When your back is really sore you may feel out of control of the situation, and that someone else must ‘take the pain away’.

Massage manipulation, heat or ice, and acupuncture are useful to ease the pain in the short term. You may have been told that there is a bone or joint in your back out of place, or that your pelvis is out of alignment, and that it must be “clicked back”. Having your back manipulated is not putting anything back in place – there was never anything ‘out of place’ in the first place!

Common beliefs that low back pain is caused by spinal subluxations, pelvic asymmetries, alterations in leg length and other simple structural issues, are incorrect. For most people with back pain X-rays and scans do not show any evidence of joints being out of place or that discs have ‘slipped’ out of place.

Research shows that people who are most disabled by low back pain are those who believe their pain relates to a problem with the structure of their spine, as this leads to heightened levels of fear, distress, and anxiety. There is very little evidence relating disc bulges to low back pain, as many people without low back pain have disc bulges without experiencing any pain. However, no study has ever shown that these bulges can be ‘clicked’ back into place by spinal manipulation. Most disc bulges resolve and shrink again over time and do not require surgery or injections.

The pain relief from all these treatments results from a reduction of the sensitivity or ‘activity’ of the nervous system, which helps to restore normal joint movement and muscle activity, and NOT from ‘clicking’ anything back into place.

Reliance on a ‘fix’ for your pain creates a dependency, reducing your self-confidence in coping with your back pain. In some cases it may be unrealistic to believe that chronic low back pain will go away completely. There are many people who have ongoing pain, but do not allow it to affect how they live their lives.

If you think about your pain constantly it becomes far worse – like an annoying song that plays over and over in your head. Like any chronic disease, such as depression, diabetes, and cardiovascular disease, low back pain must be self-managed. This can be done through developing a set of beliefs that your spine is a strong and resilient structure, and that you need not constantly worry about damaging it further.

Positive thoughts and beliefs such as 'I can be sore but safe’ – telling yourself that pain does not indicate damage, but rather a nervous system that is dialling up its intensity to get your attention – can help you manage your pain yourself.