I'm a physical therapist... here's why you REALLY have back pain (2025)

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It can sometimes seem like when you wake up with back pain, it never goes away.

And if this appears to be a universal experience, that's because it kind of is.

'Back pain is not new and humans have experienced back pain for hundreds of years,' physical therapist Jen Uschold told DailyMail.com.

'Our disability from back pain is what is changing and increasing.'

If you feel pain in a certain area of your back, the assumption is that that area - whether it's your lower back, your shoulders, and so on - is the source of the pain.

But Uschold said that this isn't necessarily true.

'Pain is complex and it involves almost every system in our body and brain,' she said.

So when she's trying to pinpoint why one of her clients is feeling pain, she usually asks about when the pain started, how long the pain lasts, what the symptoms are, what activities or positions aggravate or ease the pain, and any other patterns they've noticed.

Uschold also said she asks patients if they had any recent changes or long standing stressors for the patient in their life.

She explained that figuring out where pain comes from usually involves considering the three main 'pain buckets.'

The first is traditional pain, like when you strain your back from lifting heavy at the gym.

This type of pain is called the nociceptive pain.

Then, there are nerve injuries which are referred to as 'peripheral neuropathic pain.'

And finally, the most complex kind of pain is called nociplastic pain or Central Sensitization.

'These are patients whose pain is unpredictable and doesn’t follow anatomical or neurological patterning,' Uschold said.

This kind of pain is the trickiest to treat.

Uschold said that the big picture is that back pain is complex and involves biopsychosocial elements.

'It is easy if someone falls and lands on their hip or back to understand that there is tissue injury,' Uschold said.

'However, we know that about 30 percent of people with chronic pain have never had an injury or a surgery.

'Forty percent of people who have no back pain have bulging discs on scans.

'This is why we need to keep disseminating the information on current science of pain and how it works so that individuals can decide the best treatments for themselves and truly shift from pain to gain.'

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