Back pain – it shouldn’t hold you back
80% of people will experience some type of lower back pain during their lifetime.
Back pain is one of the leading causes of disability and work absenteeism worldwide. In fact, more than 80% of people will experience some type of lower back pain at some point in their lives. In addition to personal suffering, this represents a major cost for healthcare systems; despite all the money spent on treatments, many conventional approaches, such as surgery or injections, are not very effective.
Pain is often associated with bodily damage, but in reality, this is not always the case. Pain is not a signal that goes directly to the brain; rather, it is a response generated by the brain. When a physical injury occurs, the tissues send information to the brain, but not a pain signal itself. It is the brain, based on the information received and the context, that decides whether we feel pain and to what extent.
For example, if you are in a life-or-death situation and you get a deep cut on your arm, you probably will not feel pain at that moment because it would not be useful. Your brain, in that context, prioritises your survival and leaves the pain for later. Once the dangerous situation has passed, the pain appears as a way to protect you
Pain is, in fact, a strategy the brain uses to prevent you from using a damaged part of the body, which helps recovery. However, there are also cases of pain without apparent damage. A classic example is that of a worker who felt intense pain after seeing a nail go through his boot, but when they arrived at the hospital, they discovered that the nail had passed between his toes without causing any damage. Even so, his brain, upon seeing the nail, assumed the area was injured and generated pain. There is also the phenomenon of the “phantom limb,” in which people who have lost a limb continue to feel pain in the part of the body that is no longer there.
Kinesiofobia
In cases of back pain, it is important to highlight that the correlation between anatomical abnormalities and pain is low. Many people have disc protrusions or herniated discs without presenting symptoms, while others with chronic pain show no visible abnormalities on X-rays. Therefore, basing a diagnosis solely on an image can be dangerous. If you have back pain and get an X-ray, it is common to be told that the cause is a hernia, but you may have had that hernia for years without pain. In addition, the pain may disappear even though the hernia remains. So, is the hernia really the cause of the pain? We do not know for certain.
What we do know is that doctors’ words can have a major impact. For example, if after several months of pain you are told that you have “the back of an 80-year-old person” or that you “should never lift weights again,” your pain is likely to worsen. This happens because you will begin to fear movement, which increases the risk of the pain persisting and makes recovery more difficult. This fear of movement, known as kinesiophobia, is one of the factors that most strongly influence chronic pain.
Therefore, one of the first recommendations to reduce pain is to trust the body’s natural ability to heal itself. Many hernias, for example, are reabsorbed over time and, although they may not heal completely, they do not necessarily interfere with daily life or sports practice. Having a hernia is not a life sentence, and we should not let fear take control. Good movement, strength training and postural reeducation can help improve quality of life and reduce back pain.
Another important recommendation is to stay active. There is a clear relationship between spending too much time sitting and back pain. If you have a sedentary job, it is recommended to use a standing desk and take a short break every 45 minutes to move around. Physical activity is the best therapy for chronic back pain, and although specific exercises are often recommended, what really matters, from my point of view as a personal trainer in Geneva, is exercising in general, regardless of the type.
Studies have shown that there are no major differences between the effects of Pilates, core strengthening or general exercise in reducing pain. However, strength training appears to be more effective than aerobic exercise, and exercises such as deadlifts, when performed with appropriate loads, can be useful in the rehabilitation of lower back pain and postural correction.
When you experience an episode of lower back pain, you can try gentle exercises to help relax the affected area. In general, what your back needs is movement.
Exercise is so effective for back pain because moving without pain reduces the perception of fragility. Little by little, your brain loses fear, and the vicious cycle of fear and avoidance is broken. In addition, movement transports blood and nutrients to tissues, thereby promoting recovery. But it is important to remember that, as with any treatment, the dose of exercise matters: it should stimulate, not worsen, the pain.
Finally, we cannot forget the psychological dimension of pain. Physical damage is only one of the variables that influence pain, but factors such as anxiety, depression or work-related stress also play a role. Therefore, cognitive-behavioural therapies, which focus on modifying beliefs and internal dialogue, are useful in treating chronic pain. Avoiding catastrophic thoughts is key, since catastrophizing is one of the strongest predictors of pain persistence. Changing your mindset and gaining a better understanding of how pain works can transform your experience and help you take control of your recovery.