Back Pain Series - Topic 2 - Why Back Pain Can Persist – Understanding Pain, Sensitisation & the Nervous System

Many people with ongoing back pain worry that persistent pain means their back is damaged.

Modern pain science tells us this often isn’t the case.

Pain is produced by the nervous system

Pain is your body’s protective alarm system.

When you sprain an ankle or strain a muscle, pain helps encourage protection while tissues heal.

But sometimes, particularly with persistent spinal pain, the nervous system can become overprotective.

This is known as sensitisation.

Patient with spinal pain.

When this happens:

• Everyday movements can feel painful

• Muscles tighten excessively

• Pain can feel disproportionate to the activity

• Symptoms may persist after tissues have healed

This does not mean the pain is psychological or imagined.

The pain is very real — but the nervous system has become more sensitive and reactive.

Why stress, sleep and emotions affect back pain

Pain is influenced by much more than just tissues and joints.

Factors that can increase pain sensitivity include:

• Poor sleep

• Stress

• Anxiety

• Fatigue

• Fear of movement

• Previous injuries

• Low confidence in the body

This is why two people with similar MRI findings can experience completely different levels of pain.

Spinal scan results dont always correlate with symptoms.

The “hurt vs harm” concept

One of the most important concepts in physiotherapy is understanding the difference between:

• Hurt = pain or discomfort

• Harm = actual tissue damage

With persistent lower back pain, movement may feel sore or uncomfortable without causing damage.

Avoiding movement altogether can actually increase stiffness, weakness, fear, and sensitivity over time.

“Exercise is one of the best treatments for lower back pain”

— Lots of clever scientists

Research published in journals including the BMJ consistently shows that exercise is one of the most effective treatments for spinal pain.

Execises for spinal pain.

Exercise helps:

• Calm the nervous system

• Improve spinal strength

• Reduce fear of movement

• Improve mobility

• Build resilience and confidence

Importantly:

There is no “perfect” exercise.

The best exercise plan is one that is:

• Individual

• Gradual

• Consistent

• Sustainable

This might include:

• Walking

• Strength training

• Pilates

• Mobility work

• Gym-based rehab

• Yoga

• Functional movement training

How specialist physiotherapy can help….

All our physios are experienced in treating spinal pain. James Sweeney has a special interest in this area.

If you're struggling with persistent lower back pain, sciatica, or recurrent flare-ups, our physios provides expert assessment and treatment at PhysioHub clinics in Heaton Moor, Stockport and Middleton, Manchester. Book an appointment to start moving with confidence again.

Treatment focuses not only on reducing pain, but helping patients feel confident moving again and returning to normal life, work, exercise, and sport.

To book an appointment at one of our physiotherapy clinics in Greater Manchester (Middleton or Stockport), click here