most rehab labels back pain by where it hurts ("low back pain") or by tissue ("disc," "facet," "SI joint"). That tells you the location. It doesn't tell you why.
There's a more useful question: in what direction has your spine become susceptible to motion? For one person, sitting hurts, slouching hurts, forward bending sets it off — her spine has become susceptible to one direction of motion. For another, sitting feels fine, but standing too long, sleeping on the stomach, or twisting in the kitchen is what lights it up — a different direction entirely.
Two patients with identical MRIs can have opposite patterns and need opposite treatment. The same exercise that helps one of them can make the other worse. That's why your last round of PT may have given you an exercise sheet that didn't move the needle — the sheet wasn't wrong, it was wrong for you.
The deeper reason most rehab misses this is harder to say out loud, but it's the truth: the diagnostic frameworks that ask these questions aren't part of standard PT training. They're post-graduate specializations that take years of additional study. Most PTs aren't using these tools because they were never trained in them. The 30-minute insurance appointment is the surface problem. The training gap is the real one.
Why Strengthening and Stretching Haven’t Been Enough
The yoga class. The personal trainer. The Pilates instructor. The previous round of PT with its photocopied exercises.
None of it is the problem on its own. The problem is direction.
If your spine has become susceptible to a specific direction of motion, thirty deep forward folds in a yoga class can be thirty more reps of that exact pattern. Deadlifts in the gym, performed with a hip that's too stiff to share the load, push every rep into the lumbar spine. A trainer's strengthening program — even a careful one — can quietly reinforce the pattern that brought you in.
Good exercise in the wrong direction isn't healing. It's well-intentioned repetition of the problem.
What changes things is naming the direction first, then choosing the exercise.
“I sought help from 2 chiropractors and 2 physical therapists before I found James. His alternate approach benefitted my recovery immensely.”
- Rachel L.
“No one else has really been able to explain what I needed to do to improve my back in such an informative way.”
- Lindsey F.
How I Work
You'll have one hour. One practitioner. The same practitioner, every visit.
The first session is diagnostic, and it asks two questions at once. From the Movement System Impairment framework: which direction has your spine become susceptible to, and what daily habits built that susceptibility? From Dynamic Neuromuscular Stabilization: which deep stabilizing patterns — the ones your nervous system was supposed to run automatically — have gone offline?
Most persistent back pain involves both. Treatment is built from what I find.
Manual work where joint or soft-tissue restriction is genuinely limiting motion. Targeted retraining of the deep stabilizers when the system that's supposed to protect your spine has dropped out. Specific corrections to the directional pattern that's been stressing the tissue for years.
The exercises you'll practice between sessions are few, deliberate, and tied directly to your pattern — not a printed sheet. And the most important work happens in the daily movements you weren't paying attention to: how you sit through a meeting, how you reach into the back seat, how you load groceries, how you pick up your dog. The body learns by repetition. Every movement during the day is part of treatment.
You'll leave each session with a clear physical therapy diagnosis, a small set of things to practice, and a real sense of what's actually going on.
Who I Am
Thirty years of clinical practice. Doctor of Physical Therapy from Pacific University. Bachelor of Science in Physical Therapy from Marquette University.
Advanced training in Dynamic Neuromuscular Stabilization (DNS) — one of 110 DNS-certified practitioners in the United States, and currently the only one practicing in Washington state. Advanced training in the Movement System Impairment (MSI) framework developed by Shirley Sahrmann at Washington University. Received Board Certification in Neurologic Physical Therapy in 2005. Former clinical leadership at Cedars-Sinai Medical Center and Kaiser Permanente.
Voxmota is the work I came to Seattle to do.
Do I need a referral or imaging to come in?
No. Washington allows direct access to physical therapy — you can book without a doctor's referral. If you have recent imaging, bring it; it adds context, but it isn't required. What I'm doing is a movement diagnosis, not an imaging interpretation.
What if I think I might need surgery?
If a surgical consult is the right next step, I'll tell you, and I'll help you choose a surgeon worth seeing. Voxmota isn't trying to be every patient's only stop. It's trying to be the right one.
Answers
How many sessions will I need?
Most plans of care run six to ten visits. We'll know more after the first session, when I've actually seen what's going on. I'd rather give you an honest range than a number designed to commit you.
Book a consultation
A private hour at the Ballard studio, overlooking Puget Sound. Cash-pay. HSA and FSA accepted. No insurance billing.
Or call (206) 486-0467.
I do yoga, Pilates, or work with a trainer. Do I need to stop?
Probably not. But once we've named your pattern, you'll know which positions and exercises to ease off, which to keep, and which to add. The goal isn't to take away the things you love — it's to make sure they're working in the right direction for the body you actually have.