If you’ve been dealing with back pain for months… or years… this is for you.

Not the quick flare-up you get after lifting something heavy.
Not the “slept funny” stiffness that settles in a few days.

I’m talking about persistent back pain. The kind that lingers. The kind that keeps coming back. The kind that has you wondering what on earth is wrong with my body?

And more importantly — the kind that quietly drains your time, money, energy, and confidence.

I want to say this upfront, clearly, and without fluff:

Persistent back pain is not just the same injury happening over and over again. It’s a completely different process.

And if you don’t understand that, it’s very easy to keep wasting time and money on treatments that were never designed to work in the first place.

Let’s break this down.

1. Why Persistent Back Pain Is a Different Beast Altogether

Most people (and unfortunately, many practitioners) still think about pain like this:

“Something is damaged. Fix the damage. Pain goes away.”

That model works really well for short-term injuries.

Sprained ankle?
Muscle strain?
Acute disc irritation?

Great. Calm the tissues down, restore movement, build strength, and you’re on your way.

But persistent back pain doesn’t follow that rulebook.

By the time pain has been around for 3, 6, 12 months or more, the body has changed how it processes pain. The nervous system is no longer just responding to tissue signals — it’s learned pain.

Different pathways.
Different drivers.
Different rules.

This is why scans often show “nothing too serious”… yet the pain feels very real.
This is why rest doesn’t fix it.
This is why chasing the “one tight muscle” or “weak core” rarely works long-term.

It’s not because you’re broken.
And it’s not because you’re failing treatment.

It’s because the approach is wrong.

2. The Big Mistake That Keeps People Stuck

Here’s the mistake I see over and over again:

Persistent back pain being treated like an acute injury.

Endless hands-on treatment.
Repeated adjustments.
Massage after massage.
Temporary relief… followed by the pain creeping back in.

And each time, hope rises.
And each time, it quietly drops again.

Don’t get me wrong — these treatments can feel good. They can reduce pain short-term. But feeling better for a few hours or days isn’t the same as changing the system that’s producing the pain.

If pain keeps returning, the question isn’t:

“What treatment haven’t I tried yet?”

It’s:

“What hasn’t changed in the way my body and nervous system are responding?”

That’s the real issue.

3. Pain Is Not Just About Tissues (And That Matters)

This part can feel uncomfortable to hear — but it’s also empowering.

Pain is not a direct read-out of damage.

Pain is an output of the nervous system.

That means your brain, spinal cord, and nerves are constantly deciding whether something is safe or threatening. When the system becomes overprotective, pain can stick around long after tissues have gone through the healing process.

This doesn’t mean the pain is “in your head.”
It means your system has adapted.

And here’s the good news:

Adaptations can be retrained.

But not with passive treatment alone.

If nothing in the system is being challenged or updated, nothing changes. The nervous system keeps running the same old pattern.

This is why persistent back pain needs a retraining approach, not just a symptom-management one.

4. Why Strength, Stretching, and “Fixing Posture” Aren’t Enough

Let’s talk about the elephant in the room.

You’ve probably been told you’re:

Weak
Tight
Out of alignment
Sitting wrong
Lifting wrong
Sleeping wrong

And while movement quality does matter, this oversimplification causes problems.

I see plenty of people who are strong… flexible… active… and still in pain.

Why?

Because pain isn’t just about capacity.
It’s about confidence, predictability, and safety in movement.

If your system expects danger every time you bend, twist, or load your back, it will protect you — with pain — even if your muscles are more than capable.

Endlessly strengthening without addressing fear, sensitivity, and movement confidence is like upgrading the engine but never recalibrating the dashboard.

You’re missing the point.

5. What Actually Needs to Change for Pain to Settle

This is where things shift.

For persistent back pain to improve and stay improved, several things usually need to happen together:

The nervous system needs evidence that movement is safe
The body needs graded exposure to load and variability
Confidence in everyday movement needs to rebuild
Flare-ups need to stop being interpreted as damage
Control needs to return to you, not the treatment table

This is why one-off treatments rarely work.

Change happens through process, not quick fixes.

That process looks different for everyone, but it always involves active participation, not just being worked on.

And yes — this takes more effort than passive treatment.

But it also gives you something passive treatment never will:

Long-term control.

6. The Cost of Not Understanding This (And Why It Adds Up Fast)

Here’s the part most people don’t talk about.

It’s not just the financial cost.

It’s the mental load.
The constant scanning.
The avoidance.
The second-guessing every movement.

“I shouldn’t bend like that.”
“I’ll pay for this tomorrow.”
“I’d love to do that, but my back…”

Over time, pain shrinks your world.

And when treatment focuses only on chasing pain relief — without changing the underlying system — that shrinkage continues.

People often say to me:

“I’ve tried everything.”

What they usually mean is:

“I’ve tried lots of treatments — but nothing that actually retrained my system.”

That distinction matters more than you think.

7. Why Retraining the System Is the Missing Piece

Retraining doesn’t mean ignoring pain.
It doesn’t mean pushing through.
And it definitely doesn’t mean pretending nothing hurts.

It means working with the system, not against it.

Gradually restoring trust in movement.
Building tolerance instead of avoidance.
Understanding flare-ups instead of fearing them.

When people finally experience this approach, the response is almost always the same:

“Why hasn’t anyone explained this to me before?”

Honestly? I ask myself the same thing.

8. What to Do Before You Spend Another Dollar on Treatment

Before you book your next appointment, ask yourself (or your practitioner) these questions:

Is this approach designed for persistent pain, or short-term injury?
How does this help my nervous system adapt?
What am I learning that gives me control long-term?
If pain settles, what’s the plan to stop it coming back?

If there aren’t clear answers… pause.

Because more of the same rarely produces different results.

Final Thoughts (And a Bit of Reassurance)

If you’ve been stuck with back pain for a long time, it’s not because you’re weak, broken, or doing life wrong.

Your system has adapted — and adaptations can change.

But only if the approach matches the problem.

Persistent back pain requires a different lens, a different strategy, and a different goal. Not just “less pain today”… but a system that no longer needs to produce pain at all.

If this resonates, take it as a sign — not that you’ve failed treatment, but that it’s time for a smarter one.

And trust me… understanding this before you spend more time and money can change everything.

By Scott Howard (Clinical Exercise Physiologist) │ 29/01/2026 │ Alignment Exercise Physiology

Read This Before You Waste More Time and Money on Back Pain Treatment