Who has never had back pain?
Very few brave souls could honestly say never. It is one of the most common reasons for seeing a physiotherapist and the leading cause of disability worldwide. It also tends to come back: after recovering from one episode, around two in three people have another within a year.
This week, on 16 October, the world marked World Spine Day, a good moment to remember that looking after your back is not just about treating the pain when it appears.
The good news is that, in the vast majority of cases, there is nothing serious behind it. And there is a lot you can do to make it come back less often.
Pain with many causes
Back pain is multifactorial. It is often due to a lack of the natural activity our body is designed for. We spend much of our lives in static positions, standing or sitting, or doing repetitive work, and our spine loses mobility as a whole.
Too little movement
Long hours standing, sitting or repeating the same movement. The spine is made to move in every direction.
Load exceeds capacity
A house move, a weekend in the garden or weeks without moving followed by a big effort. When the demand exceeds what the back can tolerate, pain appears.
The body protects itself
After a flare-up, the muscles tighten and we move stiffly. That helps in the first days, but if it lasts, the back loses mobility and strength.
Fear of moving
Avoiding bending or lifting for fear of "hurting yourself" seems sensible, but in the medium term it weakens the back and makes the next flare-up more likely.
Pain does not always mean damage. Often it means the back is more sensitive and less prepared than we need it to be.
Much more than a spine: what lies in front
We should not forget the front of the body. In our clinic we often see that problems that seem purely mechanical, or confined to the spine, have an important component in excess tension in the tissues at the front: the diaphragm, the fascia that surrounds the organs or the anterior cervical fascia. We find it both in people with disc problems and in those without.
In the neck, that front tension is mainly linked to muscles such as the sternocleidomastoid or the scalenes. In the lower back, there are two well-known examples: low back pain during menstruation and so-called back labour. Contractions of the uterus, which sits in front of the lumbosacral area, are felt as pain at the back. This is what we call referred pain.
The nervous system and stress
The nervous system is another very important factor. When we live with more tension and stress, the body switches into alert mode, what we call the sympathetic state. The whole nervous system becomes more sensitive, pain can increase and, if a nerve is compressed, it can become more irritated.
That is why helping the body recover its calm mode, the parasympathetic system, helps many people with neck or low back pain after long periods of stress. Poor sleep pushes in the same direction.
Three ideas worth dismantling
"The MRI says I have a hernia, that's why it hurts"
Worn or bulging discs are very common in people with no pain at all, especially with age. The image must be read together with the examination, not on its own.
"I have to keep my back straight all the time"
There is no perfect posture. What helps most is changing position often. Bending your back to pick something up or lift is safe for a back that is prepared.
"If it hurts, better to rest until it passes"
Bed rest delays recovery. Staying active within what you can tolerate is one of the best-supported recommendations.
When to seek help and when not to wait
You can manage it
A typical flare-up
Low back pain that limits you but lets you move, with no symptoms in the legs or discomfort that stays above the knee, and that improves day by day.
Book an assessment
It does not improve or keeps returning
It lasts more than two or three weeks without improving, you have several flare-ups a year, or the pain runs down the leg below the knee with tingling.
Urgent medical care
Warning signs
Loss of sensation in the genital area or between the legs, difficulty passing urine or controlling the bladder or bowel, increasing weakness in the legs, fever or a heavy blow.
See a doctor as well if the pain comes with unexplained weight loss, if you have a history of cancer or if the pain is constant at night and does not change with any position.
What to do during a flare-up
- Keep moving. Gentle walking, several times a day, usually helps more than staying still.
- Find positions of relief and change them often: lying on your side, or on your back with your knees bent.
- Local heat can ease muscle tension.
- Return to your activities gradually, even if they still bother you a little.
- For medication, ask your doctor rather than self-medicating for days.
Relieving pain: a bridge, not the destination
Physiotherapy has different tools for back pain. Passive techniques are very useful for getting through the painful phase and improving function: mobilisations, fascial techniques, invasive techniques such as acupuncture, dry needling or neuromodulation, and advanced technology that supports the recovery process and the acute phase of pain.
They are powerful tools, but they are a bridge. Full recovery and prevention, including in many cases of herniated or bulging discs and other spinal injuries, are achieved above all through therapeutic exercise.
Therapeutic exercise, the key
What does it involve? Lumbopelvic stabilisation:
- The core. The abdominal muscles and, in particular, the transversus abdominis, which works as a natural belt: it lets us carry our own weight, lift loads in daily life and take on activities that demand more physical effort.
- The lower body. Above all the gluteal muscles, which are also part of lumbopelvic stabilisation and support the lower back.
- Progression. Exercise adapted to you, with a load that increases little by little and that you do regularly.
The evidence is fairly clear: exercise, especially combined with information about how pain works, significantly reduces the risk of new flare-ups. External belts, insoles or information alone, on the other hand, have not been shown to prevent them.
How we work at ETRYUM
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01
Assess
Your history, how the flare-ups began, what triggers them, and ruling out warning signs. We examine movement, including the front of the body, and use ultrasound when it adds information.
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02
Explain
Understanding why it hurts reduces fear, and fear is one of the factors that most keeps pain going.
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03
Relieve
Mobilisations, fascial techniques, dry needling, acupuncture, neuromodulation and advanced technology to get through the acute phase of pain and make movement easier.
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04
Strengthen
Therapeutic exercise for lumbopelvic stabilisation, with the core and glutes, and progressive load. It is the foundation of treatment.
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05
Prevent
A plan to keep what you have achieved and, when needed, coordination with the medical team to work on sleep, stress or general health.
An example to make it clearer
Illustrative case
Lucía, 45
She spends long hours sitting at work and has three or four flare-ups of low back pain a year, almost always after a one-off effort or during busy, stressful periods. She has an MRI showing "two disc protrusions" that worries her, and since then she has avoided bending and stopped going to the gym.
The assessment shows no warning signs. We explain that those findings are very common at her age and do not explain the pain on their own. We ease the flare-up with manual therapy and fascial techniques, work on the tension at the front and start a progressive lumbopelvic stabilisation programme, with core and glutes, including precisely the movements she had stopped doing.
A few months later, she carries the shopping again without fear, is back at the gym and, when she notices some discomfort, knows what to do.
The aim was not just for the pain to stop, but for Lucía to trust her back again.
To finish
Back pain is very common, rarely serious and tends to return. But it is not a fate: your back is much more than a spine, and looking after it means moving it, strengthening it and paying attention to what cannot be seen.
Move more. Understand the pain. Relieve just enough. Strengthen your natural belt. And look after tension and stress too.
Your back is made to move. Our job is to help it do so again with confidence.
This article is for general information and does not replace an individual medical assessment.
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