Why is debilitating low back pain so common? A compelling hypothesis: the spine is extremely important for survival and overreacting to false positives for spinal damage is survivable, while underreacting to false negatives is not. Vertebrates evolved to be hyper-vigilant about potential damage to their central nervous system, because this was catastrophic. Better to be safe than sorry!

Modern medical technology means that we can rule out catastrophic damage in almost all cases of low back pain; so why does the pain persist? Because our lizard brains didn’t evolve to be reassured by medical charts! To reduce pain, we have to manually reprogram and soothe the overreactive pain response. Like a trauma survivor who has experienced a trigger, it’s important to slowly increase exposure and avoid “retraumatizing”, or the cycle of pain, catastrophizing, fear, and avoidance will persist.