Physiotherapy studio, 2 Bramwell Way, Silvertown, London (2026)

18/08/2026

❗ This post is for people who suspect – or already know – that they are sensitive to histamine and have noticed a strange pattern:

Freshly prepared food is usually fine.

The very same food, after spending 24–48 hours in the refrigerator, is not.

If you're familiar with situations where yesterday’s soup triggers a headache, chicken cooked two days ago brings on a migraine, or a stew that has been sitting in the fridge for several days causes facial flushing, nasal congestion, digestive issues, or unexplained fatigue – then this post is for you.

In recent years, more and more people dealing with histamine intolerance have begun looking beyond fermented foods, aged cheeses, and wine. Increasingly, attention is turning to how long food has been stored after it was prepared.

And this is where a topic that receives far too little attention begins.

The problem is often not the FOOD itself, but WHEN IT WAS PREPARED

Many people spend months – or even years – trying to identify the "culprit" food.

They eliminate gluten.
They eliminate dairy.
They eliminate sugar.
They eliminate tomatoes.
They eliminate fruit.

Yet the symptoms keep coming back.

Until one day they notice something surprisingly simple.

Chicken cooked and eaten the same day causes no problems.

The exact same chicken after two days in the refrigerator triggers a headache.

Freshly made broth is well tolerated.

That same broth on day three is not.

A freshly prepared ground meat dish causes no reaction.

Two days later, it brings pressure in the head, fatigue, or heart palpitations.

In histamine intolerance communities, people frequently share similar experiences: freshly prepared food is often tolerated much better than the same food after several days of storage.

And the most interesting part is that science offers a possible explanation.

What happens to food as it sits?

Most people think food exists in only two states:

✔ Fresh
✔ Spoiled

But in reality, there is a middle ground.

Food can appear perfectly fine.

It can smell normal.

It can look normal.

It can taste completely normal.

And yet it may have changed.

Especially for someone who is sensitive to histamine.

Histamine is not something that is simply "added" to food.

It can be formed during storage.

Certain bacteria are capable of converting the amino acid histidine into histamine.

The more time passes, the more opportunity there is for this process to occur.

That is why it is important to understand one key point: Refrigeration does not stop histamine formation. It only slows it down.

This is one reason why many histamine-sensitive individuals notice a difference between freshly prepared food and the same meal consumed several days later.

Why can a doctor say the food is not spoiled, yet you still feel unwell?

Because these are two completely different questions.

Food can be microbiologically safe.

And at the same time, it can still be problematic for someone who is sensitive to histamine.

This distinction is extremely important.

Some people hear the same comments for years:

"The food was refrigerated, so it's fine."

"If it isn't spoiled, just eat it."

"It's probably stress."

"There's no way yesterday's soup caused that."

But the person experiencing the symptoms knows exactly how they feel.

And when the same pattern repeats dozens of times, something begins to emerge.

Not the food itself.
Not the calories.
Not the carbohydrates.
Not the protein.

But the length of time the food has been stored.

Why do meat, fish, and broths so often become the main suspects?

Not all foods behave the same way.

Histamine tends to become more problematic in foods that are rich in protein.

That is why highly sensitive individuals most commonly mention:

• Meat
• Fish
• Ground meat
• Broths and stocks
• Soups
• Seafood
• Slow-cooked dishes

Broths, in particular, are mentioned over and over again.

And this is probably not a coincidence.

The longer a food has been processed, stored, and reheated, the greater the likelihood that a histamine-sensitive person may react to it.

Symptoms commonly associated with stored food

If you are sensitive to histamine, some of these symptoms may sound familiar:

🔸 Headaches
🔸 Migraines
🔸 Pressure around the temples
🔸 Facial flushing
🔸 Hot flashes
🔸 Nasal congestion
🔸 Itching
🔸 Skin reactions
🔸 Heart palpitations
🔸 Anxiety
🔸 Sleep disturbances
🔸 Bloating
🔸 Diarrhea
🔸 Unexplained fatigue

Some people experience only one symptom.

Others experience several at once.

Sometimes the reaction begins within 30 minutes.

Sometimes it appears several hours later.

This is one reason why identifying the connection to food is not always easy.

The biggest mistake many histamine-sensitive people make

They track only WHAT they ate.

But they do not track WHEN the food was prepared.

And very often, that is where the answer lies.

Many people carefully record:

✔ I ate chicken
✔ I ate rice
✔ I ate carrots

But they do not record:

✔ The chicken was cooked three days ago
✔ The soup had been in the refrigerator for 48 hours
✔ The stew had been reheated for the third time

For someone who is sensitive to histamine, this information can sometimes be more important than the food itself.

What do people who successfully reduce their symptoms do?

They do not begin by searching for miracle supplements.

Instead, they focus on reducing opportunities for histamine to accumulate.

Common strategies include:

✔ Cooking smaller portions
✔ Eating food as fresh as possible
✔ Cooling food quickly after cooking
✔ Freezing leftovers on the same day
✔ Avoiding meals that have been sitting in the refrigerator for several days
✔ Avoiding repeated reheating
✔ Tracking their own individual reactions

The most important takeaway

If you have been struggling with migraines, headaches, flushing, digestive issues, or other unexplained symptoms for a long time – and you cannot understand why the same food feels fine one day and causes problems the next – try paying attention to more than just the food itself.

Pay attention to time.

Sometimes the problem is not the chicken.

Not the beef.

Not the soup.

Not the rice.

Sometimes the problem is that the food was prepared 48 hours ago.

And for many people who are sensitive to histamine, this single detail becomes the turning point that finally helps them understand the signals their body has been sending all along.

💬 What about you? Have you noticed that freshly prepared food is easier to tolerate than the same meal after 1–3 days in the refrigerator? Share your experience in the comments.

03/08/2026

Could Neck Stabilization Exercises Actually Make Things Worse?

Rodríguez-Sanz, J., Malo-Urriés, M., Lucha-López, M. O., Corral-de-Toro, J., González-Rueda, V., López-de-Celis, C., Pérez-Bellmunt, A., & Hidalgo-García, C. (2022). Is cervical stabilization exercise immediately effective in patients with chronic neck pain and upper cervical spine dysfunction? Randomized controlled trial. Life, 12(5), 714. https://doi.org/10.3390/life12050714

27/07/2026

Stabilisation Exercises: Miracle or Myth? What Does the Science Really Show?

One of the most common statements heard in physiotherapy is:

"If your back hurts, your deep muscles are not functioning properly. You need to activate the transversus abdominis, the multifidus, and strengthen your core muscles."

This concept has dominated clinical practice for decades. But do scientific studies actually support the claim that stabilisation exercises are superior to other forms of exercise?

A 2014 systematic review and meta-analysis published in BMC Musculoskeletal Disorders by Smith, Littlewood, and May sought to answer exactly this question.

What Was Studied?

This was not a single clinical trial, but a systematic review and meta-analysis—one of the highest levels of scientific evidence.
The authors reviewed all available high-quality randomised controlled trials investigating stabilisation exercises for the treatment of non-specific low back pain (NSLBP).

The review included:

• 29 randomised controlled trials
• More than 2,200 participants
• A variety of treatment strategies

Rather than relying on isolated cases or personal experience, the authors synthesised evidence from multiple clinical trials.

What Were Stabilisation Exercises Compared With?

Stabilisation exercises were compared with:

✔ General strengthening exercises
✔ Aerobic exercise
✔ Stretching programmes
✔ The McKenzie Method
✔ Other active exercise programmes
✔ Minimal intervention or no treatment

What Did the Results Show?

Yes – stabilisation exercises are effective.

However, they are not a miracle cure.

Compared with no treatment or minimal intervention, patients experienced improvements in pain and function.

This is hardly surprising.

People who remain physically active generally achieve better outcomes than those who are completely inactive.

However, the Most Important Finding Was Different

When stabilisation exercises were compared with other active exercise programmes:

❌ No significant difference was found.

In other words...

Stabilisation exercises were not more effective than other forms of exercise.

What About Pain?

The difference in pain reduction between groups was very small.
Although statistically detectable, the difference was not clinically meaningful.

This means that, in real-world clinical practice, most patients would be unlikely to notice any meaningful difference between a stabilisation programme and another well-designed active exercise programme.

What About Function?

The findings were similar.

Patients' ability to move, work, and perform everyday activities improved to a comparable extent, regardless of which active exercise programme they followed.

What Does This Mean in Clinical Practice?

This study does not conclude that:

❌ Stabilisation exercises do not work.

Instead, it demonstrates something quite different.

Stabilisation exercises are effective.

However, they:

• are not the only effective treatment option;
• are not superior to other active exercise programmes;
• are not necessary for every patient.

Why Is This Important?

For many years, clinicians believed that:

"If you have back pain, the first priority is to activate the deep transversus abdominis muscle."

Today, scientific evidence paints a much more complex picture.

Low back pain is not simply the result of weak deep trunk muscles.

It is influenced by many factors, including:

• Physical activity
• Sleep quality
• Stress
• Occupational demands
• Fear of movement
• Overall physical fitness
• Psychological factors

For this reason, simply "activating the core" is often not enough.
What Should Patients Take Away from This?

If you enjoy:

🏋️ Strength training
🚶 Walking
🏊 Swimming
🚴 Cycling
🧘 Pilates
💪 Stabilisation exercises
..all of these approaches can be appropriate.

The most important factor is not the specific exercise.

The key is to stay physically active and find a form of exercise that you enjoy and can maintain consistently over the long term.

What Should Healthcare Professionals Take Away?

This review reinforces an important principle of evidence-based practice:

We should not assume that one exercise approach is universally superior for every patient.

Effective rehabilitation is rarely based on activating specific muscles alone. Instead, it should focus on an individualised, patient-centred active exercise programme that is tailored to the patient's needs, acceptable to the individual, and performed consistently over time.

📚 Reference

Smith BE, Littlewood C, May S. An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskeletal Disorders. 2014;15:416.

20/07/2026

LONGEVITY MATTERS ONLY WHEN IT COMES WITH QUALITY OF LIFE

When discussing longevity, we often focus on a single question: how can we live as many years as possible? However, another question is just as important: how can we live those years while remaining strong, independent, and physically capable?

A recent study by Harvard researchers and their colleagues, published in the prestigious British Journal of Sports Medicine, provides further compelling evidence as to why strength training should become not an exception, but an integral part of everyone’s life.

What Did the Researchers Investigate?

The study involved 147,374 participants who were followed for up to 30 years. It is one of the largest and longest-running studies to examine the relationship between strength training and mortality.

The researchers sought to answer three questions:

• How much strength training per week is associated with the greatest benefit?
• Does strength training reduce the risk of death from specific diseases?
• Does it provide additional benefits for people who already engage in regular aerobic activity?

What Did the Results Show?

The greatest benefit was observed among people who spent approximately 90–120 minutes per week doing strength training.

Compared with people who did not engage in strength training, this group had:

✅ approximately a 13% lower risk of death from all causes;
✅ approximately a 19% lower risk of death from cardiovascular disease;
✅ approximately a 27% lower risk of death from neurological diseases, including dementia-related conditions.

Importantly, the greatest benefits were observed when strength training was combined with aerobic physical activity rather than performed on its own.

Why Does This Matter?

As we age, we lose not only muscle mass but also strength.

Declining muscle strength can lead to:

• greater difficulty getting up from a chair;
• an increased risk of falls;
• more frequent bone fractures;
• reduced physical independence;
• a higher likelihood of hospitalisation.

The true purpose of strength training, therefore, is not merely to achieve a more aesthetically pleasing body.

Most importantly, it helps us preserve our functional abilities so that, even in later life, we can:

✔ climb stairs without becoming short of breath;
✔ carry shopping bags;
✔ play with our grandchildren;
✔ travel;
✔ live independently.

This is precisely what is meant by healthspan: the period of life during which we live not only longer, but also healthier and better.

Is More Training Always Better?

Interestingly, increasing the amount of strength training beyond approximately 120 minutes per week was not associated with any further reduction in mortality risk.

This does not mean that exercising more is harmful.

It simply means that, in this study, a greater amount of training was not associated with an even lower risk of death.

In other words, it appears that most of the benefits can be achieved by regularly completing two or three high-quality strength-training sessions per week.

Does This Study Prove a Cause-and-Effect Relationship?

No.

This was an observational cohort study, so it cannot prove that strength training itself directly reduced mortality.

It does, however, demonstrate a strong association between regular strength training and better long-term health outcomes.

The study’s strengths include its very large number of participants, a follow-up period of up to 30 years, and a careful analysis of numerous lifestyle factors. Its findings are therefore significant and consistent with the results of previous research.

What Can We Learn from This?

Our bodies need more than walking or running.

They also need strong muscles.

For most people, it is therefore worth aiming for:

🏋️ two or three strength-training sessions per week, totalling approximately 60–120 minutes;
🚶 regular aerobic activity, such as walking, cycling, swimming, or another form of endurance exercise;
🥗 a balanced diet;
😴 good-quality sleep;
😌 effective stress management.

It is the combination of these factors that contributes most significantly to a longer and healthier life.

The key message is simple:

The goal of life is not merely to add more years.

The goal is to add more life to those years.

Regular strength training appears to be one of the important ways in which we can achieve this.

Source: Zhang Y. et al. “Long-term resistance training with all-cause and cause-specific mortality: assessing dose-response and joint associations with aerobic physical activity.” British Journal of Sports Medicine, 2026.

07/07/2026

Does lumbar manipulation really “guarantee” 95% success? The Flynn et al. 2002 clinical prediction rule

In physiotherapy and manual therapy, the Flynn et al. 2002 clinical prediction rule is frequently mentioned as a way to identify patients who may respond well to lumbar / lumbopelvic manipulation.

Sometimes, this rule is interpreted in an overly simplified way:

“If the patient meets the criteria, manipulation guarantees 95% success.”

However, this is not accurate.

The study did not show a universal 95% success rate for manipulation in all patients. It showed that, in a specific selected group of patients with acute low back pain who met at least 4 out of 5 criteria, the probability of short-term improvement in the study sample increased to approximately 95%.

This is a very important distinction.

Flynn et al. clinical prediction rule criteria:

1. No symptoms below the knee

2. Current episode of low back pain lasting less than 16 days

3. FABQ-W score, meaning the work subscale of the Fear-Avoidance Beliefs Questionnaire, less than 19

4. At least one hypomobile lumbar segment

5. Hip internal rotation greater than 35° on at least one side

The rule is considered positive when the patient meets 4 or 5 criteria.

Another important point is that “success” in the study did not mean complete recovery or a long-term resolution of the problem. In the study, success was defined as a meaningful reduction of at least 50% in functional disability, measured using the Oswestry Disability Index, within a short period of time after manipulation.

In other words, this refers to a short-term response to a specific intervention, not a guaranteed long-term outcome.

Why is this rule important?

It helped show that low back pain is not one single uniform diagnosis for which we apply the same treatment to every patient. Different patients may respond better to different interventions. Some may benefit more from manipulation, while others may require stabilization exercises, movement control, education, gradual load progression, or other approaches.

The main message of this rule is not that “manipulation helps everyone.”

The main message is that certain clinical findings may help identify patients for whom manipulation has a higher probability of being beneficial in the short term.

In practice, this means that a patient who presents with these findings may be a good candidate for a short course of manipulation as part of a broader treatment plan.

However, clinical decision-making should not be based on one rule alone. It is necessary to assess red flags, neurological symptoms, the patient’s history, overall functional status, expectations, fears, lifestyle, and treatment goals.

It is also important to understand the limitations of the study. The Flynn 2002 study was conducted with a relatively small sample, and the 95% figure came from a small subgroup of patients. In addition, the outcome was short term and was associated with a specific manipulation technique and a specific patient profile.

Therefore, a professional conclusion would be:

The Flynn et al. 2002 clinical prediction rule is not a promise that lumbar manipulation will work in 95% of cases. It is a clinical tool that helps identify a subgroup of patients for whom the probability of short-term improvement after manipulation may be particularly high.

Manual therapy can be a valuable tool, but it should not be used in isolation or applied mechanically. The best results are achieved when manipulation is combined with patient education, active movement, exercise, load management, and individualized clinical reasoning.

In clinical practice, the most important thing is not simply “applying a technique,” but understanding who it is being applied to, when, why, and for what purpose.

References

Flynn T, Fritz J, Whitman J, et al. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine. 2002;27(24):2835–2843.

Childs JD, Fritz JM, Flynn TW, et al. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation. Annals of Internal Medicine. 2004;141(12):920–928.

06/07/2026

Why MRI Often Fails to Explain Back Pain

This is one of the greatest paradoxes in medicine.

One person may have a large disc herniation and feel almost no pain.

Another may have an almost normal MRI scan, yet be unable to bend forward normally or put on their shoes.

If back pain were determined only by anatomy, this should not happen.

It is precisely this paradox that pushed researchers to look for answers not only in discs, vertebrae, or joints, but also in the nervous system.

Over the past three decades, more and more research has shown that the spine is not merely a mechanical structure. It is a complex sensorimotor system controlled by the central nervous system every second.

And this idea has changed almost the entire field of modern physiotherapy.

The Spine Does Not Function as One Single Block

In everyday language, we say:

“My lower back hurts.”

But from a neurological point of view, such a term almost does not exist.

There is L1–L2.
There is L2–L3.
There is L3–L4.
There is L4–L5.
There is L5–S1.

Each of these segments has its own intervertebral disc.
Its own facet joints.
Its own ligaments.
Its own receptors.
Its own neural innervation.
And its own local muscle control.

This means that the nervous system can alter the function of one segment while leaving neighboring segments almost unchanged.
This fundamentally changes how we think about the back.
We no longer have one large “lower back.”
We have many small segments that must function together as one system.

This Is Visible Even in Anatomy

People often say:

“We need to strengthen the back extensors.”

But the erector spinae is not one long muscle.
It is made up of several separate muscles.
Even deeper lies the multifidus.
And most importantly, their innervation is not uniform either.
Each lumbar nerve, through its posterior branch, innervates a specific portion of the back muscles.
This means that motor control happens segment by segment.
The entire back does not contract all at once.
The nervous system is constantly deciding which segments should be activated more and which should be activated less.
That is why it is completely normal for some segments to work more intensely than others.

The Multifidus Is Probably Not Most Important Because of Its Strength

For a long time, the multifidus was thought of simply as a deep stabilizing muscle.
But anatomy shows a much more interesting picture.
This muscle contains a very high number of muscle spindles.
These are receptors that are not designed for force production.
Their purpose is to collect information.

They constantly send signals to the brain:

Where is this segment right now?
How much has it rotated?
How much is it moving?
How fast is it moving?

This suggests that the multifidus is not only a stabilizing muscle.
It is an important part of the spine’s sensory system.
In other words, it does not only control movement.
It helps the nervous system understand what is happening during that movement.

What Changes When Pain Appears?

When a disc, facet joint, or ligament becomes irritated, different sensory signals begin traveling to the central nervous system.
The nervous system responds to this.
And this is where one of the most interesting phenomena occurs.
Pain changes motor control.
The activation of the multifidus in some segments may become delayed.
Some segments may become reflexively inhibited.
In some segments, selective multifidus atrophy has even been observed after an episode of acute low back pain.
One thing is important to understand.
This is not a matter of willpower.
A person does not decide to “stop activating” the multifidus.
It is an automatic response of the nervous system.

Then Compensations Appear

But the person still has to move.
They have to walk.
Sit.
Pick up a child.
Exercise.
So the nervous system looks for another solution.
If one segment works less effectively, others take over.
The superficial back extensors.
The quadratus lumborum.
The abdominal wall.
Neighboring spinal segments.
The person may not even notice that they have started moving differently.
Movement continues.
But it becomes less economical.
Some segments move less than they should.
Others move more than they should.
Some muscles activate too early.
Others activate too late.
Over time, these compensations begin to change how loads are distributed.
Then tissues start to become irritated.
And pain appears.

This Is Why a Strong Back Does Not Necessarily Mean a Healthy Back

This is one of the most common mistakes.
A person may have very strong erector spinae muscles.
They may squat 200 kilograms.
They may perform dozens of pull-ups.
Yet their segmental control may still be impaired.
Strength and motor control are not the same thing.
A pianist may have strong fingers.
But if they keep pressing one key too late, the music will still sound wrong.
A very similar process occurs in the spine.
The problem is often not strength.
The problem is activation timing, coordination, and precision.

This Is Why “Strengthen Your Core” Does Not Always Solve the Problem

If a person is already compensating with superficial muscles, making those muscles even stronger will not necessarily help.
Sometimes it can do the opposite.
The compensation becomes even stronger.
That is why modern physiotherapy is increasingly focused not only on strength.
It is focused on restoring motor control.
The goal is no longer simply to strengthen a muscle as much as possible.
The goal is to help the nervous system organize movement precisely again.

What Is Good Motor Control?

People often say:

“The spine needs to be stabilized.”

But stability does not mean rigidity.
This is a very important distinction.
A good spine is not a stiff spine.
A good spine is one in which each segment moves as much as it needs to, exactly when it needs to.
No more.
No less.

Why Does This Change the Whole Approach to Rehabilitation?

In the past, the main question was:

“Which tissue is damaged?”

Today, more and more often, the question is:

“How is the nervous system controlling this segment right now?”

That is a completely different way of thinking.
The goal of rehabilitation is no longer only to strengthen muscles.
It is important to restore a high-quality relationship between sensory information and motor response.
To restore the ability to control movement precisely.
To restore confidence in the segment.
To allow the nervous system to let go of unnecessary compensations.

Does This Mean That Discs and MRI No Longer Matter?

Absolutely not.
Disc herniations exist.
Facet joint osteoarthritis exists.
Nerve root irritation exists.
All of this matters.
But anatomy alone no longer explains all back pain.
That is why today we increasingly talk not only about what is visible on MRI, but also about how the spine functions.
Because a person does not move with an MRI image.
A person moves with a sensorimotor system controlled by the nervous system.
And this is probably the greatest shift in the modern understanding of back pain.

We are asking less and less:

“What is broken?”

And more and more:

“What has changed in movement control, and why has the nervous system chosen this particular strategy?”

This question is opening new possibilities for understanding and treating back pain today.

03/04/2026

ALLOSTATIC LOAD AND PAIN: INSTABILITY OF A BIO-SOCIAL ECOSYSTEM

https://journals.lww.com/pain/fulltext/2025/11001/allostatic_load_and_pain__instability_of_a.9.aspx

12/02/2026

BACK PAIN AND THE GUT: A CONNECTION MOST PEOPLE STILL DON’T KNOW ABOUT

Many people live with chronic back pain without suspecting that one piece of the puzzle may be… the gut – its microbiota and chronic low-grade inflammation.

Today, a growing body of research shows that back pain, the gut microbiota, and intestinal inflammation are linked not only through subjective or psychological factors, but also through clearly defined biological mechanisms.

WHAT EVIDENCE SUPPORTS THIS LINK?

Scientific studies reveal several clear areas of association.

Chronic non-specific back pain

• People with chronic back pain (especially lasting longer than 3 months) statistically more often have an altered gut microbiota (dysbiosis).
• Stool sample analyses show:
o reduced levels of beneficial bacteria producing short-chain fatty acids (e.g., butyric acid – butyrate);
o increased levels of so-called pathobionts – bacteria that can promote inflammation under certain conditions.

Disc degeneration and Modic changes

• Patients with degenerative changes in spinal discs (a common cause of chronic mechanical back pain) frequently exhibit pronounced gut dysbiosis.
• The more pronounced the disc and vertebral endplate (Modic) changes, the more pro-inflammatory the microbiota composition tends to be.

Links with intestinal diseases

• In people with irritable bowel syndrome, back pain occurs very frequently (in some studies in more than 50% of patients).
• Patients with inflammatory bowel diseases (Crohn’s disease, ulcerative colitis) often also develop inflammatory back pain (axial spondyloarthritis).

Genetic findings

• Genetic analyses indicate that genetically determined alterations in certain gut bacteria are associated with a higher risk of disc degeneration and chronic back pain.
• This means that in some cases the microbiota is not only a consequence, but also a potential risk factor.

WHAT DOES THIS MEAN IN PRACTICE: WHAT HAPPENS IN THE BODY?

Dysbiosis and increased intestinal permeability

When the gut microbiota becomes imbalanced:

• beneficial bacteria that strengthen the intestinal barrier and produce anti-inflammatory metabolites (e.g., butyrate) decrease;
• bacteria promoting mucosal inflammation increase.

As a result:

• the intestinal wall becomes more permeable – more bacterial fragments (lipopolysaccharides, etc.) enter the bloodstream;
• the immune system remains mildly activated – low-grade systemic inflammation develops.

This type of inflammation is already associated with:

• disc degeneration,
• joint pain,
• muscle pain and fatigue,
• increased overall pain sensitivity.

THE GUT–SPINE IMMUNE AXIS

Particularly well studied in inflammatory back pain (e.g., axial spondyloarthritis):

• gut bacteria influence T-lymphocyte programming (Th17; IL-17, IL-23 axis);
• activated immune cells and cytokines migrate from the gut to entheses and the spine, triggering inflammation in vertebral, sacral, or pelvic regions;
• this manifests as inflammatory back pain in the morning and at night, improving with movement but not with rest.

Although not all chronic back pain is autoimmune, a similar – milder – mechanism may operate in non-specific pain when persistent low-grade gut inflammation exists.

THE GUT–BRAIN PAIN AXIS

The gut communicates with the brain not only through nerves – also important are:

• microbial metabolites,
• inflammatory cytokines,
• vagus nerve signaling.

Long-term intestinal irritation and inflammation may:

• increase central pain sensitivity – the brain effectively amplifies pain signals;
• make normal mechanical load on the back feel intensely painful;
• explain why some people experience abdominal, back, and other chronic pains simultaneously – this is not imagined, but a neuro-immune reality.

DOES BACK PAIN ALWAYS MEAN A GUT PROBLEM?

No. It is important to remain objective.

• Some back pain is purely mechanical – e.g., acute strain, trauma, clear disc herniation flare-up.
• Some pain is mainly related to psychosocial factors, stress, sleep deprivation, or sedentary work.
However, research shows:
• a proportion of chronic non-specific back pain cases has a clear inflammatory-metabolic intestinal component;
• gut microbiota and low-grade inflammation may be one important “brick in the wall,” even if not the only one.

WHEN TO SUSPECT THE GUT MAY CONTRIBUTE TO BACK PAIN?

Especially worth considering if:

• pain lasts longer than 3 months;
• worse in the morning with stiffness and improves with movement;
• intestinal symptoms are present:
o bloating, cramping, abdominal discomfort,
o frequent or very infrequent bowel movements,
o episodes of blood in stool (seek medical attention);
• diagnosed IBS, inflammatory bowel disease, celiac disease, or other gut conditions;
• family history of spondyloarthritis, psoriasis, inflammatory bowel disease;
• certain foods (high sugar, fast food, alcohol) noticeably worsen both digestion and back pain.

WHAT CAN SCIENCE HONESTLY SAY ABOUT TREATMENT TODAY?

• Probiotics, prebiotics, dietary changes, physical activity, and stress management are being studied not only for gut health but also for back pain.
• Pilot studies suggest microbiota modulation (probiotics for specific groups, anti-inflammatory diet) may:
o reduce pain intensity,
o improve quality of life,
o decrease systemic inflammatory markers.

However:

• there is still no “miracle probiotic” or universal protocol officially recognised as standard treatment for chronic back pain;
• each case is individual – what helps one person may not help another, especially with more serious diagnoses (IBD, axial spondyloarthritis, etc.).

The key message:

The gut and microbiota are neither mysticism nor a trend, but a real part of the back pain puzzle – and must be evaluated together with spinal, muscular, psychological, and lifestyle factors.

WHAT STEPS TO DISCUSS WITH A DOCTOR?

Consult a doctor if:

• pain is persistent,
• red flags appear (weight loss, fever, night pain, neurological symptoms, blood in stool).

Ask about the possibility of:

• assessing systemic inflammation (C-reactive protein; in some cases f***l calprotectin if intestinal inflammation is suspected);
• evaluating pain not only via MRI but also from metabolic and gut perspectives.

Consider a gut-friendly lifestyle:

• more fibre (vegetables, fruits, legumes, whole grains);
• less ultra-processed food, sugar, and trans fats;
• adequate sleep and physical activity;
• stress management – important not only for mental health but also for the gut and pain system.

This is not a “quick fix,” but these types of changes have the strongest long-term scientific support.

IN CONCLUSION

Back pain is not only about “bones and discs.” Increasingly, it is understood as a whole-system story involving:

• the gut,
• the immune system,
• the nervous system,
• lifestyle.

The earlier we start viewing pain systemically rather than only locally (“my lower back hurts”), the more people can receive meaningful, holistic, and scientifically grounded care plans.

If you feel stuck with chronic back pain, discussing the inflammatory component of the gut microbiota with a specialist is worthwhile – it often explains far more than expected.

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