Low back pain is a part of being human
I know no one really wants to hear this, but low back pain is a part of being human. Up to 80% of Americans will experience low back pain in their lifetime, we know this is something that is not only common, but something an overwhelming majority of the population can relate to experiencing. And once you have back pain, your risk of experiencing it again increases.
A lot of research has been done to see how we can prevent it from happening or manage it better. And there's a lot of research still being done on prevention and management. But what if we start changing the mindset around it to a little less catastrophizing “ OMG why me?!” to “What are ways I can reduce my risk and keep living my life without it dragging me down.”
As someone who personally experiences low back pain and a PT, I am adequately educated on the prevention, yet it still happens. Talk to most healthcare practitioners (PT, OT, Sports Med Docs, ATCs, etc), personal trainers and Pilates/yoga instructors, and you will probably still find a similar prevalence. However, within that population, the argument can be made that despite all the insight and assumption that they are doing “all the right things”, they are not immune to back pain, yet it also doesn't give them the same amount of disability. So why?
There are risk factors that we know from research that can actually be changed to reduce your risk. They include occupational risk factors, BMI and smoking. Smoking has been fully established as having no benefits to health but what about the other two? Occupational risk factors are no longer just heavy manual labor, but actually sitting for prolonged periods at a desk and not moving is just as impactful to your back health. We know that moving more, changing positions and thinking about ergonomics, does make this a modifiable risk. Meaning it can change! BMI is also something that can change, not always easy, but a 5% reduction in body weight significantly decreases low back pain prevalence and disability scores. Again, MODIFIABLE!
Most of these studies have been done for decades, looking at low back pain from a more biomedical model (tissue damage). However, we are now understanding the complexity of pain to be more of a biopsychosocial model, meaning it's not just biomechanical but back pain is also impacted by social and psychological factors. And that's where we start to look at managing back pain as a more active approach, rather than only focusing on passive strategies.
Understanding pain:
Pain is a multifactorial response to input to the body: meaning pain is influenced by your tissues, nervous system, emotions, stress, sleep, beliefs, and previous experiences. From the research, we know that not all pain matches what tissue damage (biomechanical) is actually happening.
We've all heard of experiences from people bitten by sharks, soldiers injured in combat and athletes competing in races with stress fractures, but reporting no pain at the time of injury, and only experiencing it later. (True tissue damage) Meanwhile on the opposite side, we also have heard the excruciating tales of someone bending over to pick up some paper from the ground, and then laid up for 3 days unable to move. So what is that then? That is the power of the brain and the interpretation of the pain experience. I am not going to argue that we cannot injure tissue with a turn of our back, but what I will argue is the power of the brain interpreting that input. If our brain was 100% accurate in depicting tissue damage we would never have those accounts of someone breaking a bone and not noticing it!
Pain is a warning signal. The brain learns from these experiences EVERY SINGLE TIME. You fall over as a toddler hundreds of times learning to walk, run and jump, and our brain is learning from that experience. Even when it's painful. Just as we feel things for temperature, if it's sharp or dull; sense things for balance; and where our bodies are in the world (proprioception), these are all inputs going into the brain to be interpreted. And over time, our body is constantly learning from these inputs.
Now pain is not the bad guy. We need these signals to keep us safe, no matter how “wrong” they might start being interpreted. There are genetic mutations that cause someone to be born without pain signals. And guess what, their life expectancy is not very long. Why? Because pain is not bad– it is protecting us! But what happens when that pain alarm is turned on too strong, and actually starts running the show. For example, you're experiencing back pain for the 2nd time in a six-month period of time, just when you're trying to get back to working out again, and so you've stopped moving and going to the gym thinking that's what caused it to flare again.
When understanding pain science education, a comprehensive meta-analysis tracking thousands of patients published in Brain Sciences established that when Pain Neuroscience Education (PNE) is coupled with a physical therapy or walking program, average patient pain scores plummet by roughly 48.5% (dropping from 5.89 to 3.03 out of 10). We also know through clinical trials tracked by the National Institutes of Health (NIH), that restructuring health-related beliefs through CBT reduces chronic spinal pain intensity by 20% to 30%, a metric that matches or exceeds several common pharmacological interventions without any drug side effects.. This is all to say that how we view that pain is also modifiable!
Actionable steps:
Knowing and understanding pain doesn’t mean you will all of a sudden not experience back pain, but my hope would be that you feel that there is more to the experience, and the commonality of it, makes it not unique but honestly part of the human experience.
Things you can control:
Work environment: If you sit during your day, move more often. If you lift heavy things, focus on your mechanics and reducing repetitive movements
Smoking cessation: Not an easy thing by any means, but 15.7% of all global back pain disability cases are explicitly attributable to smoking. How to keep from being a part of that 15.7%? Stop.
BMI: Research has shown that being clinically classified as obese increases the odds of developing chronic, long-term low back pain by 1.72 times (Shiri R, et al.) compared to individuals with a normal BMI. While weight loss isn't easy, even modest reductions in body weight have been shown to improve pain and disability in people with low back pain.
And if those above things aren’t needing modifications, there are some sure ways to reduce disability of back pain to add:
Walking: This has been shown to help reduce low back pain and also prevent it. Low cost, easy to do, and accessible from almost anywhere. If access to PT is limited, this is a great place to start for preventing or managing your low back pain.
Exercise: While there is still debate on what type of exercise, in general, exercise itself ranks high as compared to more passive approaches (ie injections, medications, bed rest). Pilates and yoga have some good support in the research, but not enough to say its better than other types of exercise
Biopsychosocial: From studies we know people that are chronic sufferers (longer than 12 weeks) also really benefit from a multidisciplinary approach; ie not just the PT, but also the mental health therapy, and other practitioners addressing the stress, beliefs about pain, sleep and overall nervous system health.
That being said, not all low back pain should be managed on your own. If your pain follows major trauma, is accompanied by fever, bowel or bladder changes, numbness in the groin, progressive weakness, or unexplained weight loss, you should seek immediate medical evaluation as these symptoms may indicate a more serious underlying condition and require further evaluation.
But wait, do I need an MRI for my low back pain?
It's worth noting that most episodes of low back pain don’t require imaging. Research has consistently shown that many people with a healthy and pain free back, still have age-related changes show up on an MRI. Meaning that while imaging can be helpful when clinically indicated, it doesn't always provide the answers, and doesn't always match up to what someone is experiencing.
Moving More Without Fear
While reading this will not prevent you from developing back pain (or it happening again), I do hope it gives you some perspective of the treatment of back pain, and that it is something you can influence vs the other way around. Not everyone benefits just from “knowing” all this, and sometimes the specific uniqueness of your low back pain is what requires a unique and individualized plan. Understanding the science behind the pain, and the prevalence, can give you some insight to at least not be swindled by anyone claiming they can fix your back pain, once and for all.
The hope is that you can manage it better and continue to do the things that you love to do for as long as you can with less fear of the pain itself.
References
Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention.The Lancet. 2018;391(10137):2356–2367.
Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions.The Lancet. 2018;391(10137):2368–2383.
Pocovi NC, et al. Walking for the prevention of low back pain recurrence: a randomized controlled trial.The Lancet. 2024.
Delitto A, George SZ, Van Dillen LR, et al. Clinical Practice Guidelines Linked to the International Classification of Function, Disability and Health from the Academy of Orthopaedic Physical Therapy.Journal of Orthopaedic & Sports Physical Therapy.
Shiri R, et al. The association between obesity and low back pain: a meta-analysis.American Journal of Epidemiology.
Vlaeyen JWS, Crombez G, Linton SJ. The fear-avoidance model of pain.
About the Author
Katelyn Brady, PT, DPT, OCS is a board-certified orthopedic physical therapist and owner of Mobilitide Physical Therapy in Philadelphia, PA. She specializes in orthopedic and pelvic health physical therapy, helping active adults move with less pain and more confidence through evidence-based, individualized care.
Medical Disclaimer: This article is intended for educational purposes only and should not replace individualized medical advice or evaluation. If you are experiencing severe pain, significant trauma, fever, unexplained weight loss, bowel or bladder changes, numbness in the groin, or progressive weakness, seek prompt medical evaluation.
Last reviewed: August 2026