Ten Things About Back Pain That Should Change How You Train

The SparkNotes

• Back pain is rarely dangerous, and it is rarely a sign of serious tissue damage.

• Scans do not predict who hurts, who recovers, or who ends up disabled.

• Loading a back — bending, lifting, running — builds it. Graded exposure is the point.

• A flare-up is usually about load, sleep, stress and mood rather than fresh injury.

• Nothing in here applies until serious pathology has been ruled out.

The Whole Story

Most back pain advice is written for people who want to stop hurting. This is written for people who want to keep training.

The two are not the same problem, and the second one is badly served. You get told to rest, to brace, to protect the spine, to avoid the thing that hurt — advice that is aimed at getting you comfortable, not at getting you back under a bar.

An editorial in the British Journal of Sports Medicine set out ten facts about low back pain that a group of clinicians and researchers argued every person should know. They are worth reading in that light: not as reassurance, but as permission.

One: it is rarely dangerous

Persistent back pain can be frightening and genuinely disabling. It is very rarely life-threatening, and you are very unlikely to end up in a wheelchair because of it.

That sounds like a low bar. It is not — because fear about what the pain means is itself one of the things that predicts a worse outcome.

Two: getting older is not the cause

It is a widespread belief and the evidence does not support it. Age alone does not cause or worsen back pain.

If you are forty-five and assuming your back is on a downward slope because of the calendar, that assumption is doing more harm than the birthdays are.

Three: persistent pain is rarely about tissue damage

Backs are strong. When there is an injury, tissue healing happens within about three months — so pain that persists past that usually means other things are contributing.

And a lot of back pain starts with no injury at all. Stress, tension, fatigue, inactivity, an unaccustomed load — ordinary things that make the back sensitive to movement rather than damaged by it.

Four: scans rarely show the cause

This is the one that changes most people's week.

Scans help in a minority of cases. They also report a lot of alarming words — disc bulges, degeneration, protrusions, arthritis — which are common in people WITHOUT any back pain at all. Those findings do not tell you how much pain you will have, or how disabled you will be. Most disc prolapses shrink over time.

A report is not a diagnosis of your experience. It is a description of a picture.

The two phrases I hear most

When somebody hands me a scan report, two phrases come back more often than all the others put together. “Degenerative disc disease.” And “bulging disc.”

Both of them sound like a structural verdict on your back. The point of the fact above is that they usually are not.

Five: pain with movement does not mean damage

When pain persists, the spine and the surrounding muscles often become genuinely sensitive to touch and movement. The pain you feel is real, and it reflects how sensitive the structures have become — not how damaged they are.

Which is why it usually settles as you get more active. Rest, avoidance and fear are among the least effective ways to treat a back.

Six and seven: it is not your posture, and it is not a weak core

How you sit, stand and bend does not cause back pain. A variety of postures are healthy. Slouching sometimes is fine, and relaxing during everyday tasks is more efficient than holding yourself rigid.

And weak core muscles do not cause back pain. If anything, people WITH back pain tend to over-tense those muscles — a protective response, like clenching after a sprained wrist. Being strong is useful when you need the muscles to work. Bracing all day is not.

For a lifter, that is a specific instruction: brace for the set, not for the afternoon.

Eight: backs do not wear out

Loading a back makes it stronger and healthier, the same way loading any other tissue does.

Running, twisting, bending and lifting are safe if you start gradually and practice regularly. The word doing the work in that sentence is GRADUALLY — which is the same rule that governs every other tissue you train.

Nine: a flare-up is not a re-injury

Flare-ups can be severe and frightening, and they are rarely related to tissue damage.

The common triggers are poor sleep, stress, worry, low mood, inactivity, or an unaccustomed load. Which means the response that works is not the one that feels right. Instead of treating it like an injury and stopping, stay calm and keep moving.

Ten: injections, surgery and strong drugs are usually not the answer

Spinal injections, surgery and strong painkillers including opioids are not very effective for persistent back pain over the long term. They carry risk and side effects.

The care that does work is comparatively cheap and safe: education, and coaching that helps you get physically active, sleep well, stay socially and occupationally engaged, and manage the load.

The line this does not cross

All of the above applies once serious pathology has been excluded. That is not a footnote — it is the condition on everything else.

Sudden weakness, numbness in the saddle area, changes in bladder or bowel control, unexplained weight loss, fever, or pain that is severe and unrelenting at night are reasons to be assessed rather than reassured.

Screening for those signs is part of what a doctor of physical therapy is trained to do. A physical therapy evaluation includes checking for them and recommending further diagnostic testing or referral when it is warranted — so getting assessed is not a detour around physical therapy. It is part of one.

What to do with it if you lift

The practical version, for someone who has no intention of stopping:

• Stop reading the scan report as a verdict on your future.

• Keep training. Reduce the load, change the movement, shorten the range — do not stop.

• Brace for the set, not for the day.

• Treat a flare as a load-and-life problem first: sleep, stress, a jump in volume.

• Build back gradually and on purpose, rather than waiting to feel ready.

Follow along as Resurgo comes together.

Read next: Why Avoiding the Painful Movement Stops Working · What Actually Gets You Better Isn't How Many Hours You Spend in a Clinic