Can Neck & Back Pain Be Neuroplastic?
Back pain has a particularly convincing argument. Of course my back hurts. Look at my MRI.
Maybe you’ve been told you have a bulging disc, degenerative disc disease, arthritis, stenosis, a herniation, “wear and tear,” or a spine that looks older than you are. Maybe you’ve spent years adjusting your posture, strengthening your core, changing mattresses, avoiding certain exercises, buying ergonomic chairs, stretching, getting injections, going to physical therapy, or trying to find the one thing in your back that needs to be fixed.
Sometimes those treatments are exactly what someone needs. Neck and back pain can absolutely come from injury, nerve compression, inflammatory conditions, fractures, and other structural or medical problems.
But sometimes the story is more complicated.
Neck and back pain can also have a neuroplastic component, meaning the brain and nervous system have become part of what is creating or sustaining the pain. And having something show up on an MRI does not automatically rule that possibility out.
The MRI isn’t the whole story
One of the most useful things I ever learned about back pain is just how common “abnormal” imaging findings are in people who aren’t hurting.
A systematic review looked at imaging findings in more than 3,000 people without back pain. Disc degeneration was present in 37% of asymptomatic 20-year-olds and increased to 96% by age 80. Disc bulges were found in 30% of pain-free 20-year-olds, 50% of 40-year-olds, and 84% of 80-year-olds. In other words, many of the things that sound incredibly alarming on an MRI are also found in people walking around with absolutely no back pain.
That does not mean imaging findings never matter. Research also shows that some degenerative findings are more common in people with low back pain than in people without it. A disc can cause symptoms. Arthritis can hurt. A nerve can be compressed. Structural problems are real.
What an MRI cannot do by itself is tell us the entire story of someone’s pain.
That’s why I become interested in everything else the pain is doing.
Does your back hurt every time you bend, or only sometimes? Can you lift something heavy at the gym without pain but throw your back out reaching for a sock? Does sitting hurt at your desk but not when you’re sitting somewhere having fun? Does your neck pain switch sides? Did the pain begin during an extremely stressful period? Has it persisted long after an injury should have healed? Does it flare when you’re under pressure and settle when you’re on vacation?
And one of my favorites: Have you ever done something you were absolutely convinced would hurt…and then realized afterward that it didn’t?
None of those things alone tells us, Aha! Neuroplastic pain. But together they can give us information that an MRI can’t.
Your back can learn danger
Let’s say you bend down one day and experience a sharp pain in your back. That is scary.
For the next few days, you bend carefully. Maybe you brace your core before you pick things up. You avoid lifting. Eventually you try bending normally again and feel another twinge. Yep. Bending is bad.
Your brain is learning from all of this. Pain-related fear research shows that movements and other bodily cues can acquire threat associations, and that those learned fears can generalize and contribute to avoidance. This doesn’t mean fear is imaginary or that someone is simply “thinking themselves into pain.” It means the brain is doing exactly what brains are built to do: learning what seems dangerous and trying to protect us from it in the future.
The trouble comes when the protection outlasts the danger.
Maybe the original back injury heals, but bending still feels threatening. Your brain predicts pain before you move. You brace. You monitor. You move differently. If it hurts, the pain confirms the prediction: See? Good thing we’re protecting the back.
Over time, your world can get surprisingly small. You don’t lift that. You don’t twist like that. You need the right chair. You sleep in the right position. You make sure your posture is correct. You stop running because the impact can’t possibly be good for your spine.
Each individual decision can feel completely reasonable. Together, they can teach the brain that your back is incredibly fragile.
The same thing can happen with neck pain. Maybe turning your head, sitting at a computer, looking down at your phone, sleeping on the “wrong” pillow, or carrying a bag on one side has become associated with symptoms. Eventually, those activities can start to feel dangerous before you’ve even done them.
This is where PRT can offer a very different way of looking at the problem. Instead of only asking How do I protect my back or neck from this activity?, we can begin asking Does my body actually need this much protection?
What does recovery look like if the pain is neuroplastic?
It doesn’t mean waking up tomorrow and doing the single activity you’re most afraid of while shouting, “MY SPINE IS FINE.”
Please don’t do that on my behalf.
Instead, we gather evidence.
Maybe you start noticing the inconsistencies in the pain. You learn more about what your medical findings do and don’t mean. You pay attention to the experiences that challenge the idea that your spine is fragile. If movement has become frightening, you may gradually approach it again in manageable ways, allowing your brain to experience bending, twisting, lifting, running, or sitting without treating those things as inherently dangerous.
This kind of exposure has a basis in pain research. Exposure-based approaches have been developed specifically to reduce pain-related fear and avoidance, with the goal of helping people learn through experience that feared movements or activities may be safer than expected.
We may also use somatic tracking with the pain itself. Instead of immediately responding to a sensation with What did I do to my back?, we practice noticing what it actually feels like and giving the brain another possibility: This sensation is real, but it may not mean I’m damaging myself.
None of this requires pretending structural problems don’t exist. In fact, I think PRT works best when we don’t have to play that game at all. If there is a medical issue that needs treatment, treat it. If your doctor has given you a restriction because a particular movement is genuinely unsafe, follow it. But if you’ve been medically evaluated, your body is safe to move, and the pain story contains a lot of clues that the nervous system may be involved, we don’t necessarily have to keep treating your spine as though it could break at any moment.
Your back is strong.
Your neck is strong.
And sometimes the thing they need most isn’t another attempt to fix them. It’s an opportunity for your brain to learn that they can be trusted again.
If you’re wondering whether your own neck or back pain might have a neuroplastic component, you can start with my free Neuroplastic Symptoms Self-Assessment or read How Do I Know If My Symptoms Are Neuroplastic?. If an MRI or other structural finding is the thing making you hesitate, Does Structural Damage Rule Out Neuroplastic Pain or PRT? goes deeper into that question.
And if you’d like to talk through your own symptoms, I offer free 15-minute connect calls where we can discuss what you’ve experienced, what you’ve already tried, and whether Pain Reprocessing Therapy might make sense for you.
