Many people live with neck pain (cervicalgia) or back pain (lumbago) and bring with them a test result that ‘scares’ them: hernia, protrusion, wear and tear, osteoarthritis, dehydrated disc. Others, on the contrary, feel intense and persistent pain... despite test results considered ‘normal’.
This apparent contradiction is one of the greatest sources of fear, confusion, and unnecessary suffering. The good news is that current science helps us to better understand this reality and to provide more effective and safer care.
What tests show (and what they do not show)
Imaging tests such as X-rays, CT scans, or MRIs are useful tools for identifying structural changes. However, they are not a direct reflection of pain.
Studies show that changes such as disc protrusions, hernias, or signs of degeneration are common in people without pain, especially as they age. Similarly, people with significant pain may not show relevant changes in tests. This does not mean that ‘the pain is in the head,’ but rather that pain does not depend solely on structure.
Pain distinct from injury: a current view of science
Pain is currently defined as a sensory and emotional experience, associated with or similar to that associated with tissue injury. This means that pain results from the interaction between multiple factors, including:
- tissues and structures
- nervous system
- emotional and psychological context
- sleep, stress and fatigue
- previous experiences and beliefs about the body
This framework helps to understand why two people with similar test results may have completely different experiences of pain.
Neck pain and low back pain: multifactorial conditions
Both neck pain and low back pain are now recognised as multifactorial conditions, especially when they persist over time.
Scientific evidence shows frequent associations with:
- stress and emotional overload
- sleep disturbances
- fear of movement
- reduced physical activity
- recurrent episodes of pain
Therefore, a rigorous assessment should not focus solely on the disc or vertebra, but rather on the person as a whole.
Is movement safe when there is a hernia or wear and tear?
In most cases, yes.
International guidelines reinforce that movement, when properly guided, is one of the most effective tools in the care of cervical and lumbar pain, even in the presence of structural changes.
Avoiding movement out of fear can, paradoxically, contribute to:
- increased stiffness
- loss of confidence in the body
- perpetuation of pain
The goal is not to ‘force’ movement, but to reintroduce it in a progressive, safe and adapted manner.
How physiotherapy can help
Modern physiotherapy for neck and back pain is based on pillars that are well supported by science:
- pain education (understanding the body reduces fear and improves results)
- adapted and progressive therapeutic exercise
- promotion of safe physical activity
- strategies for dealing with stress and sleep, when relevant
- manual techniques, as a complement and not as the only solution
There is no single recipe. Effective care is that which respects the context, goals and pace of each person.
When it is important to investigate more closely
Without causing alarm, there are situations that warrant urgent or specialised medical evaluation, such as:
- severe pain after trauma
- progressive loss of strength
- extensive changes in sensitivity
- constant, non-mechanical night pain
- unexplained weight loss or associated fever
Outside of these contexts, most neck and back pain benefits from a conservative, informed and progressive approach.
Final message
Having a hernia, wear and tear, or changes in your examination results does not define your future or your ability to recover.
Neck and back pain are rarely explained by a single cause, and the most effective care is that which combines rigorous assessment, clear explanation, and evidence-based intervention.
At Physioclem, we treat movement and pain with science, empathy, and respect for each person's individuality.
Bibliographic references
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Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811–816. doi:10.3174/ajnr.A4173.
Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736–747. doi:10.1016/S0140-6736(16)30970-9.
Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368–2383. doi:10.1016/S0140-6736(18)30489-6.
Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, et al. What does best practice care for musculoskeletal pain look like? A systematic review and meta-analysis. Br J Sports Med. 2020;54(2):79–87. doi:10.1136/bjsports-2018-099878.
Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain. Ann Intern Med. 2017;166(7):514–530. doi:10.7326/M16-2367.
