Q: I'm mystified by the advice I've gotten for my back pain. It seems serious to me with severe degeneration of the spine and disc narrowing at all levels in my low back yet the doctor I'm seeing and the physiotherapist are insisting I need to exercise, stretch, and keep moving. Won't increased activity make it worse?

A: Many fears patients have around back pain are unfounded and become an obstacle to recovery. Patients put much more importance on back pain and assume the pain means the spine is weak and vulnerable. This just isn't true.

Research is pretty clear that movement, activity, and exercise are the keys to recovery from back pain. Rest, inactivity, and fear of movement only lead to greater limitations and increased disability. We know now that patients with low back pain who develop fear-avoidance behaviors (FABs) are at risk for a poor outcome and greater disability. Studies have also shown that when FABs are addressed in treatment, patients have much better results.

Fear-avoidance behaviors (FABs) refer to ways patients change their behavior, actions, movements, and activities based on the fear that their pain will increase or that their actions will cause reinjury. Their thoughts and emotions rule their behaviors because of concerns, worries, and fears that further harm will come to their spine.

Scientists who study the problem of chronic or recurrent low back pain are starting to see a pattern. It looks like physical activity is less likely the cause of spinal degeneration and more likely the result of genetics.

They are working on exploring the theory that instead of an injury model of low back pain, it may be possible that instead genetically predetermined factors influence what happens. The cells that make up the spine may not fail to stay healthy because of physical and occupational exposure to stress and load. They may just have a predetermined time clock that runs out regardless.

Another idea that might explain chronic back pain has to do with something called central sensitization. The spinal cord interprets incoming signals as painful whether they are or not and sends them to the brain quickly without investigating further. The spinal cord becomes highly attuned to any input and channels it all as pain messages.

This may explain why your health care providers are saying that your pain is not a sign that there is further damage to the spine with your activities. Everything we know from studies suggest just the opposite: "motion is lotion." We have to move in order to keep good spinal health. Another appropriate expression: "use it or lose it" applies here as well.

Reference: James Rainville, MD, et al. Fear-Avoidance Beliefs and Pain Avoidance in Low Back Pain -- Translating Research Into Clinical Practice. In The Spine Journal. September 2011. Vol. 11. No. 9. Pp. 895-903.