Low Back Pain and Your Nerves: What Dr Ben Says the Signals Tell Us
Quick answer: Most low back pain is "non-specific", which means no single damaged structure explains it, and most acute episodes settle well. Your nerves send your brain two kinds of message: warning signals and position and movement signals. When part of the spine stops moving well, that balance can shift, so the most helpful step is usually to keep moving, get a proper assessment, and watch for the warning signs that need urgent care.
Key takeaways
About 90% of low back pain is non-specific, with no single cause such as a fracture identified.
Your back pain is information from your nervous system, not proof that something is broken.
Scans are not routinely needed for back pain without red flags, because findings often don't match pain.
Active care, such as exercise and staying mobile, is generally favoured over passive treatments.
Some signs need prompt medical attention. They are listed below.
What is my nervous system telling me when my back hurts?
Your back pain is a message from your nervous system that something in how your spine is moving or coping needs attention.
The way I explain it to patients is simple. The joints, muscles and ligaments of your spine are full of sensors. They send a constant stream of information up to your brain, and most of that information is about position and movement: where you are, how you're balanced, how much load you're carrying. Your brain uses it to coordinate the deep muscles that hold you upright.
Alongside that, your nerves carry warning signals. When a joint is irritated, restricted or overloaded, the warning signals get louder and the position signals can get quieter. Your brain is now working with poorer information. In my clinic I often see what follows: stabilising muscles that switch on a little late, guarding, stiffness, and a back that feels unreliable.
So pain is not the whole story. It is one part of a conversation between your spine and your brain.
Why doesn't my scan show what's causing the pain?
Most low back pain doesn't come from one structure you can point to on an image, so a scan often can't explain it.
Koes, van Tulder and Thomas (2006) describe roughly 90% of low back pain as non-specific. That is often a diagnosis of exclusion: serious causes are ruled out, and no single structure is identified as the cause. The North American Spine Society guideline (Kreiner and colleagues, 2020) and the BMJ review agree that imaging is generally not recommended for routine low back pain unless red flags are present. Scan findings often don't match how much pain someone feels, and changes on a scan are common in people with no pain at all.
That is reassuring. A "worn" disc on a report does not mean your back is damaged beyond help. Facet joints, discs and the sacroiliac joints can all contribute to pain. How much each one contributes varies from person to person (Boswell and colleagues, 2005), which is why a careful examination matters more than a label.
Why does my back pain keep coming back?
Recurrences are common because pain often eases before movement and muscle control have fully recovered.
The good news first. Most acute episodes have a favourable outlook, but recurrences within a year are common (Koes et al., 2006). In my experience the pain settles, people get back to long days sitting between the office and the car, and the spine never quite gets back to moving well. The deep muscles keep firing a fraction late, and the next awkward lift or long drive sets it off again.
For me, this is the point of looking past the pain. If the signals your spine sends to your brain haven't returned to normal, the pattern is still there underneath.
Which movements help my back settle?
Gentle, regular movement is usually the most helpful thing you can do, and guidelines favour active approaches over passive ones.
The American College of Physicians guideline (Qaseem and colleagues, 2017) favours active treatments for acute, subacute and chronic low back pain. For chronic low back pain it found exercise gives small improvements in pain and function compared with no exercise. Passive treatments on their own, such as traction, TENS or heat, showed limited benefit for chronic low back pain (Airaksinen et al., 2004; Qaseem et al., 2017).
These are the simple movements I give most patients to start with:
Walking. Walk at a comfortable pace for 10 to 20 minutes, once or twice a day. In Dubai's hotter months, a mall or an air-conditioned corridor works fine.
Pelvic tilts. Lie on your back with your knees bent. Gently flatten your lower back into the floor, then let it arch slightly. Do 10 slow repetitions, 2 to 3 times a day.
Cat-camel. On your hands and knees, slowly round your back up, then let it gently dip. Do 8 to 10 repetitions, staying in a comfortable range, once or twice a day.
Break up sitting. Stand up and move for a minute or two every 30 to 45 minutes.
Each movement should feel easy. If one sharply increases your pain or sends symptoms down your leg, stop it and get assessed.
How often should I move when my back hurts?
A little and often works better than one big session.
Short bouts spread through the day give your nervous system frequent, positive movement information without overloading sore tissue. Keep doing your normal activities as much as you comfortably can. Avoid long bed rest unless a doctor has advised it.
When should I see someone?
See someone if the pain persists, gets worse, or comes with any of the warning signs below.
The guidelines stress that the first step is checking for red flags and ruling out specific disease (Koes et al., 2006). Get checked by a doctor if you have:
Pain that started before age 20 or after age 55
Pain that doesn't change with movement or position, including pain at rest or at night
Pain in the mid-back (thoracic pain)
A history of cancer, long-term steroid use or HIV
A general feeling of being unwell, or unexplained weight loss
Widespread numbness, tingling or weakness, or a visible change in the shape of your spine
Go to an emergency department straight away if you have numbness around your groin or buttocks, new problems controlling your bladder or bowel, or rapidly increasing weakness in your legs.
How does Dr Ben approach it?
I look at low back pain as a nervous system problem as much as a back problem. My aim is to restore healthy spinal motion so your body can coordinate itself well again.
I've come to see the spine as one of the body's main sources of information. When a segment stops moving properly, the brain gets more stress signals and less clear position information, and the muscles that should protect you lose their timing. My job is to find exactly where that is happening and restore motion there, precisely and gently.
That starts with a thorough first visit: your history, the red flag questions, and a hands-on examination of how each part of your spine and pelvis moves. Chiropractic care and manual therapy are considered appropriate for acute low back pain from muscle strains and ligament sprains (Troyanovich, Harrison and Harrison, 1999). For longer-standing pain, I see chiropractic as one part of an active plan. That plan includes movement, sleep, how you handle stress, and how you eat, because a body that gets the right inputs is better able to recover. I also work alongside your doctor, and I refer you to them when something needs medical attention.
Frequently asked questions
Does back pain mean I've damaged a nerve?
Usually not. Most low back pain is non-specific, and the pain reflects irritated, overloaded or poorly moving tissue rather than nerve damage. Numbness, weakness or symptoms down the leg should still be assessed.
Do I need an MRI for my back pain?
For most back pain without red flags, guidelines don't recommend routine imaging, because findings often don't match the pain. If your doctor or I find warning signs, imaging may be the right next step.
Should I rest or keep moving?
Keep moving within comfort. Active approaches are generally favoured over rest for both new and long-standing back pain.
Why does my back hurt more after sitting all day?
Long periods of sitting reduce the movement information your spine sends to your brain and keep the same tissues loaded. Breaking up your sitting every 30 to 45 minutes often helps.
Will my back pain come back?
It can. Recurrences within a year are common. Restoring good movement and keeping active after the pain settles is the best way I know to look after your back over time.
About the author
Dr Ben is a chiropractor at Heal Hub in Umm Suqeim, Dubai.
If your back keeps telling you something isn't right, let's find out what it is. Book your first visit (45 minutes) here: drbentinker.com/booking-calendar/new-patient-first-visit
References
Koes, van Tulder, Thomas (2006). Diagnosis and treatment of low back pain. BMJ.
Kreiner, Matz, Resnick (2020). Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care: Diagnosis & Treatment of Low Back Pain. North American Spine Society.
Qaseem, Wilt, McLean (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. American College of Physicians.
Airaksinen, Brox, Cedraschi, et al. (2004). European Guidelines for the Management of Chronic Non-Specific Low Back Pain. COST B13 Working Group on Guidelines for Chronic Low Back Pain.
Boswell, Shah, Everett (2005). Interventional Techniques in The Management of Chronic Spinal Pain: Evidence-Based Practice Guidelines. Pain Physician.
Troyanovich, Harrison, Harrison (1999). Low Back Pain and the Lumbar Intervertebral Disk: Clinical Considerations for the Doctor of Chiropractic. Journal of Manipulative and Physiological Therapeutics.
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