Low back pain. What to do?

A 7-minute article that will help you manage low back pain and return to an active life.

Hi, Kononov is in touch.

This article shares scientific research findings plus my personal experience — to help you recover from a low back pain exacerbation. It's for people who take responsibility for their own health. Also useful for coaches and thinking athletes.

Back pain is now believed to be a symptom, not a disease. For most people, it resolves on its own quickly — like a headache or a minor cold. For a small percentage, it drags on, becomes chronic (lasting more than 6 months), and greatly reduces quality of life.

Surgery vs. Rehabilitation

A very few people have a specific pathological cause — a vertebral fracture, a tumor, an infection — as noted by Jan Hartvigsen and co-authors in the review "What low back pain is and why we need to pay attention."

In most cases, the specific cause is hard to identify — just as with headaches. Real serious causes are extremely rare.

The doctor identifies their presence or absence through a thorough physical examination, focusing on so-called "red markers." These include: pain that persists at night and lasts more than 4–6 weeks even at complete rest, significant unintentional weight loss, visible injuries, leg paralysis, urinary incontinence, or detected blood infection.

"Looking for a problem vigorously, you will 100% find it."

As a rule, X-ray, CT, or MRI are not required in the absence of these red markers. This is indicated in modern clinical guidelines such as Clinical Practice Guidelines (CPGs) and the updated recommendations of the National Institute for Health and Care Excellence (NICE).

Why?

Unnecessary imaging causes serious negative impacts on you. Radiologists often misinterpret results, leading to useless prescriptions, unnecessary follow-up tests, or even surgery.

Patients also misinterpret findings — which leads to uncontrollable fear, movement avoidance, and impaired recovery.

My Experience with This

Once, after a knee injury during a show, the MRI wasn't urgent, so it was scheduled for five days later. During those five days, the inflammation was lessening and the pain decreasing. I started walking. I was doing rehabilitation activities. My mood was competitive. I was 99% sure it was a minor injury.

Then the MRI showed a torn ligament. That news knocked me down. In the morning I felt like a recovering person. In the afternoon, after receiving the results, I felt like a broken invalid. Nothing in my body had changed in those several hours. Only the information in my head had changed.

You can read more about that case here.

Moving Forward

Yes, an MRI can show protrusions and hernias. But first — they are NOT the direct cause of pain in many cases. And second — visualization usually doesn't affect the treatment plan. You'll have to do recovery exercises anyway.

If you want to live, you need to move.

Moreover, even if disc herniation is identified as a problem, there's already evidence of the disc's ability to "heal" on its own without surgery. The body perceives the leaked disc material as a foreign object and starts breaking it down.

The Data

Research on natural resorption of even sequestered hernias shows: improvement in wellbeing was reported after 1.5 months, these improvements appeared on imaging after 9–13 months, and the probability of natural recovery was 96% for disc sequestrations, 70% for extrusions, 41% for protrusions, and 13% for disc bulges.

The overall frequency of size reduction or complete disappearance of disc herniation without surgery: 66.66%.

Doctor vs. Auto Mechanic

Many doctors have historically looked at back pain "technically," like car mechanics. Low back pain → MRI → I see a hernia → I remove the hernia → I remove the pain.

According to Dr. Hamilton Hall, a world-renowned surgeon and founder of the Canadian Spine Institute, 92% of people who undergo spinal surgery never get rid of their pain.

Instead of the BioMedical (technical) model, the BioPsychoSocial (BPS) model is gaining recognition. This model states that pain comes from a complex interaction between body (tissue processes), brain (thoughts and beliefs), and environment (social and cultural influence).

An example from Cirque du Soleil: if you tear a callus in Canada, it's treated as almost an emergency. Training stops. If you tear a callus in the Ukrainian gymnastics hall, you spit on your hand, add more magnesia, rub it in, and continue. Same physical event. Completely different pain experience.

My Personal Experience

Suffering from lower back pain, I went to the hospital. 5-minute exam. 5 questions. Regular X-ray. The word "operation." I felt completely devastated after that visit.

I realized that if I went to get an MRI, the psychological trap would close — and I had been through that before. I received guidelines for anti-inflammatory injections and never returned to that clinic. I didn't do the MRI.

The injections relieved the inflammation and acute pain. Sleep returned. Recovery improved. I kept doing morning exercises — the simplest possible movements. Those exercises gave me hope and real confirmation that I was still alive and capable.

After 3 months I was stronger. I could work while sitting, sleep well — but couldn't walk more than 10 minutes without my glutes and legs going numb.

I decided to try shockwave therapy and got to a top physiotherapist for the required examination first. She asked thorough questions, learned about my work in professional sport and Cirque du Soleil, and what my lifestyle had looked like after leaving the stage. She did fitness testing, thoroughly checked me.

The Shocking News

Her verdict: no visible injuries. All functions within normal limits. Muscle imbalance — but overall in good shape. No shockwave therapy needed at all.

I couldn't even walk properly — and she was telling me I was fine?

Then came an important insight: when pain persists longer than 6–8 weeks, psychological consequences can appear. The brain remembers which movement caused pain and continues to generate the unpleasant signal — even after the tissue has already healed. A kind of phantom pain.

Her recommendation: keep exercising and pay attention to psychological rehabilitation. I accepted it. I focused on outdoor activities — walking, swimming, sauna, massage, music, watching sports.

Today I can walk as long as I want. I returned to gymnastics. I can do a backbend.

My Conclusion

1. Look at functions, not a diagnosis. Use motor tests and common sense.

2. Look at the problem as a whole — Body, Brain, and Environment together.

3. Remember: you'll need to do exercises to restore function anyway, with or without surgery. Better without.

4. Find a sports specialist or physiotherapist who understands that movement is life.

5. Search for facts and success stories that encourage recovery.

6. Avoid unnecessary imaging if there are no red markers and no visible physical damage.

7. No matter how painful it is — our body has enormous potential for self-healing. Keep moving, step by step, every single day.

"Run away not from problems, run to Dreams. Remember, you can always do more." — Monatik

If you're ready to start moving again with a clear daily structure, the Back Mobility Challenge was built for exactly this moment — gentle, progressive, daily exercises to restore your back movement and get out of pain step by step.

FAQ

When should I actually get an MRI for back pain?

Only when red markers are present: pain that persists at night and doesn't improve after 4–6 weeks of complete rest, significant unintentional weight loss, visible injuries, leg paralysis, urinary incontinence, or a detected infection. In the absence of these, imaging usually does more psychological harm than diagnostic good.

How can pain persist after the tissue has already healed?

The brain learns which movement caused pain and keeps generating the signal as a protective response — even after the tissue has recovered. Resuming normal movement, gradually and consistently, helps break that loop.

What is the BioPsychoSocial model of pain?

It's a framework that recognizes pain as an output of three interacting systems: the physical body (tissue processes), the brain (thoughts, beliefs, and fear), and the environment (cultural and social context). Under this model, two people with the same tissue damage can have completely different pain experiences.

What actually helped your recovery?

Anti-inflammatory injections to break the acute pain cycle, daily simple exercises (even minimal movement counts), and a shift toward psychological rehabilitation — outdoor activities, swimming, sauna, massage, music, sports watching. Movement was the core of everything. Not rest. Movement.

Keep Reading

• Core Muscles and Low Back Pain — the science behind why core weakness causes back pain — and how it becomes a trap
• The Back Mobility Vitamin — daily exercises that keep your spine moving freely
• Amazing Back Mobility Exercise for Desk Workers — a practical routine you can start today
• Global Research Statistics on the Causes of Back Pain — the data behind why backs break down worldwide
• Why Your Body Compensates — And How to Fix It — what happens when one area hurts and everything else shifts
• Why You Should NOT Do Rehabilitation Alone — when to stop guessing and get professional help