As health professionals, we have a duty to provide helpful and accurate information to our patients, especially since a majority of patients come seek our services for more information on such an uncertain event as an acute back pain episode.

Beliefs around lower back pain drive our behavior and certainly influence our experience of pain throughout all of its stages. These beliefs are exhibited by patients who feel low confidence in their ability to function despite pain (self-efficacy), negative thoughts about the causes and consequences of back pain (catastrophisation), low expectations of recovery, avoidance of movement and activities of daily living (fear avoidance), and psychological distress (anxiety, depression, stress). I think it’s pretty clear how these beliefs can contribute to the threat value of pain.

The study I’m referencing surveyed the general population, people who have back pain, clinicians, and groups from various studies about their beliefs on back pain.

A large percentage of back pain clients believe their backs are vulnerable somehow. They think there’s a structural dysfunction, weakness, and/or tissue damage. It seems as though back pain is viewed as especially harmful because of its location and how it can hinder our activities of daily living, sports, employment, spiritual, and cultural activities.

Beliefs about back pain

According to Darlow (2015), investigating the beliefs of people with back pain, the reasons for believing it’s vulnerable is ‘the back is often considered to be poorly designed or maladapted for modern life and, as it is used for most daily activities, this is seen to put it at risk of overuse or misuse. Personal factors such as physical traits, genetics, lifestyle, or previous injury creating a weak point are also viewed as reducing the strength or capacity of the back and, consequently, predisposing individuals to back problems. Observation or experience that back pain often starts after a trivial event can validate or reinforce the belief that the back is fragile. Consequently, activities which are seen as placing load on the back such as bending, lifting, twisting, and sitting are considered to be dangerous. Many people view back pain as resulting from a failure to adequately protect the back from adverse load, indicating that higher levels of protection (including avoidance of ‘dangerous’ activities) are required in future.’

Wow, as you can see cognitive factors such as belief can actually persist not only our back pain, but pain anywhere felt physically. 

Also, there’s strong evidence indicating that a clinician’s beliefs on back pain is highly influential on the patient’s beliefs on back pain. This information has a long-lasting impact on patients.

So I think health practitioners need to carefully consider and evaluate their own beliefs on back pain because they are viewed as esteemed professionals with high influence.

If I told you that your back is weak, or the joints are out of place or subluxed, or the muscles are being strained further from your activities, or your fascial sheaths are adhered together, that your vertebral discs will ooze jelly, then will this not reinforce fearful behavior around our back pain?

Perhaps offering advice that restricts the use of the back such as controlling posture, lifting techniques, bed rest, and avoiding back provoking activities negatively reinforce clients’ behavior?

I think so.

Instead, we should focus on positive outcomes and our innate ability to recover and heal. On the up side, clinicians can also have a positive influence and offer plenty of reassurance that back pain is very common, it’s not that serious in most cases, it’s OK to move, and that recovery is likely if you live your life and go on about your day. For more specifics, here are the latest guidelines on dealing with back pain


  1. Darlow, Ben, Beliefs about back pain: the confluence of client, clinician and community, International Journal of Osteopathic Medicine (2016), doi( 10.1016/j.ijosm.2016.01.005).
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