What to Tell Patients About Mechanical Back Pain
Tell your patient that mechanical back pain arises from spinal structures like bones, ligaments, discs, and joints—not from serious disease—and that staying active rather than resting is the single most important action they can take to recover quickly and prevent chronic disability. 1
Core Message: Reassurance and Activity
Emphasize that 90% of mechanical back pain episodes resolve within 6 weeks regardless of treatment, and that their pain does not indicate serious structural damage. 2 This reassurance is critical because fear-avoidance behaviors worsen outcomes and increase the risk of chronic disability. 1
Explicitly advise against bed rest and strongly encourage continuing ordinary activities within pain limits. 1, 2 The evidence shows that staying active reduces disability, while passive strategies like rest worsen outcomes. 3 Patients should return to work as early as possible, even with modified duties if needed. 1
Explaining the Mechanism
Mechanical back pain accounts for 97% of back pain cases and originates from spinal structures including bones, ligaments, discs, joints, nerves, and surrounding soft tissues. 4 Unlike serious conditions (infection, cancer, fractures), mechanical pain responds to conservative management and activity modification. 4
Tell patients that minor flare-ups may occur in the subsequent year, but this is normal and does not indicate treatment failure or worsening disease. 2
Self-Management Resources
Provide comprehensive self-management resources beyond a simple leaflet, including online audio resources, telephone helplines, paper-based information, and links to reputable healthcare charities. 1 However, signposting alone is insufficient—patients need direct support, reinforcement, and frequent contact from primary care. 1
Educate patients on proper body mechanics and safe back exercises for injury prevention. 2 Recommend ice for painful areas and gentle stretching exercises. 2
Setting Expectations for Follow-Up
Schedule a review within 2 weeks from pain onset to assess improvement and stratify risk using the STarT Back tool. 1, 5 This tool identifies patients at low, medium, or high risk for developing persistent disabling pain and guides appropriate resource allocation. 1
If there is no improvement after 6 weeks, imaging or further diagnostic testing may be warranted, but routine imaging provides no clinical benefit and can increase unnecessary healthcare utilization. 2, 6
Common Pitfalls to Avoid
Never tell patients that imaging is necessary unless red flags are present (progressive neurological deficits, cauda equina symptoms, night pain, constant pain, or abnormal neurologic examination). 5, 2 Imaging in the absence of red flags leads to overdiagnosis of incidental findings that do not correlate with symptoms. 6
Avoid framing the condition as requiring passive treatments or implying that the spine is fragile or damaged. 3, 7 This messaging increases fear-avoidance and disability. Instead, emphasize resilience and the body's natural healing capacity. 7