Chronic Back Pain: Why It’s Often More Than Just the Spine

Chronic back pain is one of the most common and frustrating conditions affecting adults today. But contrary to popular belief, the cause of persistent back pain isn’t always the spine itself. Often, it’s a combination of posture, muscle imbalances, core weakness, and joint dysfunction. This article explores why a whole-body approach is essential in diagnosing and treating chronic back pain—and why simply treating the spine may not be enough.

Understanding the Complex Nature of Back Pain

The spine is a vital structure—but it doesn’t work in isolation. It relies on a delicate balance of muscles, joints, ligaments, and nerves to function properly. When one part of the system is misaligned or weakened, the whole structure compensates—often leading to chronic strain or pain.

Common contributors to chronic back pain include:

• Poor posture (especially from prolonged sitting or screen time)

• Weak core muscles that fail to stabilise the spine

• Muscle imbalances between the front and back of the body

• Tight hips, hamstrings, or glutes that pull the spine out of alignment

• Restricted joint mobility in the pelvis or thoracic spine

When pain persists for more than 12 weeks, it is classed as chronic. But the true source of the pain may not show up on a traditional spinal MRI, leading to underdiagnosis or misdirected treatment.

Posture and Core Stability: The Hidden Drivers of Pain

Your spine is only as strong as the muscles supporting it. Modern lifestyles—marked by desk work, poor ergonomics, and sedentary habits—have created a posture crisis.

Common postural issues include:

• Forward head carriage

• Rounded shoulders

• Anterior pelvic tilt

• Flattened or exaggerated lumbar curve

All of these create chronic tension in the spinal muscles and increase mechanical stress on the vertebrae and discs. Without intervention, these postural patterns become ingrained and contribute to pain, inflammation, and stiffness.

Core stability is another major factor. The core isn’t just your abdominals—it includes the deep muscles of your back, pelvis, and diaphragm. Weakness here leads to overcompensation from the larger back muscles, which can eventually become tight, fatigued, and painful.

Muscle Imbalance and Movement Dysfunction

Muscle imbalances occur when one group is overactive while the opposing group is underactive or inhibited. For example:

• Overactive hip flexors and underactive glutes

• Tight lower back muscles and weak abdominals

• Dominant quads and underused hamstrings

These imbalances distort the way you move, placing repetitive stress on the spine. Over time, this can lead to degenerative changes—not because the spine is “bad,” but because it’s carrying loads it was never meant to manage.

At MSK Doctors, we often use motion analysis and muscle function testing to identify the true contributors to back pain. Fixing the movement pattern—not just masking the symptoms—is the long-term solution.

The Role of Diagnostics in Chronic Back Pain

While scans like MRI can be useful for detecting disc herniation or spinal stenosis, they often don’t tell the full story. Many patients with chronic back pain have normal imaging—or findings that don’t correlate with their symptoms.

That’s where functional diagnostics come in:

• Motion capture analysis (e.g. MAI-Motion™)

• Gait and posture assessments

• Core strength and muscle endurance testing

• Joint range of motion and movement asymmetry mapping

By analysing how your body moves in real time, we can detect subtle issues that don’t appear on a scan—like asymmetrical load distribution or delayed muscle activation. These diagnostics help us create highly personalised treatment plans.

Additional Patient Information

If you’ve been living with chronic back pain and feel like traditional treatments haven’t helped, it’s time to look beyond the spine. Treating posture, strengthening your core, and rebalancing your muscles can reduce pain, improve function, and prevent recurrence.

At MSK Doctors, we offer a full body approach—combining cutting-edge diagnostics with regenerative treatments, physiotherapy, and patient education. Whether your pain began from an injury, long-term desk work, or age-related changes, a tailored plan can help you take back control.

FAQs

What if my back pain doesn’t show up on an MRI?
Many causes of chronic pain are functional—not structural. Poor posture, muscle dysfunction, or joint stiffness won’t appear on a scan but still contribute to pain. Motion analysis can reveal these issues.

How does posture affect my spine?
Poor posture places uneven stress on spinal joints and muscles. Over time, this leads to fatigue, inflammation, and misalignment that contribute to chronic pain.

Can weak core muscles cause back pain?
Yes. A weak core fails to support the spine, forcing other muscles to compensate. Strengthening the core improves spinal stability and reduces pain over time.

Is back pain always caused by a spine issue?
No. Hip, pelvis, and leg dysfunction can all impact spinal mechanics. Treating the spine without addressing surrounding structures often leads to incomplete relief.

What type of exercise helps chronic back pain?
Core activation, postural correction, and mobility work are key. Programmes should be tailored, avoiding heavy impact or repetitive strain early in recovery.

Do I need surgery for chronic back pain?
In most cases, no. Conservative and regenerative options—such as physiotherapy, core reconditioning, and targeted injections—can be very effective.