Conditions
Living with persistent back pain can be frustrating—but understanding what’s happening is often the first step towards recovery.
Back pain is one of the most common reasons people seek medical advice. While most episodes improve within a few weeks, some people continue to experience pain for months or years despite scans, treatments or even surgery. At Wye Sanctuary, we believe that understanding the cause of your pain is just as important as treating it. Persistent back pain is rarely explained by a single scan finding or diagnosis. Instead, it often reflects a combination of changes in the spine, the nervous system and the way the body adapts over time. Our role is to help you understand what may be contributing to your pain, identify any conditions that require specific treatment and develop a personalised plan that helps you regain confidence and quality of life.
Many people are told they have wear and tear, disc degeneration or arthritis and understandably assume that their spine is becoming damaged. In reality, these changes are extremely common and are often a normal part of ageing. Many people with significant changes on MRI scans have no pain at all, while others experience severe pain despite relatively minor scan findings. This does not mean the pain is imagined or “all in your head.” Rather, it reminds us that persistent back pain is usually more complex than a scan alone can explain. At Wye Sanctuary, we look beyond imaging to understand the whole picture—your symptoms, lifestyle, previous injuries, general health, sleep, physical activity and the way your nervous system may have adapted over time.
Chronic low back pain describes pain felt in the lower part of the spine that persists for more than three months. For some people, pain begins after an injury or episode of acute back pain. For others, it develops gradually without a clear cause. Sometimes there is a specific structure contributing to symptoms, such as the facet joints, sacroiliac joints or an irritated spinal nerve. In many people, however, pain reflects a combination of mechanical changes, muscle deconditioning and increased sensitivity within the nervous system. Understanding these different contributors is an important part of developing an effective treatment plan.
Persistent back pain is often best understood by thinking of the nervous system as the body’s alarm system. Its job is to protect you by producing pain when it believes your body may be under threat. After an injury, this alarm system usually settles as healing occurs. Sometimes, however, it remains switched on for longer than necessary, becoming more sensitive over time. This means everyday movements such as bending, sitting or walking can become painful even though they are not causing further damage. Pain is always real. The goal is not to convince you that nothing is wrong, but to understand why the alarm has become so sensitive and how we can help turn the volume back down.
Local back pain
Aching or stiffness across the lower back, often worse after prolonged sitting, standing or certain movements.
Referred pain
Pain may spread into the buttocks, hips or thighs without necessarily indicating nerve damage.
Nerve pain (Sciatica)
Pain travelling below the knee, sometimes with numbness, tingling or weakness, may indicate irritation of a spinal nerve.
Stiffness
Stiffness first thing in the morning or after remaining in one position for long periods is common.
Flare-ups
Symptoms often vary from day to day. These fluctuations are common and do not necessarily indicate further injury.
There is rarely one single cause. Each person has a unique combination of contributing factors, which is why treatment should always be individualised.
Previous episodes of back injury
Degenerative changes within the spine
Arthritis affecting the facet joints
Disc degeneration
Muscle weakness or deconditioning
Persistent nerve sensitivity
Poor sleep
Stress and emotional wellbeing
Fear of movement
Diagnosis begins with listening. Understanding how your pain developed, what makes it better or worse and how it affects your life often provides more useful information than a scan alone. A careful examination helps identify whether symptoms are likely to arise from muscles, joints, nerves or other structures. Imaging such as MRI is useful in some situations, particularly when symptoms suggest nerve compression or another underlying condition, but not everyone requires a scan.
Most back pain is not dangerous, but you should seek urgent medical assessment if you develop:
Loss of bladder or bowel control
Numbness around the buttocks or genitals (saddle numbness)
Increasing weakness in one or both legs
Severe pain following major trauma
Fever, unexplained weight loss or a history of cancer associated with new severe back pain
These symptoms are uncommon but may indicate conditions that require urgent investigation.
MRI reports often describe findings such as disc bulges, degeneration, modic changes, facet arthritis, stenosis or spondylolisthesis. These words can sound alarming, but many findings are common and do not automatically mean your spine is damaged or that surgery is needed. The important question is whether the scan findings match your symptoms, examination and goals. We use imaging as one part of the picture—not the whole explanation.
Myth: “My spine is worn out.”
Reality: Age-related changes are common and do not necessarily explain persistent pain.
Myth: “A slipped disc means I’ll need surgery.”
Reality: Most disc prolapses improve naturally over time, and only a small proportion of people require surgery.
Myth: “Pain means I’m causing damage.”
Reality: In persistent pain, the nervous system can become more sensitive. Pain does not always mean further injury is occurring.
Myth: “I should avoid movement.”
Reality: Remaining active, within comfortable limits, is usually one of the most important parts of recovery.
Treatment is most effective when it is individualised and combines education, rehabilitation, lifestyle support and carefully chosen medical treatments.
Understanding
Learning about persistent pain reduces fear and helps you make informed decisions about treatment.
Lifestyle
Sleep, regular movement, healthy weight, stress management and pacing all influence long-term outcomes.
Physical rehabilitation
Physiotherapy, strengthening exercises and gradually increasing confidence in movement form the foundation of treatment.
Medication
Medication may reduce symptoms for some people but is rarely the complete answer.
Procedures
Injection treatments can help when symptoms arise from specific structures such as facet joints, sacroiliac joints or irritated spinal nerves.
Emerging approaches
Research supports approaches such as pain neuroscience education, cognitive functional therapy, lifestyle medicine, digital rehabilitation and selected neuromodulation techniques.
We recognise that no two people experience back pain in the same way. Our assessments are designed to understand the whole picture, identify the most likely contributors to your pain and develop a treatment plan that reflects your goals. This may include education, rehabilitation, medication review, image-guided injections where appropriate and support to help you regain confidence in movement and everyday life.
One of the commonest things I hear in clinic is, “My back is worn out.” It’s completely understandable to feel worried if you’ve been told you have degeneration or arthritis in your spine. The reassuring news is that these changes are incredibly common and often don’t tell the whole story. In my experience, understanding why your back hurts is often the first step towards reducing fear, rebuilding confidence and finding the treatments that are most likely to help. Even if you’ve lived with back pain for many years, there is almost always something we can do to help you move forward.
If you’ve been living with persistent low back pain and would like a specialist assessment, we’d be happy to help.
During your consultation we’ll take time to understand your symptoms, review any previous investigations and treatments, explain what may be contributing to your pain in clear language and work with you to develop a personalised plan.
Whether your back pain is new, recurring or has been present for many years, our aim is to help you move forward with greater understanding, confidence and practical support.
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