What is Mechanical Back Pain? ... and why you don't need to worry!

Summary: The label mechanical back pain is an outdated label still used in practise today. It suggests spinal structure as the dominant source of back pain but fails to consider the human attached to the spine, their immune, neural and hormonal health. The label can foster worse outcomes as it suggests the need to fix or protect the spine from damage. Patients should be reassured that this is not an appropriate or accurate diagnosis.

Click here for our low back physiotherapy clinic to see how we can help you.

Chances are if you have low back pain, you’ve seen a physio and there is a good chance they might have told you that you have mechanical back pain.

But what does that mean?

Well not much really. Let me explain why.

Mechanical Back Pain originally came from the era where the biomedical model dominated

It was a time where our understanding of pain was still governed by a tissue-centric role and an appreciation for things like central sensitisation and the immune system to be focal players in low back pain was not even a thought!

We believed that structures like the facet joint, the discs, the ligaments were the primary cause of pain and largely attributed this to the ‘degeneration’ associated with ageing.

Ahhh the inescapable decay over time.

Yet we now know that an MRI at baseline fails to predict people’s pain in the future (Kasch et al., 2021); this is the same MRI that allows us to look at facet joints, discs, nerves, ligaments etc.

It is woefully inadequate to explain pain and completely ignores the person that spine belongs to, and the systems that comprise the human body.

What mechanical back pain fails to consider

In our wisdom, we now know that your immune system sensitivity and inflammatory status at the first onset of an acute low back pain episode determines your recovery from pain or, whether you progress to develop persistent symptoms (Brown et al., 2025).  

No MRI scan or fitting description of mechanical low back can adequately describe or diagnose this – let alone explain it to the person sat in pain!

Unfortunately, it fairs no better when it comes to our understanding of centrally driven sources of low back pain (Nijs et al., 2021) or how fear avoidance behaviour literally mediates your improvement in pain and disability from persistent low back pain (Schütze et al., 2025).

To put it plainly, mechanical back pain fails to consider the human experience of pain, and the very fabric and framework of cells outside of the spine, that make up the human body.

It is time to let go of mechanical back pain when talking to people suffering from pain

People’s perception of their ability to recovery from low back pain, their usage of imaging and opting for possible invasive interventions is shaped by how healthcare professionals describe their diagnosis.

Diagnostic labels for low back that are suggestive of a mechanical and degenerative origin lead to worse perceived future outcome (O’Keeffe et al., 2022), increased imaging useag (Sloan et al., 2010; Martin et al., 2025) and a possible preference for more invasive options (Martin et al., 2025; Sloan et al., 2010).

Words matter – and the semantics of ‘mechanical back pain’ very much suggest a structural view of pain. One we know is no longer true, but our patients do not!

The diagnostic label of mechanical back is no longer fit for purpose and fails to reflect a systems-wide approach to low back pain.

Instead, we must embrace the complexity of pain from the perspective of the conscious experience of pain and the bodies’ health.

When relaying this to our patients, we can not shy away from complexity but must finds ways to link their relevant systems and experiential aspects together, without falling into the trap of simplicity and offering mechanical or degenerative labels for sake of ease.

If you live in Cornwall and suffer from back pain, head over to our physiotherapy service page to access the resources that can help you and see what we offer!

References

Martin, S., Smith, M., Wilson, D. A., Zadro, J. R., Ferreira, G. E., & O’Keeffe, M. (2025). Non-specific diagnostic labels for musculoskeletal conditions foster positive views about prognosis and non-invasive management but require clear explanation: a systematic review. Journal of Physiotherapy, 71(3), 167-178.

Schütze, R., Liew, B., Caneiro, J. P., O'Sullivan, P., Kent, P., Hancock, M., ... & Smith, A. (2025). Mechanisms of change in cognitive functional therapy: A longitudinal mediation analysis of the RESTORE clinical trial for disabling chronic low back pain. Behaviour Research and Therapy, 193, 104853.

Sloan, T. J., & Walsh, D. A. (2010). Explanatory and diagnostic labels and perceived prognosis in chronic low back pain. Spine, 35(21), E1120-E1125.

Brown, M. C., Kosinski, A. S., Fillipo, R., Howell, G., Giang, M. H., Hurewitz, M., ... & Goode, A. P. (2025). Patterns and trajectories of peripheral inflammatory cytokines, immune tolerance, and lymphocyte differentiation predict transition from acute to chronic low back pain in a sex and age specific manner. Pain, 167(2), 477.

O'Keeffe, M., Ferreira, G. E., Harris, I. A., Darlow, B., Buchbinder, R., Traeger, A. C., ... & Maher, C. G. (2022). Effect of diagnostic labelling on management intentions for non‐specific low back pain: a randomized scenario‐based experiment. European Journal of Pain, 26(7), 1532-1545.

Kasch, R., Truthmann, J., Hancock, M. J., Maher, C. G., Otto, M., Nell, C., ... & Schmidt, C. O. (2022). Association of lumbar MRI findings with current and future back pain in a population-based cohort study. Spine, 47(3), 201-211.

Nijs, J., George, S. Z., Clauw, D. J., Fernández-de-Las-Peñas, C., Kosek, E., Ickmans, K., ... & Curatolo, M. (2021). Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine. The Lancet Rheumatology, 3(5), e383-e392.