When it comes to back pain, we have to start with a statistic that is, at the very least, sobering: 80% of adults have suffered, currently suffer, or will suffer from it at some stage in their lives.
However, according to physiotherapist and author Juanma Ortega - an expert in musculoskeletal health and non-surgical spinal injury recovery - many existing treatments merely address the symptoms while neglecting the root cause.
As a physio, his objective is to free you from pain by targeting the specific source of your back issue, with the aim of finding a solution that ensures your discomfort never returns. Wondering about his expert tips to help solve back pain? Here, he shares his insights.
It seems that almost everyone will suffer from back pain at some point. Why do you think it is such a recurring issue?
"In my view, based on the cases I see daily in the clinic, there are several key causes. The first is that today's jobs are becoming increasingly specialised and repetitive; the body suffers when it spends hours performing the exact same movements. This inevitably overloads certain tissues while neglecting others, leading to muscular stiffness and, consequently, restricted joint mobility - which in some cases results in physical 'blockages'.
© Getty Images"I also believe the social concept of playing sport 'to stay healthy' is somewhat misguided. For example, someone who spends eight hours in an office and plays, say, padel three times a week is often considered active and health-conscious. But, over time, this same person is highly likely to develop injuries.
"Playing sport is excellent, but it must be supported by at least three days of fundamental physical conditioning. This should focus on strength and muscular elasticity, specifically tailored to counteract any sedentary work postures and the physical demands of whichever active hobby they enjoy.
"This is why statistics show that approximately 80% of the population will suffer from back pain or serious spinal injuries during their lifetime. If the figure is that high, it suggests that, as a society, we're clearly doing something wrong when it comes to physical self-care."
To what extent do our lifestyle habits influence back pain?
"While lifestyle certainly plays a part, I believe the lack of preparation for the specific demands of our lives is a far greater factor. What do I mean by this? If you have an office-based job, you have to physically prime your body to sit correctly. This means ensuring your shoulders are positioned in a way that avoids putting undue strain on the lumbar (lower back), thoracic (middle) or cervical (neck) regions.
"Patients often tell me: 'I try to sit up straight whenever I remember.' But we know that the brain cannot effectively multitask in this way. If you are consciously focusing on maintaining your posture, the moment your attention shifts to your computer or mobile, your posture is going to slump.
"We know that our habits influence us, and we lead the kind of lifestyle for which the human body was not naturally designed. The important point, though, is to prepare your body for the life you actually lead. It's the same reason a football team doesn't just play football; they also have a strength and conditioning coach to prepare them for 90 minutes of high-intensity play."
© Getty ImagesIs back pain caused by office-based work?
"I believe the back is a major victim of office work and, really, most modern professions. In my clinical experience, the greatest risk doesn’t necessarily stem from lifting a heavy load ten times a day. The real issue is the repetition of the same movement hundreds of times. If those repetitions involve any weight at all, you are exponentially increasing the risk of suffering a significant spinal injury.
"This is why I often tell my patients that the problem isn't their office chair or their mattress - the problem is their own physical condition. Each of us should analyse our lifestyle and our physique to understand how to prevent injury. Unfortunately, most people only seek help once they have already sustained fairly serious damage."
© Getty ImagesCan all back pain be fixed?
"Saying 'all' would be unrealistic... Every case, every individual, and every body requires a bespoke analysis and tailored considerations to rectify the imbalances.
"To give you a clear example: more than 95% of patients who visit a clinic with back pain or spinal injuries have not experienced a specific trauma. Consequently, the vast majority of cases are postural in origin, which is why a success rate of over 90% is entirely achievable.
"If your posture has caused certain injuries or symptoms, your body - in most instances - possesses the capacity to rehabilitate and return to its pre-injury state."
Isn't the pain itself just a sign of an underlying issue?
"Precisely; pain is simply another symptom. We use that phrasing because almost every patient who walks through my door is understandably fixated on the pain itself. That is their primary concern: they want to be rid of the discomfort, and often, they aren’t interested in anything else.
"If back pain persists for more than eight or ten days without change - or even worsens - waiting is rarely the best course of action... Postponing treatment only leads to a more difficult recovery"
"Consequently, when a patient presents with a radiology report diagnosing a specific spinal injury - such as a herniated or 'slipped' disc - accompanied by pain radiating down the leg, they are often taken aback when I tell them that neither the pain nor the injury is the actual root problem.
"Provided there hasn't been a traumatic event, the key to repairing the injury and stopping the pain lies in identifying which part of the body created the initial imbalance. By rebalancing the system, we can eliminate the painful symptoms for good.
"The priority isn't to focus solely on the pain, as the patient does - though I appreciate that's what is most distressing and limiting their lives - but to understand why the injury occurred and is manifesting those specific symptoms. Unless the clinical approach adopts this perspective, it is incredibly difficult to provide a definitive solution and achieve lasting relief."
So, is the key identifying the cause of the pain?
"Logically, yes. If we focus solely on the pain, the tingling, the cramp or any other symptom, we can modulate or relieve that sensation temporarily, but we will never manage to eradicate it for good without identifying the cause.
"In my view, the cause isn’t simply having a slipped disc; rather, it's why you have that slipped disc, or why you have arthritis in the spine or any other injury. As I said earlier, the the vast majority of patients I see are not there because of one traumatic event."
© grinvaldsWhat are the most common causes of back pain?
"The two most common causes are:
- Our modern sedentary lifestyle, which is detrimental to musculoskeletal health.
- Muscular stiffness. Most patients have developed deep imbalances in their muscle tissue between the body's two most fundamental physical capacities: strength and flexibility.
"For example, if you focus heavily on strength to maintain muscle mass but neglect flexibility, your muscles will eventually become rigid rather than elastic. Over time, this restricts joint mobility and ultimately leads to more significant injuries.
"We must never forget that our bodies are designed for survival. If one hip hurts, your brain will automatically shift more weight onto the other leg. This same compensation happens across every one of our joints."
Should we always see a doctor when we have persistent back pain?
"Nowadays, we are very accustomed to labels: 'the doctor', 'the physiotherapist', and so on. Personally, I believe you should consult a professional who takes a holistic view of the body - someone who doesn’t just focus on the patient's symptoms, but uses those symptoms as a clue to trace the thread back to the actual cause of the condition.
"I always use the same analogy: if you’re driving and the low fuel light comes on, you have two choices. If you want to focus only on turning off the light, you could smash the bulb with a screwdriver. The light goes out, but you haven't solved the problem. To truly address the 'symptom' of the light being on, you have to stop at a petrol station and refuel.
"The body works in exactly the same way: you can mask the pain, which is what concerns the patient most, or you can help them understand why it is happening and coordinate the necessary treatment to correct it. You can even teach the patient how to keep the pain at bay themselves if the issue stems from their posture habits."
© Getty ImagesWhat would you say to someone who finds their back pain isn't going away with time?
"The most important piece of advice I can give is not to delay in consulting a professional who can help find a definitive solution. We regularly see patients in the clinic who have lived with pain for months or even years. Many of them believe that if they simply wait, the pain will vanish on its own. Alternatively, rather than waiting, they take inadequate measures - such as self-medicating - that are merely aimed at masking the symptoms.
"As with any injury or illness, the longer you wait to address the root cause, the more difficult it becomes to resolve. Then the pain causes greater disruption to your life, and the eventual rehabilitation process will be significantly more complicated."
Can back pain be a sign of a serious underlying illness?
"There are hundreds of potential causes behind back pain. Fortunately, the vast majority are not life-threatening illnesses. However, it is true that at the most severe end of the scale, we do occasionally treat patients with intense back pain where we eventually discover spinal tumours.
"This is why I always urge patients not to sit at home taking painkillers, hoping the discomfort will eventually subside. If the pain lasts for just two or three days, it may be a postural issue caused by a specific activity. But when that pain persists for more than eight or ten days without change - or even worsens - waiting is rarely the best course of action.
"I must emphasise: postponing treatment only leads to a more difficult recovery and increases the risk of an injury or illness becoming more serious."
© Getty ImagesIs it always necessary to consult a physiotherapist to resolve back pain?
"In an ideal world, no. Ideally, society would possess a foundational understanding of physical education, allowing people to grasp the advice we provide in the clinic before they even arrive. What do I mean by this? If one of the primary causes of spinal injury is an imbalance between strength and flexibility, we should be teaching these concepts from childhood, ensuring people know how to maintain that balance throughout their lives.
"I realise that prevention is the most effective approach, but I also recognise how difficult it is to shift the mindset of a society that increasingly seeks 'quick fixes'. Unfortunately, in healthcare, I don't believe lasting results can be achieved easily or instantly; they require knowledge and discipline."
Should you rest when you have back pain?
"Personally, the answer is generally no, but - as with all medical advice - you can't really generalise. You have to understand the underlying cause of the pain before recommending whether it requires rest or mobilisation. Patients must also keep in mind that not all movement is beneficial; there are many exercises, sports and physical activities that may be more or less appropriate depending on the specific nature of the injury. This is why I always point out that it isn't a case of black or white; there are many shades of grey."
© Getty ImagesWhat should we do in the event of acute, sudden-onset back pain?
"Clearly, the first step should be to visit an A&E department or an urgent care centre to determine the cause. If necessary, imaging or scans should be carried out to investigate why the pain is so severe in that specific area. If an injury is diagnosed near the site of the pain, we must analyse its origin - whether it resulted from a specific trauma, if a sudden physical effort triggered the body's 'alarm system', or if it is simply down to a long-standing mechanical imbalance.
"Ten years ago, the typical patient walking through my door was likely to be between 54 and 55 years old. Today, the average age of the patients we treat has dropped to around 43 or 44"
"In some cases, the pain can be incredibly intense even if there is no direct structural injury at the site of the discomfort. This is why it is essential to investigate the root cause rather than simply ignoring it."
Chronic pain is a different matter entirely, isn't it?
"Of course. In these cases, things become slightly more complex. When chronic pain is diagnosed, it is often accompanied by degenerative changes in the skeletal system. I am referring to bone wear, osteoarthritis, or arthritis caused by excessive compression between the spinal joints.
"If a patient has reached this stage, we can still analyse their condition and identify any muscular issues. By working on the muscular component, we can often help to reverse some of the pain. However, if the chronic pain is caused by significant deterioration of the bone or joints that cannot be physically repaired, it is realistically difficult to restore a 100% quality of life."
© Getty ImagesIs this a health problem that affects women more, or are the percentages similar across the sexes?
"I wouldn't distinguish so much between the sexes as I would draw significant attention to the patient demographic we are currently seeing in the clinic. Ten years ago, the typical patient walking through my door was likely to be between 54 and 55 years old. Today, the average age of the patients we treat has dropped to around 43 or 44. To me, this is a much more significant and worrying statistic.
"If our patients are getting younger, we are facing a major social problem. It suggests that the majority of back injuries are not necessarily linked to age-related wear and tear, but rather to an inappropriate lifestyle and poor physical conditioning."
About the expert
Juanma Ortega is a physiotherapist and author of the Spanish-language book Tu dolor de espalda tiene solución - si sabes cómo (Your Back Pain has a Solution - If You Know How to Find It).
