Why Your Food Choices Might Be Making your Back Pain Worse - And How To Fix It?

Back pain is one of the most common reasons people seek physiotherapy in Truro — but what many people don’t realise is that their food choices may be quietly amplifying their symptoms. The link between diet, inflammation, and musculoskeletal pain is now well‑established, and for anyone searching for back pain physio in Truro or trying to understand the root cause of persistent discomfort, nutrition is a crucial part of the puzzle.

Your body evolved in an environment rich in whole foods, fibre, omega‑3 fats, and phytochemicals — not the ultra‑processed foods that now make up 65% of daily calorie intake in the UK (Madruga et al., 2023). The changes in during and post-industrial revolution saw the induction of processed and ultra-processed food into our diet, which has steadily increased in total calorie consumption to present day. These modern dietary patterns don’t just affect metabolic health; they directly influence the inflammatory pathways involved in back pain.

Nova 1	Foods directly derived from plants or animals that have undergone no processing stages in between other than cooking! Or as I like to say, from the pasture to the plate. Examples are beans, grains, berries (fresh / frozen), meats that are cut straight from the animal
Nova 2	Processed culinary ingredients, such as oils, butter, sugar and salt, are substances derived from Group 1 foods or from nature by processes that include pressing, refining, grinding, milling and drying
Nova 3	Processed foods, such as bottled vegetables, canned fish, fruits in syrup, cheeses and freshly made breads, are made essentially by adding salt, oil, sugar or other substances from Group 2 to Group 1 foods. Processes include various preservation or cooking methods, and, in the case of breads and cheese, non-alcoholic fermentation
Nova 4	Ultra-processed foods, such as soft drinks, sweet or savoury packaged snacks, reconstituted meat products and pre-prepared frozen dishes, are not modified foods but formulations made mostly or entirely from substances derived from foods and additives, with little if any intact Group 1 food

How Foods Influence Low Back Pain and Sciatica Through Neuroinflammation

Across persistent back‑pain conditions — including chronic low back pain, radicular pain, and fibromyalgia — researchers consistently find neuroinflammation at the tissue, spinal cord, and brain level (Ji et al., 2018). This inflammation increases sensitivity in the nervous system, making it easier for pain signals to fire.

At The Tissue Level (In The Low Back Area)

Multiple pro-inflammatory cytokines such as TNF-α, interleukin 1β (IL-1β), prostagladins and reactive oxygen species (ROS) increase the sensitivity of the tissue and reduce the threshold required for the nociceptor to fire an action potential back to the spinal cord (Ji et al., 2018; Grace et al., 2014). This means your back becomes more sensitive to movement, load, and even normal daily activities.

In people with chronic pain, nociceptive thresholds have been predicted based on the type and extent of peripheral immune cell activity (Grace et al., 2014) highlighting the interrelated network of neuroimmune changes.

Changes In The Spinal Cord

Glial cells are immunocompetent cells in the central nervous system including microglia, astrocytes and oligodendrocytes and influence spinal cord sensitivity for months after the initial event. They diffuse and bind to receptors on presynaptic and postsynaptic terminals in the spinal dorsal horn to modulate excitatory and inhibitory synaptic transmission (Grace et al., 2014). These signalling molecules released by or expressed on immunocompetent cells in the spinal cord region include CD11b, IBA1, CX3CR1, ROS, the cytokines TNF, IL-1β, and IL-6 and chemokines CCL2 and CXCL1 (Ji et al., 2018; Grace et al., 2014).

The targeting the 18-kDa translocator protein (TSPO) is a protein mainly located on the outer mitochondrial membrane of various cell types and is in high abundance in the neuroforamina in the spinal cord (Loggia et al., 2024). It is expressed in low levels in a healthy CNS but high levels in dysfunctional and concentrations of TSPO in the spinal cord correlate with symptoms in people with persistent low back pain with sciatica (Schipholt et al., 2025).

Changes in the brain

Emerging evidence in low back pain animal models show increased neuroinflammation in the brain in the prefrontal cortex, anterior cingulate cortex and periaqueductal grey area which are associated with the emotional dimension of pain and descending facilitatory pathway respectively (Vergne-Salle & Bertin, 2021).

Neuroimmune sensitivity and neuroinflammation due to immune system dysfunction increase pain sensitivity to movement and pain intensity in low back pain and sciatica and may be responsible for the persistence of low back pain symptoms (Morris et al., 2020; Pinto et al., 2023).

Ultra-processed foods increase back-pain-related inflammation

Eating processed and ultra-processed foods increases inflammation and immune system dysfunction characterised by increased levels of cytokines including TNF-a, IL-6 and CRP and immune system dysregulation leading to a state of low-grade inflammation (Hart et al., 2021; Dos Santos et al., 2023). 

Research shows for every 100g increase in consumption of UPFs, there is an associated 2.5% increase in high sensitivity CRP concentration (95% CIs: 0.8–4.3%, p = 0.004), even after sensitivity analysis (Lane et al., 2022).

In other words: your diet can make your back pain louder!

Mediterranean and Whole-Food Approaches Reduce Back-Pain-Related Inflammation

Food is a powerful weapon in our arsenal as therapists to help calm shit down in the body.

I can appreciate that we are not nutritionists or dieticians but an awareness and appreciation for the simple suggestions that could have a huge impact on our patients in pain (or ourselves) can have lasting effects!

The Mediterranean approach involves consuming higher amounts of fruits, vegetables, legumes, vegetables, olive oil, fish and less red and processed meats and dairy (as shown in Table 1 below). This is often one of the key bits of advice I discuss with my clients for their back pain in my Physiotherapy clinic in Truro, Cornwall. This is consistently effective in reducing inflammatory cytokines like IL-6 and CRP (Koelman et al., 2022; Davis et al., 2015; Wu et al., 2021)

The short questionnaire reproduced below (see Martínez-González et al., 2004) can serve as a barometer to how closely you follow the Mediterranean approach and identifying areas you need to tweak.

I would caution the higher wine intake and advise to reduce it as whilst high in phytochemicals, the wines purported in the Mediterranean are from specific Vineyards and often very expensive and difficult to obtain in the UK!

Whole-food approaches also show reduced disease-related inflammatory markers in people suffering with Chrons disease (Limketkai et al., 2025) and Gingavitis (Pappe et a., 2025) and see improvements in symptoms and reduced disease-based markers in as little as 8-weeks (Limketkai et al., 2025).

Current thinking in the area suggests the focal mechanisms behind improved inflammatory markers following either the Mediterranean or whole-food based approach are the increased intake of dietary fibre, Omega-3 fatty acids and phytochemicals (Thomas et al., 2023) all of which have potent anti-inflammatory properties (Thomas et al., 2023). You cannot go wrong with firstly eliminating processed stuff from your diet before then trying more intensive, time-consuming dietary approaches!

Food is a powerful weapon in our arsenal as therapists where sensitive, painful tissues can often prevent effective loading protocols that would allow the person to engage fully with their valued activities and calm the tissue down over the long run.

If you’re dealing with persistent back pain, your food choices may be quietly fuelling inflammation and sensitising your nervous system. By shifting toward whole foods and reducing ultra‑processed intake, you create the internal environment your body needs to heal — making physiotherapy more effective and recovery faster. If you need a back pain physio in Truro to seamlessly integrate Physiotherapy with your Nutrition practises then my Three Pillars approach fits perfectly for helping you resolve your back pain - so book your appointment now.

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