Why Does Your Back Hurt?

Summary

• Chronic low back pain has 6 main pain generators: discs, facet joints, SI joints, muscles, central sensitization, and spinal stenosis
• In more than 85% of chronic low back pain cases, no single cause can be identified
• MRI "abnormalities" are usually normal aging — the same changes found in 96% of pain-free 80-year-olds
• Because multiple sources are involved, combined, multi-modal treatment approaches tend to work better than targeting one structure
• "MRI abnormality → surgery" is not supported by the evidence