You have had back pain for weeks, maybe months. You go to the doctor. They order an MRI scan. The report arrives: "L4-L5 disc protrusion", "mild spondylolisthesis", "degenerative changes at L3-L4". And suddenly you have a name for what is happening to you. A name that sounds serious. A name that, in some way, justifies the pain you have been feeling for so long.
The problem is that this report is not telling you the whole story.
The image is not the diagnosis
In 2015 a study was published that changed the way many physiotherapists and doctors understand back pain. The researchers performed MRI scans on completely healthy people, with no symptoms at all, and analysed what they found in their spines.
The results were striking: 37% of pain-free people in their twenties had findings on imaging. Among people in their fifties, the proportion with symptom-free disc degeneration reached 80%. Herniations, protrusions, degenerative changes — all present in the spines of people who felt absolutely nothing (Brinjikji et al., 2015 · PMID 25430861).
What this means is uncomfortable but important to understand: finding something on a scan does not explain why you hurt. And the absence of pain does not necessarily mean your spine is fine. The image and the pain are two different things.
Pain is not a signal from the tissue
For a long time, pain was understood as a direct alarm from the body: if there is damage, there is a signal. If there is a signal, there is pain. Simple.
The problem is that the body does not work like that.
Pain is a signal produced by the central nervous system in response to a perceived threat. The brain gathers information from many sources — tension in the tissues, yes, but also emotional context, stress levels, your history of previous pain, expectations and beliefs — and decides whether there is enough reason to generate the experience of pain. It is a protective decision, not a direct transmission of damage.
Moseley and Butler explain this in detail in their work on the neuroscience of pain (2015 · PMID 26051220), and it is the basis of what is known as pain neuroscience education: understanding how pain works in order to address it more effectively.
It does not mean the pain is made up. It means there are more factors involved than the ones that show up on an image.
Why this explains recurring pain
If pain were only a matter of tissue, treating the tissue would be enough. But if the nervous system has learned to trigger the pain alarm under certain stimuli — particular movements, postures or stressful situations — that alarm can keep going off even after the tissue has healed.
This is what is known as central sensitisation: the nervous system becomes more sensitive, more reactive, with a lowered pain threshold. Not because there is more damage, but because the system has been on alert for a long time.
This is what lies behind back pain that comes and goes. The kind that improves with rest and returns as soon as you pick up daily life again. The kind that gets worse under stress even when you have done nothing physically different. The kind that has been appearing in the same place, with the same intensity, for years, despite several courses of treatment.
The most common mistake with recurring pain
The mistake is to treat the pain as if it were purely structural when there is a significant component of nervous-system sensitisation.
Rest, heat, anti-inflammatories — all of these can relieve things in the moment. But if the nervous system is not addressed, the pattern returns. The brain has still learned that this situation — this movement, this posture, this level of load — is a threat. And the alarm sounds again.
What changes with this approach is graded exposure: teaching the nervous system, with real and safe evidence, that it can move without anything bad happening. That loading is not dangerous. That pain does not always indicate damage. That takes time, progressive movement and an understanding of what is going on.
Understanding pain is part of the treatment
Something happens when someone truly understands how pain works. Not as psychological reassurance — but as a real change in the response of the nervous system. Pain neuroscience has documented that explaining the mechanism of pain reduces the perceived threat, and with it, the pain itself.
It is not the only step. But without it, many treatments act on the symptoms without touching the cause.
In the Reset Program, the first block of Session 1 is dedicated to exactly this: understanding why it hurts before you start moving. Not as theory, but as the foundation that makes every exercise meaningful in your body.
Because when you understand that pain is an alarm signal and not a verdict on the state of your discs, something changes. You start to move in a different way. With different information.
If you recognise this in your own back, the Reset Program works on all four axes of the method from session 1.