Spine
(Chronic Low Back or Cervical Pain, Degenerative Disc Disease)
Core message: Disc and facet degeneration on imaging correlate poorly with symptoms; exercise targeting motor control, endurance, and thoracolumbar coordination is the cornerstone of recovery.
Key evidence:
Brinjikji W et al., AJNR Am J Neuroradiol 2015;36(4):811‑816 — Meta‑analysis showing high prevalence of “abnormal” MRI findings in asymptomatic individuals.
Hayden JA et al., Cochrane Database Syst Rev 2021;9:CD008943 — Exercise therapy reduces pain and improves function in chronic low back pain compared with minimal care.
Saragiotto BT et al., JAMA Intern Med 2016;176(7):985‑995 — Motor control exercise is effective for chronic nonspecific low back pain.
Spine: Chronic Back Pain, Degenerative Disc Disease
Clinical Layer:
MRI findings and structural degeneration poorly correlate with pain; exercise targeting neuromuscular control and stability is the mainstay, not surgery.
Sleep quality and daily activity rhythms directly impact symptom severity and recovery trajectories.
Chronobiological Layer:
Disc cells express robust rhythmic control of protein turnover. Disruption of central and peripheral clocks leads to abnormal matrix composition, reduced resilience, and persistent pain.
Flattened circadian patterns from chronic poor sleep, shift work, and artificial lighting potentiate ongoing tissue degeneration.
Why Should I Care?:
Consistent exercise helps back pain, but your body's overnight repair cycles drive deep recovery. Restoring your sleep and daily rhythm is vital, more important than any single therapy.