Low back pain is one of the most common complaints in clinical practice and, paradoxically, one of the most misunderstood.
Many people live with pain for weeks, months, or even years without really knowing why it started, what keeps it going, or what they should do to treat it—and ideally prevent it from coming back.
Between contradictory advice, excessive rest, fear of movement, and constant attempts to “protect the back,” low back pain often ends up taking up a disproportionate space in a person’s life—not only in the body, but also in the mind.
Throughout this text, the goal is not just to talk about low back pain, but to help you move from a state of uncertainty and fear to a clearer understanding of what is happening in your body—and what you can safely start doing again.
In recent years, the way low back pain is diagnosed and treated has evolved significantly. This shift has brought more effective, more human, and above all more person-centered approaches that better reflect each individual’s complexity.
This article exists to help you understand this modern perspective and to show how a contemporary osteopathic approach can truly make a difference.
What You Should Know About Low Back Pain
Low back pain is common, but the experience of pain is always unique—and should be approached that way: centered on the person, not just on the complaint.
It is estimated that about 80% of people will experience at least one episode of low back pain during their lifetime. For some, it is a single episode. For others, the pain returns cyclically or becomes persistent. That is exactly what we want to prevent—and if you happen to be in the latter group, help reverse.
Low back pain is located in the lower region of the spine, between the last ribs and the buttocks, and may or may not radiate into the leg.
However, reducing low back pain to “a back problem” is an oversimplification that does not do justice to clinical reality or to the impact it has on a person’s life.
Low Back Pain — From a Clinical Perspective
Two people with apparently similar symptoms may experience completely different levels of impact in their lives, in what they can or cannot do, and in how they recover. This happens because pain does not depend only on muscles, discs, ligaments, joints, “bone spurs,” etc., but on how the organism as a whole interprets, responds to, and reorganizes itself around multiple stimuli.
In clinical practice, most low back pain is classified as non-specific low back pain.
This does not mean there is no cause, nor does it invalidate the person’s suffering (quite the opposite). It simply means there is no direct and linear relationship between a single anatomical structure and the pain experience.
At some point, many people undergo imaging exams such as X-rays or MRIs. The reports often include terms like disc protrusion, disc herniation at L4-L5 or L5-S1, disc degeneration, reduced intervertebral space, disc dehydration, misalignment, etc.
When this information is delivered without proper clinical context or without time for the person to integrate it, it can generate fear and disproportionate interpretations about the real meaning of these findings—which, in most cases, are not even related to the patient’s symptoms. A classic example is the large number of people who believe they have a disc herniation (and indeed it appears on imaging) but have none of the clinical symptoms of one.
All of this contributes to the nocebo effect—which occurs when an explanation or clinical information creates a sense of threat or negative expectation and, as a result, increases pain perception and functional limitation.
In low back pain, this often happens when the information received leads the person to believe their spine is fragile or that movement is dangerous.
The nervous system then begins to interpret normal movements as threatening, leading to more body vigilance, more tension, more movement avoidance—and often, more pain.
Over time, this cycle can drastically contribute to the chronification of symptoms, even without any structural worsening.
Understanding and reducing the nocebo effect does not mean ignoring important clinical signs. On the contrary, it requires careful assessment, solid clinical reasoning, and responsible communication.
Osteopathy and Low Back Pain
A modern osteopathic approach to low back pain is centered on a global understanding of the person. In practice, this means dedicating time not only to physical assessment, but also to clearly explaining what is happening, validating existing fears, and progressively building movement strategies adapted to each person’s reality—safely, without shortcuts and without simplistic narratives.
Osteopathy can be used as a tool to relieve pain, improve body awareness, and facilitate movement, always integrated into a broader recovery plan aimed at restoring confidence in movement, autonomy, and patient self-efficacy.
The ultimate goal is not just to reduce pain, but to help the person regain trust in their body, move safely again, and return to a functional, active, confident, and fulfilling life—doing the activities that have always brought them pleasure.
If you feel that low back pain is limiting your daily life and you are looking for a modern, evidence-based clinical approach (forget about miracles) focused on understanding your case and your present and future motivations, then a consultation may be the first step toward a life full of movement and health—whether you are in pain right now or not.
References
O’Sullivan, P., Caneiro, J. P., O’Keeffe, M., & O’Sullivan, K. (2016).
Unraveling the complexity of low back pain. Journal of Orthopaedic & Sports Physical Therapy, 46(11), 932–937.
O’Sullivan, P., Smith, A., Beales, D., & Straker, L. (2017).
Understanding adolescent low back pain from a multidimensional perspective. Physical Therapy, 97(6), 674–686.
Moseley, G. L., & Butler, D. S. (2015).
Fifteen years of explaining pain: The past, present, and future. The Journal of Pain, 16(9), 807–813.
Moseley, G. L., & Vlaeyen, J. W. S. (2015).
Beyond nociception: The imprecision hypothesis of chronic pain. Pain, 156(1), 35–38.
Brinjikji, W., et al. (2015).
Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR, 36(4), 811–816.
Author:
Dr. Pedro Malheiro – Professional Osteopathy License No. C-31076
Osteopath in Porto | Musculoskeletal Pain Specialist
Rua de Santos Pousada 1041, 4000-489 Porto