Managing Your Back Pain — House of Rehab

Patient Education Guide

Managing Your Back Pain

What the evidence actually says — and what you can do about it

What the Research Shows About MRI and Back Pain

One of the most important studies in the history of back pain was published in 2015 by Brinjikji and colleagues. They examined MRI scans from 3,110 people with no back pain at all. What they found changed how physiotherapists interpret imaging:

68%

of pain-free people in their 40s had disc degeneration on MRI

80%

of pain-free people in their 50s had disc degeneration on MRI

88%

of pain-free people in their 60s had disc degeneration on MRI

This means that if your MRI shows disc bulges, degeneration, or other "abnormal" findings — those findings are likely normal features of a spine that has been used, not evidence of damage. Your pain is real. But the scan finding may not be causing it.

Common Myths vs What the Evidence Says

Myth

My disc bulge is causing my pain and needs to be fixed

Evidence

Disc bulges are present in ~50% of pain-free 40-year-olds. The bulge may be incidental, not the cause.

Myth

I should rest and avoid movement until the pain stops

Evidence

Active rehabilitation — progressive loading and movement — consistently outperforms rest for back pain recovery.

Myth

Pain means I'm damaging my spine

Evidence

Pain is your brain's protective response — it doesn't always reflect tissue damage. Movement that causes mild discomfort is generally safe.

Myth

I need to maintain perfect posture

Evidence

There is no single "correct" posture. Variety of position and regular movement is more important than any fixed posture.

Pain Signals — What to Pay Attention To

Generally fine to continue

Mild ache during or after activity that settles within 24 hours
Stiffness in the morning that improves with movement
Familiar pain that doesn't change significantly

Modify and monitor

Pain that increases significantly during activity
Symptoms lasting more than 24 hours after exercise
New or changing symptoms

Seek immediate assessment

Numbness or weakness in both legs
Loss of bladder or bowel control
Pain after significant trauma or fall
Night pain that wakes you consistently

What Actually Helps Back Pain

Movement and progressive loading

The spine is designed to move. Gradually returning to and increasing activity — even when it causes some discomfort — is consistently shown to improve outcomes faster than rest and avoidance. We will guide you on what movements are appropriate at each stage.

Strength training

Building the strength of the muscles supporting your spine reduces load on passive structures. This is a long-term investment that pays dividends well beyond your acute episode.

Sleep

Poor sleep increases pain sensitivity and slows recovery. If your sleep is being disrupted by pain or stress, this is worth addressing — not just tolerating.

Stress management

Psychological stress is a genuine driver of persistent back pain — not because the pain is imagined, but because the nervous system becomes more sensitive under stress. If this applies to you, we can discuss it as part of your management.

Staying at work and active

Research consistently shows that people who stay at work (with modifications if needed) and remain active recover faster than those who take extended rest. Complete avoidance of activity is rarely the right answer.