By John Tourle
Registered Osteopath | Rehabilitation Lecturer | CrossFit Coach
5-minute read
Back pain is one of the most common reasons people seek help from healthcare professionals. It can range from a mild, persistent ache to an episode of pain so severe that getting out of bed, putting on your socks or walking to the kitchen feels almost impossible.
When pain is that intense, it's entirely understandable to assume something must be seriously wrong.
Perhaps you've been told you’ve ‘slipped a disc’, ‘damaged a joint’, ‘worn something out’ or ‘put your back out of alignment’?
But here's the important question:
Does the amount of pain you're experiencing actually tell us how much damage has occurred?
The answer is often no.
Pain and damage aren't the same thing
Pain is a protective experience produced by the nervous system. It helps alert us to potential threats, but it isn't a direct measurement of tissue damage.
Think about the last time you got some shampoo in your eye whilst washing your hair. The discomfort can be extraordinary, yet it doesn't necessarily indicate significant structural injury.
Back pain can behave similarly.
You can experience substantial pain, stiffness and muscle guarding without having sustained a serious injury to your spine.
Equally, some structural injuries can initially produce relatively little pain.
This doesn't mean pain is imaginary, exaggerated or something you should simply ignore. Pain is real, but its intensity doesn't reliably tell us how much tissue damage is present.
Understanding that distinction can be an important part of recovery.
What about bulging discs, degeneration and arthritis?
One of the most common concerns I hear in clinic involves MRI or X-ray findings.
Patients are understandably worried when a scan identifies a bulging disc, degenerative changes or arthritis in their spine.
But these findings need context.
Research has demonstrated that structural changes in the spine are remarkably common in people who experience no back pain whatsoever. Read that bit again!
A widely cited systematic review by Brinjikji and colleagues (2015) examined imaging findings in 3,110 people without symptoms. It estimated that disc degeneration was present in approximately 37% of asymptomatic 20-year-olds and 96% of asymptomatic 80-year-olds.
That doesn't mean these changes can never cause symptoms. Some certainly can.
It means finding something on a scan doesn't automatically establish that it's responsible for your pain.
Clinical assessment is essential to interpreting those findings appropriately.
Your back isn't as fragile as you might think
The spine is a remarkably strong and adaptable structure.
It's designed to move, bend, rotate and tolerate physical loads.
Yet many people experiencing back pain become understandably cautious about movement. They worry that bending forward, lifting something heavy or returning to exercise might make the problem worse.
Sometimes, temporary modifications are appropriate. Certain injuries require specific precautions, and symptoms should always be considered in context.
However, for many common presentations of non-specific lower back pain, gradually returning to normal activity is an important part of recovery.
The goal isn't to ignore pain or force yourself through movements that are clearly aggravating your symptoms.
It's to find a manageable starting point and progressively rebuild your confidence and capacity.
Movement isn't automatically dangerous just because it's uncomfortable.
So why does back pain happen?
This is where things become more complicated.
Back pain rarely has a single, simple explanation that applies to everyone.
Symptoms can be influenced by several interacting factors, including:
Recent changes in physical activity or workload.
Previous injuries and episodes of back pain.
Sleep, stress and general recovery.
Individual physical capacity and conditioning.
Sensitivity of the nervous system.
Certain underlying medical or structural conditions.
These factors don't all contribute equally to every person's pain, and identifying a particular factor doesn't necessarily prove that it caused the symptoms.
That's why a good clinical assessment should involve more than finding a painful muscle or identifying a movement that hurts.
We need to understand the person, their symptoms, their medical history and what they're trying to get back to doing.
Do you need treatment to put your back right?
This is where my clinical philosophy becomes particularly relevant.
I don't believe most people with back pain need to be convinced that their spine is out of place, structurally fragile or dependent on repeated treatment to function properly.
Hands-on treatment can be useful for symptom relief in some circumstances, particularly when it helps someone move more comfortably or engage with rehabilitation.
But it shouldn't automatically be the entire treatment plan.
For many people, effective management involves a combination of education, appropriate activity, exercise and practical strategies for managing symptoms.
Sometimes that means strength training. Sometimes it's modifying a particular activity or gradually returning to normal movement. Sometimes it's simply understanding that an uncomfortable sensation doesn't necessarily mean something harmful is happening.
And sometimes, further investigation or referral is the appropriate next step.
My aim isn't to make patients dependent on treatment. It's to give them the understanding and confidence to manage their own recovery.
When should back pain be taken more seriously?
Although most episodes of lower back pain aren't caused by serious underlying disease, certain symptoms require urgent assessment.
Seek emergency medical attention if you develop new difficulty passing urine or loss of bladder or bowel control, loss of sensation around the genitals or saddle area, or new or progressive significant weakness in the legs, particularly when these symptoms raise concern about cauda equina syndrome.
Other features, including fever, unexplained weight loss, significant trauma or a history of cancer alongside new back pain, may warrant prompt medical assessment.
These symptoms don't automatically indicate serious pathology, but they shouldn't be ignored.
The takeaway
Back pain can be painful, disruptive and frightening. But pain intensity alone doesn't tell us how much damage has occurred, and structural findings on a scan don't always explain the symptoms.
For many people, the most useful starting point is understanding what's happening, identifying appropriate management options and gradually returning to meaningful activity.
Your back is strong and adaptable. Experiencing pain doesn't automatically mean it's damaged.
And recovery shouldn't have to revolve around endless appointments.
Back Pain Assessment & Rehabilitation in Buxton
At High Peak Osteo, we provide osteopathic assessment, treatment and rehabilitation for people experiencing acute, persistent or recurring back pain.
Our approach focuses on clear explanations, evidence-informed management and helping patients build the confidence to manage their symptoms independently.
If you're struggling with back pain or unsure what you should and shouldn't be doing, an assessment can help establish an appropriate plan.
Learn more about back pain treatment in Buxton
References and further reading
Brinjikji W, Luetmer PH, Comstock B, et al. (2015). Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology, 36(4), 811–816.
NICE Guideline NG59. Low back pain and sciatica in over 16s: assessment and management.
Hartvigsen J, Hancock MJ, Kongsted A, et al. (2018). What low back pain is and why we need to pay attention. The Lancet, 391, 2356–2367.