Low back pain (LBP) remains a leading cause of disability. Structural degeneration on imaging is a poor predictor of symptoms; instead, altered load distribution, segmental motion, muscular coordination, and posture drive dysfunction. Key objectives include clarifying biomechanical and degenerative mechanisms, linking spinal kinesiology to pain, and emphasizing functional assessment to guide rehabilitation. Narrative review findings show pain relates more to impaired stability, lumbopelvic rhythm, and neuromuscular deficits than to structural changes. Functional evaluation—movement analysis and task-based testing—directs individualized care. Early graded activity and neuromuscular retraining outperform passive approaches, underscoring the importance of function-focused rehabilitation.
Objectives (1) Summarize biomechanical and degenerative mechanisms associated with LBP; (2) Highlight principles of spinal kinesiology and their interaction with pain; (3) Emphasize functional assessment as a foundation for rehabilitation; (4) Translate mechanistic knowledge into individualized management strategies.
Design A narrative synthesis of contemporary literature on spinal biomechanics, intervertebral disc physiology, degenerative processes, and pain generation was performed. Evidence from imaging, kinematic studies, and clinical trials was reviewed with attention to mechanical loading patterns, muscular control, and psychosocial factors.
Results Degenerative changes represent a normal aging continuum and frequently occur without pain. Pain is more strongly associated with aberrant load transfer, diminished regional stability, and neuromuscular dysfunction than with structural variability. Altered lumbopelvic rhythm, impaired deep stabilizer activation, and compensatory movement strategies increase tissue strain. Functional assessment—including motion analysis, endurance testing, and task-based evaluation—guides diagnosis and rehabilitation. Early graded activity and neuromuscular re-education outperform passive or rest-based strategies.
Conclusions LBP management should prioritize functional restoration over structural correction. Integrating spinal biomechanics, movement analysis, and patient-specific impairments supports effective rehabilitation. Dispelling myths linking degeneration to disability and fostering active, strength-based reconditioning are key to improved outcomes.
