What You See is NOT What You Get in Health

Seeing is believing, isn’t it? That’s what I’m challenging, because it often causes more harm than good in the area of health I work in.

The issue in our modern world is that we have more and more scans, posture advice, ergonomics, manual handling rules, mental health awareness and ways to be social, but low back pain is increasing, not decreasing.

What’s going on? Could it be that lots of what we use to diagnose and manage back pain is not only non-evidence-based but actually making the problem worse?

“Appearances can be deceptive"

The facts...

1. Damage on scans is often a red herring

The more we research, the more we find that damage on scans is normal rather than causative of someone’s pain. In 50 year olds without pain 80% had disc degeneration; 60% had disc bulges.

A recent high-quality study in Finland found that 96% of people aged 40-76 without pain had rotator cuff abnormalities, yet many of these findings will be incorrectly blamed as the source of pain when it fits with what you’re looking for and gives a nice, clean diagnosis.

Staying with shoulders, even if you do the gold standard of a randomised controlled trial and have some people have the surgery and others have placebo surgery (incision but nothing more), there’s no difference after 10 years in the groups.

Ian Harris, an eminent surgeon, has written a book all about this called Surgery, The Ultimate Placebo.

We’re so indoctrinated into the belief that getting a scan will show us what the problem is that when we see damage there, we draw an erroneous link to the pain that is very hard to move past for all concerned.

2. Posture has nothing to do with pain

Posture often gets blamed when people have pain, it’s nonsense from an evidence-based stance. The problem is how widespread the belief that posture causes pain is. We hold onto our beliefs tightly and this is one that can be challenging to change, especially with all the constant reinforcement the world provides.

A whole industry has sprung up out of posture as a cause for pain, with ergonomics and posture aids to hold you in the right position.

Not only are they costly and often ineffective, but they drive fear and a psychological burden about slipping into the mythical wrong posture.

This is not only misguided but forms a perfect repeated focus of attention, driving a powerful, evidence-based factor for issues becoming chronic and ongoing, namely hypervigilance.

Manual handling can’t escape scrutiny, and by now you’ll not be surprised to hear that the generic, straight back and bend your knees advice, when looked at by what is considered the gold standard in research, a Cochrane review found “none of the studies provided evidence that training and provision prevented back pain compared to nothing or another intervention”.

3. Social media is a mirage of social connection

Social relationships have a strong positive impact on health.

In 2025 The World Health Organisation did a global report on social connection, declaring it as a global health priority.

Amongst the drivers for social isolation and loneliness was “Unhealthy use of digital technologies”.

Social media has tricked people into believing they are being social using it when the opposite is true, and they are creating isolation and loneliness.

It also creates an emperor has no clothes type illusion about how well everyone else is doing and gives people unlimited comparison subjects, hijacking our conformity bias of wanting to fit in, which is impossible because we’re looking at highlight reels, not real life.

What can you do?

Knowledge is power, knowing this allows you to start asking more informed questions of the people you seek care from and yourself.

1. Context matters

Pain is complex, so make sure the person who is leading your care understands you, your life story and goals.

Be wary, of simple fixes, especially if you have had your issue for a while.

If having imaging or a discussion with a surgeon, ask questions like

“What happens if I do nothing?”

“Are there studies comparing having surgery to ‘sham’ placebo surgery?”

I’d also check what they define as a successful outcome and check if it matches yours.

Ultimately, we all get wrinkles on our faces as we age and the same is true under the skin. We don’t call them degenerative disease of the face so maybe we could think of things like degenerative disease of the discs like normal age-related wrinkles.

2. Comfort and the next posture is your best one

Posture is a really hard belief to challenge in people because it’s drilled into us from a young age at school.

Posture does have effects on our success in life, so it absolutely influences things in the social domain. If you interviewed someone who slumped back and put their feet on your desk, it would probably be a mark against, not for them.

When it comes to posture all the mixed messaging means that people in pain are hurting and tense, trying to find the ‘right’ posture, which doesn’t exist. Aiming for comfort and learning how to relax their body and unguard it is a better goal.

Another thing about posture is that when you are in pain, often the area is tight and sore and trying to maintain a static posture means you are compounding this soreness by trying to hold yourself there; that’s like clenching your fist when you have sprained your wrist, it only makes it worse.

Movement variability is hugely valuable when lifting. Consider that animals and kids rarely injure themselves while lifting and have never done a lifting and handling course, or been consciously controlling their bodies as they do it.

The aim is to get as much of the body involved in the movement as possible because many hands make light work.

3. Consider the cost of [un]social media

Australia have banned social media for under 16’s, and there are likely to be lots of countries, including ours follow suit.

It’s quite fitting that 16 is the same age as smoking, because in the fullness of time, I think we’ll look back on just how crazy it was that everyone did it and didn’t realise the danger, just like smoking years ago.

Community is the thing that humans really benefit from so push your comfort zone and join in with more. Real things where you are in the room and present.

Get to know your neighbours, there are lonely people on your street.

Places are desperate for volunteers in causes that are probably close to your heart, so jump in and be the change you want to see in the world.