Discogenic Back Pain: What It Is, Why It Happens, and How to Recover

What Is Discogenic Back Pain?

Discogenic back pain refers to low back pain originating from a spinal intervertebral disc, rather than from muscles, joints, or nerves. It is one of the most common causes of persistent or recurrent low back pain, particularly in adults aged 30–60.

Intervertebral discs act as shock absorbers between the vertebrae. When a disc becomes degenerated, sensitised, or structurally disrupted, it can generate pain — even without a disc herniation or nerve compression.

Importantly, discogenic pain can exist without sciatica, making it harder to identify and often misunderstood.

Why Do Discs Cause Pain?

Healthy discs have very limited nerve supply. However, with degeneration or injury:

• Small tears can develop in the outer disc (annulus fibrosus)

• Inflammation can increase within the disc

• New nerve fibres can grow into deeper layers of the disc

• Mechanical loading becomes painful

This combination results in pain that is mechanical, inflammatory, and load-sensitive.

Common Causes of Discogenic Back Pain

Discogenic pain rarely comes from a single event. Instead, it develops from a combination of factors, including:

1. Repetitive Loading

• Prolonged sitting

• Repeated bending and twisting

• Occupational lifting

• Poor load management during sport or exercise

2. Disc Degeneration

• Normal age-related changes

• Genetic predisposition

• Reduced disc hydration and resilience

Degeneration does not automatically equal pain, but it can increase vulnerability when combined with poor loading strategies.

3. Sudden Load Spikes

• Rapid increase in training volume or intensity

• Lifting something heavier than usual

• Returning to activity after a break without conditioning

4. Reduced Trunk Strength and Control

Weakness or poor coordination of:

• Deep abdominal muscles

• Spinal extensors

• Hip musculature

This increases strain on spinal discs during everyday tasks.

What Does Discogenic Back Pain Feel Like?

Common features include:

• Deep, aching low back pain

• Pain worse with sitting or bending

• Difficulty tolerating prolonged positions

• Pain that improves with walking or changing posture

• Morning stiffness

• Flare-ups with load or fatigue

Pain is often central or slightly off-centre and may refer into the buttocks, but not usually below the knee.

How Is Discogenic Back Pain Diagnosed?

Clinical Diagnosis Comes First

Discogenic pain is primarily a clinical diagnosis, based on:

• History

• Symptom behaviour

• Physical examination

Imaging alone cannot confirm discogenic pain, as disc changes are extremely common in pain-free individuals.

Imaging (When Appropriate)

• MRI may show disc degeneration, annular tears, or buldges

• Findings must correlate with symptoms to be meaningful

Imaging is usually reserved for:

• Persistent pain >6–8 weeks

• Progressive symptoms

• Exclusion of serious pathology

How We Assess Discogenic Back Pain at Body Fit Physiotherapy

Our assessment focuses on understanding how your spine responds to load.

Assessment Includes:

• Detailed pain history and aggravating factors

• Postural tolerance (sitting, standing, bending)

• Movement testing (flexion, extension, rotation)

• Load response and symptom reproduction

• Strength and endurance testing of trunk and hips

• Functional tasks relevant to your lifestyle or sport

This allows us to identify modifiable contributors, rather than simply labeling the disc as “damaged”.

Evidence-Based Treatment for Discogenic Back Pain

1. Education and Load Management

Understanding how pain behaves is one of the most powerful treatments.

Evidence shows that appropriate activity modification, not rest, improves outcomes.

Key strategies include:

• Avoiding prolonged flexion early

• Breaking up sitting

• Gradual reintroduction of load

• Removing fear around movement

2. Exercise Therapy (Core of Treatment)

Strong evidence supports graded exercise therapy for discogenic pain.

Programs typically focus on:

• Trunk endurance and control

• Hip and lower limb strength

• Progressive spinal loading

• Functional movement patterns

Exercise helps:

• Reduce disc strain

• Improve load tolerance

• Restore confidence in movement

3. Manual Therapy (Adjunct, Not Standalone)

Manual therapy may help:

• Short-term pain relief

• Improve movement confidence

• Reduce protective muscle guarding

It is most effective when combined with active rehabilitation, not used in isolation.

4. Cognitive and Behavioural Factors

Persistent disc pain is influenced by:

• Fear of movement

• Pain catastrophising

• Avoidance behaviours

Physiotherapy that addresses both physical and psychological contributors leads to better long-term outcomes.

What Doesn’t Help Long-Term?

• Prolonged rest

• Passive treatments alone

• Avoiding movement indefinitely

• Over-reliance on imaging findings

• Quick-fix approaches

Surgery is rarely indicated for isolated discogenic back pain without nerve compression.

Getting Back to What You Love

Recovery from discogenic back pain is about capacity, not perfection.

Key Steps to Return to Activity:

1. Restore tolerance to daily activities

2. Build strength and endurance

3. Gradually reintroduce bending and lifting

4. Progress sport-specific or work-specific loads

5. Develop strategies to manage flare-ups

Most people return successfully to:

• Work

• Sport

• Gym training

• Family and recreational activities

Prognosis: What Does the Evidence Say?

The outlook for discogenic back pain is positive with appropriate management.

Research consistently shows:

• Exercise-based rehab improves pain and function

• Discs can adapt positively to load

• Pain does not equal damage

• Long-term outcomes are best with active care

How Physiotherapy at Body Fit Can Help

At Body Fit Physiotherapy in North Adelaide, we:

• Identify the true drivers of your pain

• Create an individualised rehab plan

• Progress loading safely and confidently

• Support your return to work, sport, and life

• Teach long-term self-management strategies

Key Takeaways

• Discogenic back pain originates from spinal discs but is treatable

• Diagnosis is clinical, not just imaging-based

• Exercise and load management are the cornerstone of recovery

• Fear and avoidance slow recovery

• Early, active management leads to the best outcomes

Reference List

1. Brinjikji W et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR.

2. Bogduk N. Clinical anatomy of the lumbar spine and sacrum.

3. O’Sullivan P et al. Cognitive functional therapy for chronic low back pain.

4. Hayden JA et al. Exercise therapy for chronic low back pain. Cochrane Review.

5. Hartvigsen J et al. What low back pain is and why we need to pay attention. The Lancet.

6. McGill SM. Low back disorders: evidence-based prevention and rehabilitation.