Back pain is not a single condition. It is a spectrum of experiences shaped by your movement habits, pain triggers, nervous system sensitivity and lifestyle.
Back pain is not a single condition. It is a spectrum of experiences shaped by your movement habits, pain triggers, nervous system sensitivity and lifestyle.The “One Size Fits All” Problem With Back Pain
If you have ever been handed a leaflet of generic exercises after a GP appointment and sent on your way, you are far from alone. Back pain is one of the most common reasons people seek healthcare in the UK, yet it is also one of the most poorly matched to individualised treatment. The trouble is that “back pain” is a broad label that can describe dozens of different clinical presentations; from a stiff lumbar spine that flares up after sitting at a desk, to sharp nerve-related pain triggered by certain movements, to deep aching that seems to have no obvious mechanical cause at all.
Treating all of these with the same protocol is a bit like giving everyone the same prescription glasses. For some people it will help. For most, it simply will not. Here in Brighton, our chiropractors and physiotherapists offer much more.
What the Research Actually Says About Individualised Care
The evidence for tailoring back pain treatment to the individual is compelling and growing.
Large-scale research consistently shows that people who receive treatment matched to their specific symptoms do significantly better than those given a standard programme. The difference is not a modest statistical improvement on a graph; it is the difference between a person who gets better and a person who does not.
Part of the reason for this comes down to something that clinicians have long suspected but that research is now confirming in detail: people with back pain are not all the same. A 2025 study in the European Journal of Pain found that even among people with straightforward, recent-onset back pain, there were clearly distinguishable groups based on how their body and mind were responding to the problem. Some were experiencing a heightened physical sensitivity in the affected area. Others were struggling primarily with anxiety about their pain; worried about movement, anticipating the worst. A third group had relatively mild responses across the board. The point is not the number of groups but the implication: if people’s experiences are this different at the outset, treating them identically makes very little clinical sense.
A 2024 review in the journal Physical Therapy looked at a treatment approach that takes this idea seriously; one that works with a person’s specific movement habits, unhelpful beliefs and day-to-day behaviours rather than applying a blanket exercise plan. Across multiple trials and different practitioners, people receiving this kind of personalised care reported meaningful reductions in both their pain levels and their ability to get on with daily life. Encouragingly, the results held up regardless of which clinician was delivering the treatment, suggesting it is the individualised approach itself that makes the difference, not the particular person in the room.
Taken together, this evidence points firmly in one direction: understanding the type of back pain a person has, and what is specifically driving it, is not a luxury. It is a clinical necessity.
Pain Patterns: Not All Back Pain Feels or Behaves the Same
One of the first things our Brighton chiropractors explore during an initial consultation is the pattern of your pain. This goes well beyond asking where it hurts.
Directional preference is one of the most clinically useful concepts in back pain assessment. Some people find their pain centralises; meaning it moves away from the legs and towards the spine, when they extend backwards. Others respond better to flexion movements. Getting this wrong and prescribing the opposite movement can actively make someone worse, not better.
Symptom behaviour over time also tells a story. Does your pain ease as the day goes on, or does it worsen? Is it worse after rest, or after activity? Morning stiffness that loosens up with movement points to a very different underlying mechanism than pain that builds steadily throughout a working day.
Referred pain and nerve involvement add another layer of complexity. Pain that travels down the leg, causes pins and needles, or changes with coughing or sneezing requires a different clinical approach than localised muscular discomfort.
None of this is visible on a standard referral form. It can only be uncovered through careful, personalised assessment.
Triggers: Why Your Back Pain Starts
Understanding what provokes your pain is just as important as understanding the pain itself. Triggers are highly individual.
For some people, prolonged sitting is the main culprit; particularly common in Brighton’s growing population of remote workers who spend long hours at poorly set-up home workstations (we saw a massive increase in this sort of onset during Covid). For others, it is a specific posture, a repeated lifting pattern, or even a psychological stressor that causes the nervous system to amplify pain signals.
The concept of pain sensitisation is particularly relevant here. Research has consistently shown that in chronic back pain, the nervous system can become sensitised; meaning it responds to stimuli that would not normally be painful, or amplifies pain signals beyond what the tissue damage would warrant. This explains why two people with identical MRI findings can have wildly different levels of pain and disability. The scan is not the whole story.
Sundial chiropractors will not just ask what positions hurt you. They will ask about your work, your sleep, your stress levels and your relationship with movement. All of these factors influence how your nervous system processes pain.
Movement Tolerance: Why the Wrong Exercise Can Make Things Worse
“Just keep moving” is advice that is well-intentioned but dangerously oversimplified. Movement is generally good for back pain; but the type, timing and load of that movement matter enormously.
Someone in an acute inflammatory phase, for example, may need gentle, low-load movement and relative rest before progressive loading is appropriate. Throwing them into a general strength class at this stage can delay recovery significantly.
We see patients who have developed back pain after doing exercises that require them to bend over, such as in yoga or Pilates or doing deadlifts in the gym. These have often been recommended to help back problems but are the wrong thing to do.
Someone with lumbar instability, where the deep stabilising muscles are not activating correctly, needs a very specific progression of motor control exercises before they are ready for heavier work. Skipping this stage, or substituting it with generic core exercises, can leave the underlying problem unaddressed.
Conversely, someone who has become genuinely fearful of movement because they have been told their spine is fragile or damaged may actually need more exposure to movement, not less. Graded movement exposure, combined with education about the true resilience of the spine, can be transformative for this group.
Matching the exercise approach to the movement profile is not optional. It is the difference between treatment that works and treatment that does not.
The Evidence for Spinal Manipulation in Back Pain Treatment
Spinal manipulation as used in chiropractic treatment is one of the most thoroughly studied hands-on treatments for back pain, and the evidence for its efficacy continues to strengthen. It works through several well-documented mechanisms. These include reducing joint stiffness and improving range of motion; activating the joints’ own sensory receptors, which send signals to the brain that effectively turn down the volume on pain; releasing the protective muscle tension that builds up around a sore area and allowing the body to move more freely; and influencing the central nervous system’s processing of pain. When applied at the right time and to the right person, it can produce rapid and meaningful improvements in both pain and function.
A well-designed trial published in The Journal of Pain put chiropractic spinal manipulation to the test properly; comparing it against a sham treatment in people with chronic low back pain, so that any improvement could be attributed to the manipulation itself rather than the experience of being treated. People receiving genuine spinal manipulation reported meaningful reductions in their pain and improvements in their ability to function day to day. What made the findings particularly interesting was that the benefits were not purely physical. The researchers also saw reductions in the degree to which the nervous system had become over-sensitised to pain signals and in the tendency to catastrophise (that is, to dread and amplify the pain experience mentally). This points to something important: spinal manipulation appears to work not just on the joints and muscles but on the way the brain and nervous system are processing pain.
That said, it is not a universal solution. The research is also clear that spinal manipulation works best when it is chosen for the right person, at the right stage of their recovery. This is precisely why our Brighton chiropractors will assess your movement patterns, pain behaviour and how your tissues respond before deciding whether manipulation is appropriate for you and if so, how to combine it with other elements of your care.
How Chiropractic Care in Brighton Tailors Treatment to You
A good chiropractor does not arrive at the treatment table with a fixed plan. They arrive with a framework for assessment that adapts to what they find.
That assessment typically includes a detailed history covering the onset, pattern and behaviour of your symptoms; a physical examination looking at movement quality, joint mobility, muscle function and neurological signs; and a clinical reasoning process that draws all of this together to form a working diagnosis.
From that point, treatment might involve spinal manipulation, soft tissue work, mobilisation techniques, specific therapeutic exercise, postural coaching or education about pain neuroscience, often in combination. We might refer you to our physio for treatment or recommend deep tissue massage. The key is that the selection of each element is driven by your specific presentation, not by habit or protocol.
Progress is also monitored actively. If something is not working, a skilled practitioner will reassess, revise their hypothesis and change course. This is fundamentally different from running through a fixed treatment programme regardless of how the patient is responding.
Why Getting the Right Assessment Early Matters
One of the most consistent findings in back pain research is that early, appropriate care significantly reduces the risk of acute pain becoming chronic. The longer pain persists without effective intervention, the more the nervous system adapts to it, and the harder it becomes to treat.
This is not a reason to panic if your pain has already been going on for some time. Chronic back pain can absolutely be treated effectively, and many people do make substantial progress even after years of struggling. But it does underline the value of seeking proper assessment sooner rather than later, and making sure that assessment is thorough enough to identify what is actually driving your pain.
If you have been living with back pain in Brighton and have tried generic treatments without success, it may not be that treatment cannot help you. It may simply be that the right treatment, the one matched to your specific pain pattern, triggers and movement capacity, has not yet been found.
The Bottom Line
Back pain is not one thing. The research is clear that treating it as though it were leads to worse outcomes for a significant proportion of patients. An individualised approach; one that assesses your specific pain patterns, identifies your triggers and matches your treatment to your actual movement tolerance, produces meaningfully better results.
If you are looking for a chiropractor in Brighton who takes the time to understand your pain before treating it, Sundial offers comprehensive initial assessments designed to get to the root of what is driving your symptoms. Because the right treatment for your back pain is not the one that works for everyone. It is the one that works for you.
Frequently Asked Questions About Back Pain Treatment
Why does my back pain keep coming back even after treatment?
Recurring back pain is usually a sign that the underlying driver of your symptoms has not been fully identified or addressed. Generic treatment can reduce pain in the short term without resolving the movement pattern, postural habit or muscle imbalance that caused it in the first place. A thorough reassessment looking at what specifically triggers your pain and how your body moves is often the missing piece.
How do I know if I need a chiropractor or a physiotherapist for back pain?
Both chiropractors and physiotherapists can treat back pain effectively, and there is significant overlap in approach – but chiropractors are specialists in back pain. A Sundial chiropractor will typically place particular emphasis on spinal joint function, movement assessment and hands-on treatment including spinal manipulation with our Impulse IQ adjusting instruments, alongside rehabilitative exercise. The most important factor is our detailed individual assessments rather than applying a standard protocol. If you are unsure, an initial consultation will give you a clearer picture of what is driving your symptoms and who is best placed to help.
Can stress really cause back pain?
Yes, and this is one of the most under-appreciated aspects of back pain management. Psychological stress activates the nervous system in ways that can heighten pain sensitivity, increase muscle tension and reduce pain tolerance. Research into pain sensitisation has shown that emotional and psychological factors are not separate from physical pain. They influence how the brain and nervous system process pain signals. A biopsychosocial approach to back pain takes all of these factors into account.
Is it safe to exercise with back pain?
For most people, yes; but the type, intensity and timing of exercise matters enormously. The wrong exercise at the wrong stage of recovery can delay healing or aggravate symptoms. A proper movement assessment will identify which movements are safe and beneficial for you specifically, and build a progressive plan from there. Blanket advice to “just keep active” is a good starting point but should not replace tailored guidance.
How long does it take to see results from chiropractic treatment for back pain?
This varies considerably depending on how long you have had the pain, what is causing it and how well the treatment is matched to your presentation. Many people notice meaningful improvement within three to six sessions. Longer-standing or more complex pain patterns may take longer to respond, but a good practitioner will set realistic expectations early and monitor your progress at each visit. If you are not improving as expected, they should reassess and adjust the approach rather than continue with the same plan.
What should I expect at my first appointment with a chiropractor in Brighton?
Your first appointment will last longer than follow-up sessions, usually around 45 minutes. It will include a detailed conversation about your pain history, triggers and daily habits; a physical examination of your movement, posture, joint function and neurological signs; and a clear explanation of what the assessment has found and what treatment is recommended. You’ll leave with a working diagnosis and a plan, not just a treatment and a follow-up booking.
Can chiropractic care help if I have had back pain for years?
Chronic back pain absolutely responds to chiropractic care, though treatment for long-standing pain often needs to address nervous system sensitisation and movement confidence alongside the physical aspects. Many patients who have struggled for years make significant progress once their care is properly tailored to their specific pattern of pain. The key is a thorough assessment that goes beyond surface-level symptoms.
Does spinal manipulation hurt?
Most people find spinal manipulation to be comfortable, and many report immediate relief or a sense of ease in movement afterwards. You may hear a popping sound during treatment but this is simply the movement of gas in the joint and is entirely normal. A small number of patients experience mild, temporary soreness in the area treated, similar to the feeling after unaccustomed exercise. This typically settles within 24 to 48 hours. Your chiropractor will always explain what they are doing before they do it and will adapt their approach to your comfort and tolerance.
References
About Matthew Bennett, Chiropractor Brighton
Matthew Bennett is the founder and principal chiropractor at Sundial Clinics Brighton, established in 1991. With over 35 years of clinical experience, Matthew qualified from the Anglo-European College of Chiropractic in 1987 and served as President of the British Chiropractic Association for four years. As a Fellow of the Royal College of Chiropractors and former team chiropractor for Brighton and Hove Albion FC and the British Alpine Ski Team, Matthew combines evidence-based chiropractic treatment with sports performance expertise. His authority in musculoskeletal health has been recognised through national media appearances, expert witness roles and contributions to professional publications. Matthew’s commitment to clinical excellence ensures patients receive the most effective chiropractic care in Brighton