As a chiropractor, I see back pain every single day. Much of the time, there is a musculoskeletal component, things like tight muscles, irritated joints, poor mechanics, or simply the strain of living busy, full lives. But musculoskeletal issues are rarely the whole story.
Back pain is often more complex than a single cause, and many people have underlying factors that influence how strongly they feel pain or how well they recover.The nervous system, hormones, stress, emotions, past experiences, and even unrecognized patterns in the brain can all influence how pain shows up and how it leaves.
This page is dedicated to helping you understand the other drivers of pain, the ones most people don’t talk about, and how to start finding the right support if your pain isn’t resolving the way you hoped.
The Nervous System: The Master Amplifier of Pain
While pain receptors in tissues can signal pain, the ultimate sensation and experience of pain are consciously generated and modulated entirely by the Central Nervous System (brain and spinal cord).
When the nervous system is calm and regulated, pain signals are clearer, more proportional, and much easier to address. Conversely, when the system is overwhelmed, dysregulated, or under chronic stress, those same danger signals can become amplified and perceived as louder, sharper, and far more challenging to resolve.
If the Vagus Nerve and its role in modulating pain perception come to mind, you’re on the right track. While the pain process is far more complex than a single nerve, the Vagus provides a valuable readout of the nervous system’s health and regulatory capacity. Understanding this connection allows us to explore how factors like stress, sleep, and emotional health contribute to chronic pain.
The role the Vagus nerve plays in the process and extent of pain awareness is why we measure Heart Rate Variability (HRV) in our practice. HRV is one of the most reliable, research-backed ways to understand how well someone’s nervous system is functioning and, therefore, how well their body may be able to heal and resolve pain. A higher HRV generally reflects a more resilient, adaptable nervous system, whereas a lower HRV can indicate chronic stress, inflammation, or reduced recovery capacity.
By looking at HRV, we can better understand the whole picture of your pain and guide you toward care that supports both your body and your nervous system, ensuring you have all the tools to manage your pain.
To understand the deeper impact stress has on the body, not just on pain but on how we store fat, build muscle, access energy, and relate to the people in our lives, it helps to look at Dr. Paul Gilbert’s Threat–Drive–Soothe Model.
This model explains how our emotional regulation systems shape everything from inflammation to tension to recovery.
The Three-System Model (Threat–Drive–Soothing)
Your nervous system moves between three core states:
1. Threat System-Fight / Flight / Freeze
This system is activated by experiences of stress, anxiety, shame, criticism, overwhelm, trauma, and internal and external pressures of how to look, be, perform, etc. In this state, your brain is scanning for danger, not healing. The experience of pain can feel sharp, hard to calm, and unpredictable.
The body prioritizes survival over recovery. Muscles tighten, breathing becomes shallow, cortisol rises, and pain signals amplify.
2. Drive System-Productivity, Pushing, Doing
This is the “go, go, go” mode where you are constantly doing, it’s the “keeping up with the Joneses’ state. Drive is our push to excel, to achieve, to make it through, and keep going. This state can also be influenced by the stories we inherit, family expectations, cultural values, or generational patterns that teach us we must always push, achieve, or stay busy to be enough. Perfectionists often spend a lot of time in this state. Also, parents, particularly single parents, can find themselves stuck in this state of drive, trying to hold everything together. Keep in mind, however, that the Drive system can be incredibly helpful until it becomes the only gear you operate in.
Constant overfunction cannot be said to be a singular causal factor for tightness in the neck and shoulders; however, many people experience the drive response as consistent tension in those areas. This overfunctioning of the drive system can also manifest as fatigue and burnout. In HRV, we often see an upregulated system that may eventually falter, leading to burnout. When Drive is fueled by threat rather than purpose, the nervous system never gets a chance to settle.
3. Soothing System-Safety, Calm, Connection
This is the system where your body can finally repair, metabolize well, heal efficiently, and let go of tension. For those entering or experiencing perimenopause, accessing this state can become more challenging, as hormonal changes often create added nervous system stress. When you picture the Soothing System, think of the feeling of a warm hug from someone you love and trust, a comforting cup of tea, or waking up fully refreshed after a deep sleep. In this state, pain softens, regulates, and responds more effectively to chiropractic care, movement, and breathwork. This is also the state where inflammation decreases, digestion improves, hormones rebalance, and the body becomes more metabolically efficient.
How the Threat-Drive-Soothe system can be understood in the broader context of chronic pain. When you are stuck in a Drive or Threat, you may notice increased muscle tension, shallow breathing, inflammatory signals, sleep disruption, insulin dysregulation, slower recovery time, and a lower pain threshold. When we help shift the system toward Soothing, even for just a moment, pain becomes more manageable, and treatment becomes more effective.
This is why we measure Heart Rate Variability (HRV) in practice. HRV gives us a window into how well your nervous system is regulated, and how primed and able your body is to heal.
2. Stress & Cortisol
Stress is not just something we feel emotionally; it is also a chemical process that can profoundly affect the way pain shows up in the body. Cortisol is incredibly useful and necessary: it helps us wake up in the morning, it fuels excitement before a first date, and it rises appropriately when we work out, problem-solve, or rise to a challenge. These short, healthy bursts support energy, focus, performance, and motivation.
The issue arises when cortisol stays elevated for too long or doesn’t cycle properly throughout the day. In those situations, the body shifts into survival mode rather than healing mode. Muscles tighten, inflammation increases, sleep becomes disrupted, digestion slows, and the nervous system becomes more reactive and sensitive. Pain becomes louder, sharper, and harder to settle, and the body has a more difficult time turning off those signals.
Prolonged stress also leads to bigger physiological changes. Elevated cortisol over time increases the production of inflammatory cytokines, chemical messengers that heighten the body’s alarm system. These cytokines sensitize nociceptors (nerve endings that detect pain), causing them to fire more readily and respond more intensely to normal movement or pressure. This lowers your pain threshold, meaning discomfort that once felt mild can become amplified or persistent. At the same time, chronic stress disrupts the brain’s natural ability to modulate pain, making the spinal cord and brain more reactive to incoming signals.
The result is that long-term stress doesn’t just influence how we think about pain; it changes how the entire pain-processing system functions. Pain becomes easier to trigger, harder to quiet, and more likely to linger. This is why stressful seasons of life, difficult relationships, aggressive work environments, parenting strain, or caregiving demands often coincide with flare-ups of back pain, neck tension, headaches, and persistent discomfort.
3. Sleep Quality & Back Pain
Poor sleep doesn’t just make you tired; it changes how your body experiences and processes pain. Research shows that even a single night of sleep loss can increase pain sensitivity by 20–40% the following day, with pain-sensing regions of the brain becoming up to 126% more reactive and the brain’s own pain-dampening system dropping by as much as 60–90%.
In this state, discomfort that would normally feel manageable becomes amplified, tissues don’t repair as effectively, inflammation rises, and emotional resilience decreases. Many people who think they have a “back problem” actually have a sleep problem that’s worsening their pain.
Deep sleep or slow-wave sleep (I use my Apple Watch to measure this) is particularly critical for tissue repair, hormone regulation, immune balance, and clearing inflammation, while REM sleep supports emotional processing and nervous-system regulation. What current research supports most strongly is not a single “magic sleep window,” but rather consistent sleep timing aligned with your natural circadian rhythm; some large population data suggest that a sleep onset between roughly 10:00 and 11:00 p.m. is associated with better cardiovascular and metabolic health, but overall, regularity, adequate total sleep, and circadian alignment appear far more important than a specific clock time.
Poor or inconsistent sleep makes the nervous system more sensitive and reactive, which means the low back feels pain more quickly and more intensely. When your body isn’t repairing overnight, the muscles, joints, and discs of the spine become stiffer, more inflamed, and less able to handle everyday load, making low back pain far more likely. Sleep is so very important in the management of pain.
4. Metabolic Health & Insulin Resistance
This is a big but often unexplored driver of pain. Insulin resistance happens when your cells stop responding properly to insulin, the hormone that moves sugar out of the bloodstream and into your muscles for energy. When this occurs, your body produces more and more insulin to compensate, leading to higher blood sugar, increased fat storage (especially around the belly), inflammation, and reduced energy, all of which can affect healing and pain. Low back, hip, knee and neck pain can all have links to metabolic health and insulin resistance. Pair insulin resistance with high cortisol (a very common presentation), and you get slower tissue healing, disc injury rates increase, muscles get tired much faster, and pain signals are amplified.
Women in midlife are often the ones who feel this most intensely.
A quick note on spinal discs: Discs are 80% water and rely on deep sleep, hydration, and movement throughout the day to stay healthy. When inflammation, stress, or poor sleep disrupt this natural cycle, discs are more prone to irritation and injury. A disc injury can be incredibly painful and challenging. Taking care of your discs is a very important part of preventing and treating low back pain.
5. Hormonal Changes
Puberty, pregnancy, postpartum changes, perimenopause, and menopause all influence the body in ways that can affect back pain, including shifts in ligament laxity, inflammation, sleep quality, muscle mass, tissue repair, and overall pain sensitivity. Throughout these hormonal transitions, fluctuations in estrogen and progesterone can significantly impact how the spine, muscles, and nervous system function, which is why many women, especially those over 40, notice more frequent or persistent back pain during these stages of life and have an increased incidence of disc herniation and injury, which can lead to significant low back pain. Addressing hormonal concerns can have a big impact on pain.
6. Movement Patterns & Sedentary Lifestyles
Sitting too much, tech-neck, weak glutes, a deconditioned core, or repetitive movement patterns all change how the spine absorbs daily load, and even very active people can develop imbalances, such as strength training without mobility, cardio without stability, yoga without strength, or running without cross-training. Movement is medicine, but it has to be the right movement. For some people under chronic stress, excessively high-intensity cardio can actually work against a healthy, regulated nervous system. In these cases, lower-intensity aerobic work, known as zone-two cardio, offers major cardiovascular and metabolic benefits without the strain of long hours on a stair climber. Short, well-structured bursts of high-intensity training can also be beneficial when balanced appropriately.
However, when it comes to building true lower-back strength and stability, nothing is more effective than well-designed weight training. Strength work improves the endurance of the deep spinal stabilizers, supports the pelvis and hips, and helps the body tolerate daily load with far less strain, making it one of the most powerful tools for preventing and reducing low back pain.
Where to Start If Your Pain Isn’t “Just Mechanical”
If your pain isn’t behaving like a simple mechanical issue, the next step is to support the whole system, not just the spine. Chiropractic care can reduce mechanical stress, improve mobility, calm pain signals, and help the body process discomfort more effectively. From there, breathwork and grounding practices shift the nervous system out of threat and into healing, while strength training builds resilience, stabilizes joints, and strengthens the core and hips that support the spine. Sleep optimization is often the missing piece and cannot be overstated. Also, improving metabolic health, especially insulin resistance, inflammation, and cortisol patterns, can make a dramatic difference in how pain presents.
For pain that feels stuck or deeply rooted, somatic or trauma-informed care can help release long-held patterns. And sometimes the most powerful approach is a supportive care team working together: chiropractic, massage, osteopathy, psychotherapy, and guided movement. You don’t have to figure this out alone. Guelph is home to an incredible community of skilled healing professionals who understand the power of collaborative care.
Pain is not just a physical signal; it is a conversation between the body, brain, and nervous system. Your pain may come from a joint, a disc, a muscle, a stressful season, a nervous system stuck in protection mode, an emotional load you didn’t realize you were carrying, or a combination of all these factors. My role isn’t just to adjust your spine, it’s to help you understand what your body is saying, find clarity, and guide you back to resilience. If you’re experiencing persistent back pain, I’m here. There are answers, there is support, and there is always a next step.