Grab a cuppa. This is a big topic.

In this blog, we are going to talk about Australia’s #1 cause of combined death and disability – back pain. Yes, you read that correctly. In 2016, back pain caused more combined disability than heart disease, mental health disorders, stroke, lung cancer and Alzheimers. It 2001, it directly cost the country over $1billion, and 71% of this was for services such as GP appointments (3.7 million of these for back pain in 2015), physio, chiro, massage and so on. The indirect costs were estimated at over $9billion! Staggering. And the prevalence is not reducing, while the cost of the problem continues to rise. It is one of the most significant physical, psychological, social, and financial issues of our healthcare landscape. Fair to say that we as a society are not winning the battle against back pain, and we need to do better.

So where are we going wrong, and how can we do better? A huge question which I will only scratch the surface of here. Let’s start by squashing a few MYTHS AND MISCONCEPTIONS:

“My disc has slipped.”

No, no it hasn’t. Anatomically impossible. Next question.

“My spine has gone out of alignment and needs to be clicked back into place.”

If you believe this, you’d best be careful not to sneeze/bend/breathe deeply/look the wrong way. Fortunately, the spine is incredibly robust, can withstand huge forces, and there is no strong evidence that the back “goes out” or can be assessed as such.

“I should rest.”

Evidence shows us rest for more than a few days is in fact linked to back pain persisting. Current evidence recommends staying active in exercise, work and life, as best you can and within reason.

“I need a scan to diagnose the problem.”

The vast majority of back pain (>90%) can not be diagnosed by medical imaging. Pretty startling really. The reason? Back pain is multifactorial. In most cases it is far more complex than one structure being the cause of the problem. Back pain is influenced by your work, your lifestyle, your beliefs and fears, your postural habits, movement habits, exercise levels, strength, diet, stress, sleep quality, other health issues…

Did any of these statements shake your tree? If so, you should probably look deeper into the evidence, and how you perceive back pain.

So what does predict and influence back pain? The research tells us that psychosocial factors are MORE predictive of back pain hanging around than what your back looks like on a scan! We’ve seen through multiple papers that a patient who BELIEVES their back pain will persist is vastly more likely to suffer ongoing pain. And other things really closely linked to back pain hanging around?

– stress – emotional stress, work stress, financial stress

– anxiety/depression

– poor sleep quality

– lack of exercise and poor physical conditioning

– lack of social involvement

– dissatisfaction with work

– catastrophising (“No, not my back! This is going to be a disaster, I’ll never run again, I don’t know how I will work…”)

– fear of movement

Let me say this very clearly again – these factors above are MORE predictive and linked to back pain than the structure of your back itself.

But let’s go a step further, into what you can DO about back pain. Read the list above again – these are ALL things that you have an element of control over (unlike that your spine’s appearance on that MRI of yours!). And making positive steps in any one of these areas is making a positive step for your back.


This is our number one. It matters less what you do, more that you MOVE. Choose an activity that doesn’t aggravate your back, start with a small amount, and be regular. Walk more, every day. Hold yourself accountable. This is what we as physiotherapists do well – finding an effective and personalised way for you to get movement into your body.


Cardiovascular exercise is bloody excellent. For back pain. And just about every other part of you. Goal is >75 minutes/week.


Your back needs a little TLC. This could be a hot bath, some gentle stretches, lying with your feet up a wall, five minutes in child pose, some gentle trigger ball and foam roll work, lying down for fifteen minutes.


We’re finding out more and more about the inter-relationship between nutrition and pain. Simply, if you’re not eating well, or you’re consuming too much alcohol, you are promoting a pro-inflammatory state for the body. This isn’t good news when you’re trying to sort out your back.


This comes in many forms. It starts by examining, in a non-accusational way, how stress could be affecting you. You may find it hard to see the link with your pain – we can point you in the direction of countless bits of research that suggest it is. You need to look after your mental and emotional health, and this looks different for each person. Go for a walk with a mate; meditate; focus on slowing your breathing; unplug from your devices; spend time with your family.


Ok, maybe you can’t increase the amount of sleep you’re getting right now. But you can almost certainly get a better night’s sleep by practicing good sleep hygiene. Avoid screens for at least an hour before bedtime. Breathe and meditate for five minutes before bed. Create a ritual. A restorative sleep is critical.

Think of this like a checklist for back health – how many of these things are you doing well?  To think critically, if you don’t look after these fundamentals of back health, can you reasonably expect your back pain to improve? Check the resources below for more good information.

We really hope this blog helps you, as there are some powerful messages in here. At Stack St Physio we are passionate about evidence based health care. This then needs to be tailored to each individual, as everyone’s requirements will differ. Start on some of the points above, but don’t fight the battle by yourself – we are here to guide you through this process and to a less painful back.

Drop us a line with any questions or comments on, or give us a call at our Fremantle clinic on 0421 195 553!

Ben Mather | APA Musculoskeletal Physiotherapist | Practice Principal

Stack St Physio | Fremantle, WA

November, 2019

RESOURCES (for the people):
Good infographic on physical activity here

Do you know how much physical activity you should be getting? Are you getting it? Find out here.

PainHealth – evidence based advice for managing pain

Read up on your sleep hygiene here

Talking back pain podcast with movement legend Dr Kelly Starrett

REFERENCES (for the nerds):

Australian Institute of Health and Welfare

Brinjikji W. (2015) Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. Am J Neuroradiology

Campbell P. (2013) Prognostic Indicators of Low Back Pain in Primary Care: Five-Year Prospective Study. J.Pain

Department of Health Guidelines

Heneweer H. (2011) Physical activity and low back pain: a systematic review of recent literature. Eur Spine J.

IHME (Institute for Health Metrics and Evaluation) –

Lin (2019) What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med

Walker BF (2003) Low back pain in Australian adults: the economic burden. Adia Pacific J. Public Health

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