Low back pain: what’s really going on?
Understanding the true drivers of low back pain (LBP) — beyond scans, tissue damage, and structural changes — is the first step toward lasting relief.
~10%
of the global population affected bylow back pain
What is non-specific low back pain?
Non-specific LBP refers to back pain with no identifiable structural cause — no inflammation, degeneration, or disease on imaging. It accounts for roughly 90% of all LBP cases, meaning most people’s scans won’t explain their pain.
Do I need a scan for low back pain?
For most people, scans are not required to diagnose or treat LBP. Imaging findings such as disc bulges or degeneration are common in people without any pain, and structural changes seen on scans often don’t correlate with pain severity or recovery.
Why do unhelpful beliefs make LBP worse?
Beliefs that LBP signals serious damage, or that movement is dangerous, reduce confidence in exercise and activity. This creates avoidance behaviours, weakens motor and postural control, and drives a cycle of persistent pain. Over time, these beliefs can contribute to anxiety, stress, and depression.
What kinds of beliefs are linked to chronic LBP?
Believing that pain always means tissue damage, that rest is the safest response, or that you need to “protect” your spine are common, unhelpful beliefs. Research shows people holding these views are significantly more likely to develop chronic (long-term) LBP.
Recognising and challenging unhelpful pain beliefs is key. Building a positive, active mindset — supported by evidence-based pain coping strategies, graded exercise, and education — significantly improves outcomes for people with LBP.
Common unhelpful beliefs include:
- Persistent LBP is always related to tissue damage
- Scans are always needed to find the cause of LBP
- I should stop anything that hurts my back
- I have a sore back because of poor posture and a weak core
Facts about LBP:
- Persistent LBP is rarely associated with serious tissue damage
- Scans rarely show the causes of LBP
- Pain with exercise and movement does not equal harm
- LBP is not caused by bad posture and a weak core
Many of us may think that LBP is always associated with tissue damage or spine deterioration. However, there are a lot of factors that can cause LBP and pain does not necessarily mean that your back is damaged. In addition, finding the cause to your LBP does not always require medical imaging such as MRIs, CTs, X-rays, unless serious spinal pathology is suspected. Research shows that symptoms we experience may not correlate with scan findings. Most of the LBP can be improved effectively with conservative treatment involving pain education, activity modification, improving movement patterns and active exercise. Effective long-term management also involves self-management such as how to manage flare-ups and pacing activities. As physiotherapists, we will assist you and help you to move in a safe and better way.
Ways we help to achieve the best care for managing persistent LBP,
Build a positive mindset😊
It is important to identify unhelpful beliefs as they directly affect how our bodies move. Pain does not always equal to harm, our back does not wear out with just loading and bending! It could only mean our body is not used to that movement because we have been avoiding for a long time. So don’t stop moving just because you feel sore. Having a better knowledge of LBP enables you to build confidence in moving and staying active.
Improve movement patterns
Our bodies move in different ways. The underlying reasons for LBP may not only be biomechanical but also neuromuscular in nature. We identify unfavourable movement patterns which may drive LBP. Functional movements such as sit to stand, squats, bending forwards and lifting are common ones that we assess. By learning the correct patterns, strengthening and/or relaxing the appropriate muscle groups, your body will move better with less or even no pain.
Self-management strategies
Knowing how to manage flare-ups can be challenging. A sudden change in load may cause pain flare; therefore pacing yourself is crucial. Ways to manage flare-ups include setting achievable goals, modifying activities etc. You will learn how and when to progress/regress your exercises (including frequency and intensity) and be confident to move in a safe way. We will set a management plan for you to empower yourself in building strength and tolerance to exercise. It is also important to know when to get in touch if things do not go well.
Stay active and get your body stronger
Lastly, it is to get your body fitter and stronger! It does not matter if it is doing your home exercise program, strengthening at the gym or attending physio-supervised Clinical Pilates classes, we will assist you to find the safest, the best (and fun!) way to build your physical capacity and develop a habit of exercise.
To make an appointment, call our physio clinic on (08) 9384 1555 or make an appointment online.
