Low Back Pain: When it Keeps Coming Back
You’ve done the stretches, strengthened your core, bought a better chair and pillows. Maybe you’ve tried massage or acupuncture. Yet the pain keeps coming back — sometimes catching you off guard.
You are definitely not alone!
Low back pain is one of the most common reasons people seek physiotherapy and remains a leading cause of disability worldwide.1 Many treatments for back pain do help for a while, but lasting relief is often harder to achieve. For a lot of people, the pain just keeps returning.
So what’s going on here?
Looking at Pain Through a Broader Perspective
For a long time, back pain was seen mostly as a “mechanical” problem — something wrong with the muscles, joints, or discs. And those physical things do matter. An injury, strain, or changes in the back often start the cycle of pain.
What we’ve learned over time, though, is that pain isn’t only about damage to the tissues. It is influenced by a complex mix of biological, psychological, and social factors.
Biological: strength, flexibility, genetics, hormones, nutrition, sleep
Psychological: thoughts, feelings, beliefs, personality traits, coping styles, stress
Social: relationships, social connections, work demands, past experiences
Including these other factors doesn’t dismiss the physical side of pain — it adds to it. Understanding how these pieces work together helps us find more ways to reduce pain and restore function. That’s why a purely physical approach (like stretches or strengthening alone) sometimes falls short.
What Research Shows
A recent large study from Australia, known as the RESTORE trial, explored what happens when treatment takes this bigger picture into account. The program focused on helping people understand their pain and address unhelpful thoughts and habits that can contribute to ongoing pain.
For many people, this kind of approach feels different. It’s not about ignoring the body, but about understanding how the body, mind, and daily life all interact and influence recovery. In the study, people received individualized support, which included gradually building up activity, learning to move with less fear and more confidence in their back, and returning to the things that mattered most to them.
The results were impressive: participants experienced meaningful improvements not only right after treatment, but also years later. Pain relief and improved function were sustained for three years.2 That kind of long-term change is rare in back pain research.
Seeing results like this reinforces what I’ve observed in practice. Lasting progress happens when we treat the whole person, not just the back.
Where Exercises Fit
Don’t get me wrong — movement and strength matter. Exercises that stretch and strengthen the muscles around your back play an important role in recovery, helping you move more freely and regain confidence in your body.
But if your back pain keeps coming back, it might be time to take a broader approach — one that considers not just your muscles and joints, but also your thoughts, habits, and overall lifestyle. This broader perspective may give you a better chance at lasting relief.
References:
da Silva, T., Mills, K., Brown, B. T., et al. (2019). Recurrence of low back pain is common: a prospective inception cohort study. Journal of Physiotherapy, 65(3), 159–165.
O’Sullivan, P. et al. (2025). RESTORE Trial: Cognitive functional approach for chronic low back pain — long-term outcomes. British Journal of Sports Medicine, in press.