Why Does My Back Hurt? Hinges, Wires, and Alarms

Why does one person's back pain improve with a particular exercise while someone else gets no relief from the same approach?

The answer may have less to do with where the pain occurs and more to do with what's contributing to it.

Two people can hurt in exactly the same place and have very different pain experiences.

Watch the full lecture

Key Takeaways

• The location of pain does not necessarily reveal its underlying mechanism.

• Tissue-related pain, nerve-related pain, and altered pain processing can produce different patterns.

• Several mechanisms may contribute to the same person's pain, and their relative importance can change.

• Understanding the pattern is more useful than assuming everyone with pain in the same place needs the same approach.

Why Does My Back Hurt When Someone Else's Doesn't?

Imagine three people walking into a healthcare clinic.

All three point to their lower backs.

All three say, "My back hurts."

Perhaps they even rate their pain the same way: seven out of ten.

Same location. Same intensity.

Same problem?

Not necessarily.

Once we begin asking questions, the apparent similarities may start disappearing.

When does it hurt? How does it feel? What makes it worse? What makes it better?

Those questions begin telling us something that pain location alone cannot.

Because words such as "back pain," "knee pain," and "shoulder pain" mostly tell us the geography.

They tell us where.

They don't necessarily tell us the story.

Quick clip: Same Back Pain. Three Different Stories. (0:38)

In my clinical teaching, I like to use three simple images to explain why these distinctions matter.

Hinges. Wires. And alarms.

They aren't diagnoses. They're ways to think about different mechanisms that may contribute to pain.

Three Different Pain Mechanisms: Hinges, Wires, and Alarms

The Hinge: Tissue-Related Pain

Our first person reports pain in a relatively specific area.

Bending and lifting predictably aggravate it. Reducing the load or changing the activity allows symptoms to settle.

There's a recognizable relationship between what the tissues are being asked to do and what happens next.

For simplicity, picture this as a hinge.

Not because your back is literally a hinge, but because the pattern suggests a substantial tissue-related, load-responsive contribution.

In pain science, we call this nociceptive pain.

Nociceptive pain arises from actual or threatened damage to non-neural tissues, involving the activation of specialized sensory receptors called nociceptors.

Examples can include certain injuries, inflammatory conditions, or other tissue-related problems.

But pain that changes with movement isn't automatically nociceptive, and a pattern alone doesn't establish a diagnosis.

The Wire: Nerve-Related Pain

Now consider our second person.

Their back hurts too, but the symptoms extend into the leg.

They describe burning, tingling, numbness, or shooting sensations that feel almost electrical.

These features may raise suspicion that a nerve is contributing to the problem.

Think of this as our wire.

The corresponding scientific term is neuropathic pain.

Neuropathic pain results from a lesion or disease affecting the somatosensory nervous system—the system responsible for detecting touch, temperature, and other bodily sensations.

A peripheral nerve or nerve root may be involved.

The important distinction is that symptoms such as tingling or electric sensations are clues, not proof of neuropathic pain.

A qualified clinician considers the history, examination, neurological findings, and other relevant information before drawing conclusions.

The Alarm: Altered Pain Processing

Our third person describes another experience.

Their pain is broader and less predictable.

Several activities may provoke it. Sometimes even relatively gentle input seems to produce substantial discomfort.

The pain doesn't appear to correspond neatly with one particular movement or tissue.

For this pattern, imagine an alarm system that has become unusually sensitive.

Researchers use the term nociplastic pain to describe pain associated with altered nociception when there isn't clear evidence of tissue damage or somatosensory disease sufficient to explain it through the other mechanisms.

This is a real pain experience involving real biological processes.

It doesn't mean the pain is imaginary or that the person is simply worrying too much.

But widespread or unpredictable pain alone is not enough to establish a nociplastic mechanism.

Proper clinical evaluation still matters.

These three descriptions help us begin asking better questions.

They don't sort every painful condition into three perfectly separate categories.

Why Pain Is Often More Like a Recipe

Here's where the story becomes more interesting.

People don't always fit neatly into one category.

Pain may involve contributions from multiple mechanisms at the same time.

You might have some tissue-related irritation, some nerve-related involvement, and changes in pain processing.

Think of pain as a recipe.

Several ingredients may be present.

But one ingredient may be contributing more substantially to the current pattern.

This changes the question we ask.

Instead of asking only, "Which kind of pain do I have?" we might ask:

"What appears to be contributing most—right now?"

Those last two words matter.

Right now.

Because pain isn't necessarily static.

Tissue irritation can change. Nerve sensitivity can change. Pain processing, activity demands, and a person's circumstances can also change.

The factors contributing most strongly today may not remain equally important in the future.

And when the pattern changes, the approach may need to change with it.

If the pattern shifts, the plan should be willing to shift too.

Quick clip: What If the Plan That Helped You Yesterday Isn’t the Plan You Need Today? (0:16)

Why the Same Treatment Doesn't Work for Everyone

Imagine that a friend tells you a particular stretch completely resolved their back pain.

You try it.

Nothing happens.

Someone else recommends massage, an exercise, an injection, or another intervention.

Again, you don't experience the same result.

It's easy to become discouraged.

You may begin wondering whether anything will work for you.

But consider another possibility.

Perhaps the recommendation wasn't inherently unreasonable.

Perhaps it simply wasn't appropriate for the factors contributing most to your symptoms.

A strategy that helps someone with a predominantly tissue-related problem may not be equally useful when neurological symptoms or altered pain processing are important contributors.

Of course, treatment response depends on more than pain classification. Health history, physical capacity, expectations, preferences, and numerous other factors matter.

Still, identifying relevant mechanisms can help inform more individualized clinical decisions.

The treatment should be informed by the problem—not simply by the location of the pain.

This is part of clinical reasoning.

We gather information, recognize patterns, consider possible explanations, and revise our understanding when new evidence becomes available.

One symptom rarely gives us the entire answer.

Several clues together can begin telling a more useful story.

What About MRI Findings?

Imaging can provide valuable information about anatomy, injuries, and disease.

But seeing a disc bulge, arthritis, or another structural change doesn't automatically establish what is producing someone's pain.

Research has found that certain degenerative spinal findings are common even among people without symptoms.

That doesn't mean imaging findings are irrelevant.

It means they must be interpreted alongside the person's history, symptoms, and examination.

An image may show us structure. It doesn't necessarily explain the whole experience.

Try This: Look for the Pattern, Not Just the Location

If you experience recurring discomfort, consider observing a few details before your next healthcare appointment.

Ask yourself:

1. When does it occur? Is the discomfort associated with particular activities, positions, or times?

2. How does it feel? Is it localized, spreading, burning, tingling, or difficult to describe?

3. What changes it? Notice what seems to aggravate or settle the symptoms.

These observations aren't enough to determine which mechanism is responsible.

But they may help you give a qualified healthcare professional a clearer account of what you're experiencing.

New or worsening neurological symptoms, particularly progressive weakness or changes in bladder or bowel control, require prompt medical evaluation.

The Bottom Line: Read the Story, Not Just the Map

At STRATA, our movement education and coaching studio serving Sarasota and Lakewood Ranch, I encourage people to develop a better understanding of their movement and physical capabilities.

Part of that understanding involves recognizing that pain is more complex than a single body part or imaging finding.

The hinge may settle.

The wire may become less irritable.

The alarm may become less sensitive.

Not every condition changes in the same way, and no particular outcome is guaranteed.

But the pattern someone experiences today isn't necessarily the pattern they'll always experience.

Here's what I want you to remember.

Don't just chase the spot that hurts. Look at the pattern.

Instead of asking only, "Where does it hurt?" there may be another question worth asking:

What is this pain telling us?

That question moves us from simply looking at a map to actually reading the story.

Related STRATA Lectures

• When Pain Turns Up the Volume: Understanding the relationship between pain intensity and nervous-system sensitivity.

• What If Your Body Learned to Hurt? How learning and experience can influence protective movement responses.

Explore Your Movement Possibilities at STRATA

If you're interested in better understanding how your body moves and exploring strategies for building movement confidence and capability, I invite you to schedule a STRATA Movement Discovery Session.

Book your Movement Discovery Session →

STRATA — HURT LESS. MOVE BETTER.

40 Sarasota Center Blvd., Suite 104, Sarasota, FL 34240. Call (941) 377-0111 or visit https://thestratamethod.com/

References

International Association for the Study of Pain. (n.d.). Terminology. https://www.iasp-pain.org/resources/terminology/

Finnerup, N. B., et al. (2016). Neuropathic pain: An updated grading system for research and clinical practice. PAIN, 157(8), 1599–1606. https://doi.org/10.1097/j.pain.0000000000000492

Kosek, E., et al. (2016). Do we need a third mechanistic descriptor for chronic pain states? PAIN, 157(7), 1382–1386. https://doi.org/10.1097/j.pain.0000000000000507

Brinjikji, W., et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173

Disclaimer: For general education; not medical advice. This article is not intended to diagnose pain mechanisms or replace individualized medical evaluation or treatment. STRATA provides movement education and coaching.