Imagine driving a high-performance sports car and never changing the oil or doing maintenance because the engine hasn’t made any strange noises.
Most of us would never do that, yet that’s exactly how many people treat their spine. We assume that if it doesn’t hurt, it’s healthy. But by the time pain appears, the body has often been compensating for months, or even years. And the most interesting part is that pain doesn’t necessarily mean there’s a structural spine problem, which is why I utilize a whole-person, functional approach to spine care.
I often tell my patients that the spine is less like a stack of building blocks and more like a living ecosystem. Every system in your body contributes to its health. Hormones influence bone density and muscle mass. Metabolic health affects inflammation and tissue repair. Nutrition provides the raw materials for strength and healing, while sleep and psychological well-being determine how effectively your nervous system recovers and adapts. When one system struggles, the spine often feels the consequences.
The Pain Game
The truth is, pain doesn’t always mean damage—and damage doesn’t always cause pain.
One of the most important (and reassuring) things I explain to my patients is that pain and structural damage aren’t the same thing. Your spine is comprised of bones, discs, ligaments, and joints that create structure and mobility, and the spinal cord and spinal nerves are the communicators between your brain and body. While damage can occur to these parts of the spine from injury or aging, the pain response may not correlate with a structural problem. Large studies have shown that many people with absolutely no back pain have bulging discs, arthritis, or age-related changes on MRI scans. At the same time, some people experience significant pain despite having very little visible structural abnormality.
Why? Because pain is produced by the nervous system, not by an MRI image. Your brain constantly interprets information coming from your musculoskeletal system, and it also considers stress levels, sleep quality, previous injuries, inflammation, emotions, and even expectations. Pain is very real, but it’s not always a direct measure of tissue damage. Understanding this can be incredibly empowering, because a painful back doesn’t automatically mean a fragile back.
Built to Move
A common misconception I hear is the idea that one wrong movement is all it takes to “throw out” your back. In reality, healthy spinal tissues become stronger through gradual, consistent loading. Like muscles and bones, the structures supporting your spine adapt to the demands you place on them.
Most spine injuries don’t result from a perfectly healthy person bending over incorrectly once. More often, they develop from years of repetitive poor movement patterns, prolonged sitting, weak supporting muscles, inadequate recovery, and sudden demands placed on tissues that have gradually lost their capacity. Fear of movement can actually make pain worse, while intentional mobility is safe and protective for your spine.
Protecting Your Spine
Your muscles are often your greatest source of protection, and strengthening them becomes even more important as we enter into midlife and see changes in muscle mass and quality.
The deep core muscles—including the diaphragm, multifidus, transverse abdominis, pelvic floor, and gluteal muscles—work together as an integrated system to stabilize the spine before you even realize you’re moving. When these muscles become weak or poorly coordinated, the spine doesn’t necessarily become unstable. Instead, movement becomes less efficient. Other muscles compensate, fatigue develops more quickly, and everyday activities begin requiring more effort. But strong, coordinated muscles don’t simply improve performance—they build resilience.
“By the time pain appears, the body has often been compensating for months, or even years.”
How Your Brain Plays a Role
Perhaps the most misunderstood aspect of spine health is the role of psychological resilience. To be clear, this doesn’t mean pain is “all in your head.” It means your nervous system becomes more protective during times of chronic stress.
Poor sleep, untreated anxiety/depression, chronic stress, fear of movement, and a persistent negative outlook or “catastrophizing” all influence how the brain processes pain. In fact, research consistently shows these factors increase the risk that an episode of acute back pain becomes chronic due to patterns of fear avoidance. The goal isn’t to ignore pain, but rather to gradually build confidence in movement so your body remembers that it’s capable, adaptable, and strong.
A 2025 systematic review and meta-analysis of more than 5,300 lumbar spine surgery patients found that people with untreated anxiety or depression reported more postoperative back pain, greater disability, and worse overall functional outcomes. This highlights the importance of addressing mindset and psychology as part of your overall health: recovery after spine injury or surgery is powered by the brain.
Patients who approach rehabilitation with confidence, maintain a sense of purpose, stay engaged in movement, and believe they can improve consistently recover better than those whose lives become dominated by fear, helplessness, or avoidance. That’s not wishful thinking; it’s one of the most reproducible findings in spine research. Building resilience, both physically and psychologically, is an essential part of protecting your spine.
Creating Spinal Health
One of the most important lessons is to build your reserve before you need it—and that means a larger focus on recovery.
Personally, it took me a long time to really understand this. As fitness-focused women, we often celebrate hard workouts and obsessively track activity metrics. I played soccer in college and then spent several years as an endurance runner, hyper-focused on mileage and less attentive to proper strength training, mobility, and nutrition. As I’ve gotten older, I’ve had to shift my mindset and workouts to create more balance and develop more compassion for my body. It’s important for me to practice what I preach, and I’m grateful that as a medical community we’re doing more research and developing a much deeper understanding of women’s health, fitness, and physiology, so we can sustain and support mobility and strength throughout our lives.
Invest in Longevity
One of the greatest privileges of my job is watching what the human body is capable of when it’s prepared. Not long ago, I cared for a 52-year-old female athlete who required spine surgery. Many people assume surgery marks the beginning of a long, difficult recovery. In her case, the opposite was true. She recovered remarkably quickly—not because the operation was different, but because she had invested in the health of her body long before she ever entered the operating room.
She prioritized sleep and nutrition. She challenged her body with strength training, maintained excellent cardiovascular fitness, and approached recovery with confidence rather than fear. Surgery corrected the structural problem, but it was her foundation that powered her recovery and got her back to doing everything she was capable of before the injury.
I see this pattern over and over again. Patients who are physically strong, metabolically healthy, psychologically resilient, and committed to movement often recover more quickly, regain function sooner, and return to the activities they love with greater confidence. Of course, every patient and every operation is different, and no amount of fitness guarantees a particular outcome. But the science is increasingly clear: the body’s “reserve” matters.
Think of foundational health like money in a savings account. Every strength workout, every night of restorative sleep, every protein-rich meal, every walk, every stress-management practice is another deposit. You may not notice the balance growing from one day to the next, but when life presents a challenge—whether it’s surgery, an injury, or simply the natural changes of aging—you have something to draw upon. Think of it as training for your future self.
After caring for thousands of patients, from professional athletes to older adults hoping to thrive and move as they age, it’s clear that a healthy spine is the common denominator of human performance. It’s quite literally the foundational core of our movement, confidence, independence, and recovery. My work has reinforced one lesson above all others—the healthiest spines are built long before surgery is ever needed. Build resilience for whatever tomorrow brings, and treat your spine like the remarkable engine that it is.
Your Spinal Health Prescription
Check these off your to-do list this month—consider it an investment in your future spinal mobility.
- Move your spine and joints in multiple directions every day—not just at the gym.
- Strength train, focusing on proper form, at least twice weekly to build the muscular “armor” that protects your spine.
- Advocate for early bone health screening.
- Prioritize sleep and stress management as seriously as exercise, as they directly influence pain sensitivity and tissue recovery.
- Don’t fear occasional back pain. Stay active, seek guidance when needed, and remember that pain doesn’t automatically mean injury.
