Low back pain remains one of the most costly and disabling health problems in Western society. Remarkably, despite the wide availability of scientific evidence, many patients still receive expensive treatments with little or no added value. With the 8 Commandments for Low Back Pain, PijnWijzer (NSIS Painless Lifestyle Network–VUB) aims to change this by translating scientific knowledge into awareness and better-informed choices. These commandments do not introduce new guidelines. Instead, they turn strong existing evidence into clear and practical principles for the wider public.
1. Movement is the cornerstone of every treatment for low back pain
The specific type of exercise matters less than people often think: almost any form of physical activity can help reduce low back pain. There are also no inherently “dangerous movements” that will structurally damage your back.
The best approach is to consult a physiotherapist who can guide and support you in staying active.
2. Understand pain so you can manage it better
People often believe back pain must be caused by a damaged disc, an “unstable” back or wear and tear (osteoarthritis). Yet back pain rarely means there is ongoing structural damage.
When people understand that pain can persist long after an injury has fully healed, they are far more likely to engage in active treatment approaches. Understanding how pain works reduces fear and supports recovery. Learning what pain is — and how to respond to it — is therefore essential.
3. Lifestyle matters: how you live affects how you recover
Sleep, stress, nutrition, smoking and physical fitness all influence pain and recovery. Recent scientific insights show that a personalised approach to these factors is now among the best-supported strategies for managing persistent pain.
A healthy lifestyle is therefore not a side issue. It is an essential part of treatment.
4. Do not fall for commercial “miracle solutions”
Expensive mattresses, electrotherapy devices, vibration plates, colourful tape and similar products are often marketed with persuasive claims. Yet there is no solid scientific evidence that these treatments can cure low back pain.
For example, a study by researchers at the Vrije Universiteit Brussel showed that the Soleve® electrotherapy device from Nervomatrix performed no better than placebo treatment.
5. Spinal manipulation has only a limited role
Whether performed by an osteopath, chiropractor or manual therapist, hands-on treatment alone contributes only modestly to recovery.
Manual therapy may have some added value, but only when combined with active rehabilitation such as exercise therapy or sport.
6. Needles will not “fix” back pain
Whether it is dry needling, acupuncture or injections featured in investigative media reports, needles may at best provide temporary pain relief. They do not cure the underlying back problem and have no proven long-term effect.
7. Surgery for back pain is rarely the right solution
There was a period when healthcare professionals believed surgery could solve almost every case of back pain. Unfortunately, the evidence has forced us to reconsider this assumption.
Surgery may help in a small number of rare and specific conditions, but in the vast majority of cases it is not recommended when low back pain is the only complaint.
8. Active recovery is the key
All these insights lead to one central message: the best way to overcome low back pain is through active therapy, with the patient playing the leading role.
Active approaches such as movement, exercise, education and behavioural change are superior to passive treatments.
The common thread running through all eight commandments
Effective care for low back pain is, above all, active, insight-driven and grounded in behaviour and lifestyle.
In practical terms, this means:
- less focus on passive treatments and quick “fixes”
- greater emphasis on self-management, movement and understanding
- a critical approach towards interventions without proven added value
A necessary shift in pain care
This initiative aligns with a broader international movement advocating value-based healthcare: care that is effective, evidence-based and genuinely relevant to patients.
By informing patients more effectively and supporting healthcare professionals in communicating this message, PijnWijzer aims to contribute to:
- less medicalisation of back pain
- better-informed choices
- more sustainable healthcare
References:
1. Wang XQ, Zheng JJ, Yu ZW, et al. A Meta-Analysis of Core Stability Exercise versus General Exercise for Chronic Low Back Pain. PloS one 2012; 7(12): e52082.
2. Nijs J, Apeldoorn A, Hallegraeff H, et al. Low back pain: guidelines for the clinical classification of predominant neuropathic, nociceptive, or central sensitization pain. Pain physician 2015; 18(3): E333-46.
3. Nijs, Jo, et al. "Personalized multimodal lifestyle intervention as the best-evidenced treatment for chronic pain: state-of-the-art clinical perspective." Journal of clinical medicine 13.3 (2024): 644.
4. Nijs J, Meeus M, Cagnie B, et al. A modern neuroscience approach to chronic spinal pain: combining pain neuroscience education with cognition-targeted motor control training. Physical therapy 2014; 94(5): 730-8.
5. Aguilar Ferrandiz ME, Nijs J, Gidron Y, et al. Auto-Targeted Neurostimulation Is Not Superior to Placebo in Chronic Low Back Pain: A Fourfold Blind Randomized Clinical Trial. Pain physician 2016; 19(5): E707-19.
About PijnWijzer
PijnWijzer is an initiative of the Vrije Universiteit Brussel focused on translating scientific knowledge about pain into accessible, practical and lifestyle-oriented strategies for patients and healthcare professionals.