Low back pain and manual therapy

Did you know?

Did you know that low back pain ranks 1 with the wining trophy for the most common musculoskeletal presentation worldwide?


If that didn’t surprise you, the next figure probably will. Did you know that low back pain causes 40% of absence from sickness in the NHS (1*)?


Far from being something that we as a society have under control, truth is our health system lacks an effective system to offer people experiencing this musculoskeletal presentation.


Our health system has little time, knowledge, tools or the patience to deal with an individual’s low back pain. There’s also a lot of misinformation and lack of information regarding low back pain and musculoskeletal pain and also A LOT of information in general, which makes it hard to know for someone experiencing low back pain, what to believe is best or what to do.


It’s important to understand that up to date research shows that low back pain doesn’t directly correlate with tissue damage, injury, spinal or disc problems (2*). This means that imaging testing, like for example MRI, in this case, doesn’t mean much.

So why are we experiencing back pain?

The answer is complex I’m afraid. Today we know that pain levels and general health is determined by a combination of biopsychosocial factors, that is biological, psychological and social. Welcome to the new age of the biopsychosocial model.


What this means is that musculoskeletal pain is much more complex than what we thought and that an effective approach towards addressing pain must take these previous factors into consideration. Therapies that see and address the body as a material, one dimensional thing, independent from these other aspects that make a human being’s pain experience, therefore fall behind and are not the most effective way to approach musculoskeletal pain.


Another important point is that pain levels are not determined in the tissue but in the nervous system and brain. A hyper sensitised system, caused by, for example, our very common friend “stress”, can directly mean, at a physiological level, increased pain levels.

How do we look at our body and what are we looking for?


Our body is a tensegrity system that holds itself in balance (tensional – compressional forcers keep things in place). Bones, fascia, muscle, organs… etc

When one or more of these elements becomes restricted or weak it destabilises the balance of the whole system, that automatically adapts to compensate for it. That’s how we end up twisting, bending and modifying the way we move in space. This makes our system less effective, more vulnerable to injury, pain and faster wear and tear.

When a therapist is faced with someone in pain is able to look at their body or the way they move in order to identify and release those structures that might be contributing to the pain.

Have a look at the work of Tom Myers and the Myofascial meridians for more information on this matter. Tom Myers studied our musculoskeletal structural system, the myofascial system and captured it in 12 myofascial meridians. These myofascial meridians are considered lines of pull which distribute strain, transmit force and affect the structure and function of the body.

On another note personalised strength based exercise has shown effective in clinic as well as for eradicating pain (3*)

So how do we keep out of pain?

The answer is simple and yet soooo hard. We must take care of all aspects of our being, especially in our society. We are in contact with so many stressors and challenges, mental, physical, spiritual… let’s be honest, we don’t live in an easy world. But, if a pill could take our pain away, would we seek to be better? Where would the fun be? Truth is the answer is on each one of us and no one can do the work for us.


A therapist will help, and an exercise rehab specialist or a psychotherapist, a nutritionist, a meditation teacher or a breathing specialist, but it’s ultimately on us to put in the work and do the exercises, commit to a block of sessions, or decide to change our thought patterns.



  1. The global burden of low back pain [website]. International association for the study of pain. 9 of July 2021  http://bit.ly/3GLJpdw

2. Maureen C. Jensen, Michael N. Brant-Zawadzki et al. Magnetic Resonance Imaging of the lumbar spine in people without back pain. 1994https://bit.ly/3ZDQVzP


3. Kell, Robert T1; Asmundson, Gordon J G2

A comparison of two forms of personalized exercise rehabilitation on programs in the management of chronic non-specific low back pain. March 2009 http://bit.ly/3XfgK7K


4. Myofascial Meridians for Manual Therapists and Movement Professionals. May 2020 by Thomas W. Myers (Author).