Pain, scans and getting moving again

A lot of what people believe about pain made sense once, but the research has moved on. Over the past few months we've shared short posts on some of these ideas. Here's the longer version, with the studies behind each one so you can read them yourself.

None of this replaces an assessment. Everyone's situation is different, and there are always exceptions. But these five ideas shape how we think about pain and recovery at Element.

Hurting isn't always harming

Pain is real, but it isn't a simple readout of tissue damage. In 2020 the International Association for the Study of Pain updated its definition of pain, the first revision since 1979. The new wording describes pain as an experience associated with, or resembling that associated with, actual or potential tissue damage [1].

In plain terms, your nervous system acts more like an alarm than a damage meter. The alarm can be turned up or down by things besides the tissue itself: how much load you've been under, how you've been sleeping, stress, and how much you've done lately.

That's why some discomfort early in recovery is often part of getting better rather than a sign of harm. Working out which is which is a big part of what a physiotherapist helps with.

Scans don't always tell the whole story

What an image shows and how your body feels are two different things. A 2015 systematic review pooled imaging results from 3,110 people with no back pain at all. Disc degeneration showed up in 37% of 20-year-olds, rising to 96% of 80-year-olds [2].

The authors concluded that many of these findings are likely part of normal ageing and not linked to pain. They stressed that scans need to be read alongside how the person is actually doing [2]. The reverse happens too: some people hurt a great deal with images that look normal.

Scans still have an important place, particularly when something more serious needs ruling out. High-quality guidelines recommend using imaging selectively rather than routinely [3]. That's why an assessment looks at how you move, load and respond, not just at a picture.

If you've been told about something on a scan and it's worrying you, bring the report in and we'll talk it through.

3. A sore back rarely needs bed rest

For much of the last century, a few days in bed was the standard advice for a sore back. That's changed. A Cochrane review compared advice to rest in bed with advice to stay active for acute low back pain (pain lasting under six weeks) [4].

People told to stay active had small improvements in pain and function compared with those told to rest. For people with sciatica, the difference between the two was small or absent [4]. So the honest version isn't "movement fixes back pain." It's that lying down and waiting doesn't seem to help, and gentle activity is a reasonable default for most people.

In practice that might mean short walks, changing positions often, and carrying on with daily life as much as is comfortable. Guidelines also recommend addressing activity and exercise, and helping people stay at work where possible [3].

There are exceptions worth checking, which is where an assessment comes in. If back pain is dragging on, or comes with symptoms like numbness, weakness or changes in bladder or bowel control, get it looked at. Those last ones need urgent medical attention.

Your best posture is your next one

There's no single "correct" way to sit. A 2020 review of 41 systematic reviews looked at spinal posture, sitting, standing, bending and lifting. It found mixed results and no agreement that any particular posture causes low back pain [5].

That doesn't mean posture never matters. A 2023 review found a moderate link between chronic back pain and some workplace demands, such as heavy lifting and awkward positions held for long periods. Sitting and standing showed little or no link [6].

The practical takeaway: the position that tends to bother people most is the one they're stuck in longest. Move often, shift around, and get up now and then. If your job keeps you in one position all day, we can help you work out what's realistic.

"Will physio hurt?"

Usually not in the way people fear. Some rehab does involve working into a little discomfort, and that's often part of the process rather than a warning sign.

A 2017 review compared exercise where some pain was allowed with pain-free exercise for people with long-standing musculoskeletal pain. Allowing some pain gave a small short-term benefit for pain, and no difference in the longer term [7]. The authors' conclusion was that mild pain during exercise doesn't need to be a barrier to getting better.

What that means for you: discomfort can be acceptable when it's manageable and has a purpose.