Why Back Pain Happens — and What Rehab Needs to Consider

Back pain is one of the most common reasons dogs are referred to rehabilitation. Yet it is often approached as a single diagnosis, when it is not. Before choosing exercises or progressing load, rehabilitation needs to answer two fundamental questions.

Is the back the primary problem — or a compensation?

The first step is distinguishing primary from secondary back pain.

Primary back pain originates from the spine itself, such as disc pathology, facet joint disease, or instability. In these cases, the spine is a genuine pain generator.

However, many dogs present with secondary back pain, where the back becomes painful because it is compensating for dysfunction elsewhere — commonly abnormal limb use or limb pathology (e.g., hip dyplasia, patellar luxation).

In these cases, the back is not the source of the problem, but the structure that has been overloaded to maintain function. Treating secondary back pain as if it were primary often leads to ongoing or recurrent symptoms.

What is the source of the pain?

The second key consideration is whether pain is musculoskeletal or neurologic in origin.

Musculoskeletal pain is typically related to tissue load. It tends to fluctuate with activity, improves with rest, and often responds to changes in movement strategy.

Neurologic pain, which is common in lumbosacral disease or intervertebral disc disease, behaves differently. Nerve root irritation and neural sensitisation can cause pain that is disproportionate to imaging findings and easily aggravated by fatigue or over-exertion. This type of pain cannot be treated like muscle pain. The pain needs to be controlled by appropriate pain medication, medical treatment or even surgery.

 

What this means for rehabilitation

Rehabilitation success depends less on exercise selection and more on problem definition.

Before progressing strength or intensity, rehab must consider:

·       whether the back is the primary issue or a compensatory one

·       whether pain is driven by tissue load or neural sensitivity

Exercise should be used not only as treatment, but as an assessment tool to guide progression, regression, or restraint.

Take-home message

Back pain is not one diagnosis. Effective rehabilitation is not about fixing the back, but about changing the conditions that made the back painful in the first place.

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