Do you have back pain?

Updated 08/17/2025
 
Did you know?

• 84% of all adults will have low back pain.
• 85% of elite athletes will have low back pain.
• 85% of back pain is classified as non-specific.
• Less than 1% of back pain is due to serious pathology.
• 0% of disks slip.
• 90% of herniated disks heal on their own.
• Depression is more predictive of future low back pain than MRI results.
• Most back pain will improve at home.
• Recurrence of low back pain is very common, with more than two-thirds of individuals having a recurrence within 12 months after recovery (da Silva, et al, 2019). 
• Back surgery can lead to failed surgery syndrome.

Back pain can be scary, especially when an MRI reveals an abnormality. While they can seem scary, structural findings on a diagnostic scan don’t always equate with pain or cause the pain.

Abnormal MRI findings are normal in people without pain, especially as age increases. Over 50% of 30-year-olds with no pain show signs of disk degeneration, rising to 80% at age 50 (Brinjikji et al, 2015).

And although chronic back pain is a common medical complaint, no specific cause is found in up to 85% of cases, with central sensitization as a potential contributing factor (Sanzarello et al, 2016), along with fear of pain and activity as maintaining factors.

Remember, all pain is biopsychosocial. Research has found that "when individuals with low back pain consider they have a flare, they do not always have greater than average pain, but have worse psychosocial features" (Costa, et al, 2021).

Read the World Health Organization's guideline for non-surgical management of chronic primary low back pain.

Check out these back facts from OSullivan, et al, 2020:

1. Persistent back pain can be scary, but it's rarely dangerous.
   Persistent back pain can be distressing and disabling, but it's rarely life-threatening, and you are very unlikely to end up in a wheelchair.
2. Getting older is not a cause of back pain.
   Although it is a widespread belief and concern that getting older causes or worsens back pain, research does not support this, and evidence-based treatments can help at any age.
3. Persistent back pain is rarely associated with serious tissue damage.
   Backs are strong. If you had an injury, tissue healing occurs within three months, so if pain persists past this time, it usually means there are other contributing factors. A lot of back pain begins with no injury or with simple, everyday movement. These occasions may relate to stress, tension, fatigue, inactivity or unaccustomed activity which make the back sensitive to movement and loading.
4. Scans rarely show the cause of back pain.
   Scans are only helpful in a minority of people. Lots of scary-sounding things can be reported on scans, such as disc bulges, degeneration, protrusions, arthritis, etc. Unfortunately, the reports don’t say that these findings are very common in people without back pain and that they don’t predict how much pain you feel or how disabled you are. Scans can also change, and most disc prolapses shrink over time.
5. Pain with exercise and movement doesn't mean you are doing harm.
   When pain persists, it is common that the spine and surrounding muscles become really sensitive to touch and movement. The pain you feel during movement and activities reflect how sensitive your structures are – not how damaged you are. So it’s safe and normal to feel some pain when you start to move and exercise. This usually settles down with time as you get more active. In fact, exercise and movement are one of the most effective ways to help treat back pain.
6. Back pain is not caused by poor posture.
   How we sit, stand and bend does not cause back pain even though these activities may be painful. A variety of postures are healthy for the back. It is safe to relax during everyday tasks such as sitting, bending, and lifting with a round back – in fact, it’s more efficient!
7. Back pain is not caused by a ‘weak core’
   Weak ‘core’ muscles do not cause back pain; in fact, people with back pain often tense their ‘core’ muscles as a protective response. This is like clenching your fist after you’ve sprained your wrist. Being strong is important when you need the muscles to switch on, but being tense all the time isn’t helpful. Learning to relax the ‘core’ muscles during everyday tasks can be helpful.
8. Backs do not wear out with everyday loading and bending.
   The same way lifting weights makes muscles stronger, moving and loading make the back stronger and healthier. So, the activities, like running, twisting, bending, and lifting, are safe if you start gradually and practice regularly.
9. Pain flare-ups don’t mean you are damaging yourself.
   While the pain flare-ups can be very painful and scary, they are not usually related to tissue damage. The common triggers are things like poor sleep, stress, tension, worries, low mood, inactivity or unaccustomed activity. Controlling these factors can help prevent exacerbations, and if you have a pain flare-up, instead of treating it like an injury, try to stay calm, relax, and keep moving.
10. Injections, surgery, and strong drugs usually aren’t a cure.
    Spine injections, surgery, and strong drugs like opioids aren’t very effective for persistent back pain in the long term. They come with risks and can have unhelpful side effects. Finding low-risk ways to put you in control of your pain is the key.

 
Learn more

• Surgery won’t fix my chronic back pain, so what will?
• Endless pain
• Spinal cord stimulation doesn't help with back pain, says new review
• The chronic pain sufferers living with the impacts of failed spinal cord stimulators and surgery
• WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings
• ANZBACK Public Lecture 2023: Rethinking How Low Back Pain is Treated (1:05:47)
• RESTORE Clinical Trial for Back Pain
• Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews
• Dr. Peter O'Sullivan: Disabling Chronic Back Pain - The Mechanical Care Forum (47:32)
• Back to basics: 10 facts every person should know about back pain 

• 10 Facts every person should know about back pain. Presented by patients (4:15)
• Patient Stories Behind the 10 Back Pain Facts Every Person Should Know (9:40)

• Making Sense of Disabling Back Pain - Peter O’Sullivan Koadlow Lecture 2021 (1:30:29)
• The Empowered Beyond Pain Podcast (includes several discussions about back pain and back pain myths/facts)
• Communicating with people seeking help for lower back pain (a quiz for providers, but also beneficial for patients)
• Pain-Related Fear, Disability, and the Fear-Avoidance Model of Chronic Pain
• Your Back Is Not Out of Alignment
• Low Back Pain​
• Central Sensitization Syndrome (CSS) - Dr. Christopher Sletten (22:19) 
• 3 orthopaedic surgeries that might be doing patients (and their pockets) more harm than good
• DIM SIM Therapy 
• Back in Control (a resource center created by a retired spine surgeon)
• Ozzy Osbourne: Former surgeon was f***ing insane (7:03)
• Spinal cord stimulators: ineffective treatment found to be costly and risky
• University Hospitals Tees education and resources
• Discs Don’t Slip DAMMIT
• Placebos Can Alleviate Chronic Back Pain, Even When Patients Know They’re Placebos
  

​Research

• Central sensitization in chronic low back pain: A narrative review (sourced in article)
• Low Back Pain Flares: How do They Differ From an Increase in Pain? (sourced in article)
• Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis
• Noninvasive Treatments for Low Back Pain: Current State of the Evidence
• Prevalence of back pain in a group of elite athletes exposed to repetitive overhead activity
• Central sensitization in chronic low back pain: A narrative review​
• Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Do as Much Harm as Good​
• Failed Back Surgery Syndrome
• Recurrence of low back pain is common: a prospective inception cohort study
• Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): 3-year follow-up of a randomised, controlled trial​
• Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations (sourced in article)
• Benefits and Harms of Interventions With Surgery Compared to Interventions Without Surgery for Musculoskeletal Conditions: A Systematic Review With Meta-analysis

For Providers: Five recommendations to build stronger relationships and improve outcomes