The aetiology of low-back pain (LBP) is still largely unknown. The injury model and our biomechanical hypotheses do not seem to be appropriate in explaining degeneration or common painful conditions. The spine has an extensive network of small and large muscles capable of finely adjusting load transfer on the spinal structures while providing mobility. The sensory system responsible for proper motor control of these muscles is not known. The clinical picture we often see in patients with LBP suggests that muscles are involved. The body is under constant change owing to ageing and degeneration, and, obviously, so is the spine. This implies that the sensory motor control system must adapt to these changes, which may imply reorganisation of muscle activation. Such an adaptation may be the physiological response that we call LBP. Even if it is painful, it may be beneficial in the long run. Chronic pain may be the result of maladaptation.
European Musculoskeletal Review Vol. 4, Issue 1, p. 44-47