Lower back pain myth No.3: persistent back pain means serious damage.

Persistent back pain is rarely associated with serious tissue damage.

The majority of back pain has no major injury associated with it, and imaging doesn't help with identifying a cause. Most of this may be explained by muscle strains or spasms, stress to other structures around the joints, such as the capsule and ligaments, or various other factors.

If you do have an injury, tissues heal within three months. Pain beyond this point usually means there are other contributing factors such as stress, tension, fatigue, inactivity or unaccustomed activity which make the back sensitive to movement and loading.

People sometimes fear that exercise will cause further damage, but in fact exercise is very helpful for lower back pain, so finding ways to overcome this sensitivity to movement and loading is important. Injuries heal, and we're not so fragile as we might think. We do better for movement, and worse for avoiding it.

If you've had an extended period of pain, your nervous system responds to this by laying down new pathways that can prolong your experience of pain beyond the point where tissues have healed. Your nervous system has simply got used to firing off in a certain way, and this is the reason for your ongoing pain.

Stress, anxiety and fear associated with back pain can contribute to this, and can be made worse by things like your social situation, how the back pain affects your work and life, and also by your thoughts and beliefs about low back pain. There are usually plenty of people ready to tell scare stories! All this can affect how you respond - what you do and don't do - and sometimes some of these decisions can be unhelpful in resolving your pain.

This can be addressed, often in large part by simple education about back pain, and support in developing positive coping strategies. Exercise, stress management techniques, sometimes counselling, and generally taking a proactive approach can all be helpful.

When low back pain doesn’t go away, it’s natural to start to wonder why, but sometimes the way we make sense of back pain can lead to anxiety and poor coping strategies which lead to worse experiences of pain.

Addressing some of the myths around lower back pain can help people start to have confidence they can get better, and provide motivation to take control of managing their own recovery.

Fact: persistent lower back pain is rarely a sign of serious damage, and can be helped with an approach that takes into account a broader range of factors.

If you have back pain that isn't getting better on its own, it can be helpful to talk to a professional.

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