Chronic Spine Pain Doesn't Need an Injection: The 2025 BMJ Guideline Just Torched Common Spine Treatments (and Why PT Still Wins)

Let’s get one thing straight: if you’ve been told that chronic spine pain means you need an injection, a nerve burn, or a steroid cocktail to “get your life back,” you’ve been sold a shortcut with no finish line.

The 2025 BMJ Clinical Practice Guideline just dropped a bombshell on the spine world, and it’s one we’ve been preaching at Summit Sports Lab for years:

Most commonly used interventional procedures for chronic axial and radicular spine pain have little to no lasting benefit.

After crunching data from 81 randomized controlled trials and nearly 8,000 patients, here’s what the science says:

Procedures That Don’t Pass the Sniff Test:

• Epidural injections (local anesthetic, steroid, or combo)

• Radiofrequency ablation (facet joints, dorsal root ganglia)

• Facet joint blocks and steroid shots

• Intramuscular trigger point injections

Despite their popularity, these interventions showed no meaningful improvement in pain or function compared to placebo or sham procedures. Some even carry risks: dural punctures, infection, bleeding, and maybe the most damaging, false hope.

The Real Fix: Move. Load. Adapt. Repeat.

When the needles stop working, you’re left with what actually heals tissue: stress + adaptation.

At SSL, we combine sport science, movement analysis, and strength programming to do what a steroid shot never could:

• Restore joint integrity and segmental control

• Reinforce neuromuscular coordination (aka your spine’s air traffic control)

• Build tissue tolerance to real-world load (lifting your kid, biking, skiing, living)

• Challenge pain beliefs with graded exposure and mechanical confidence

You can’t zap your way to better spine mechanics. But you can absolutely train your way there. While also using non invasive modalities like manual, adjustments, cupping, and dry needling to help with immediate sensations of pain.

Let’s Get Nerdy: Spinal Biomechanics & Load Capacity

• The lumbar spine handles load through a complex interplay between disc pressure, ligament tension, core bracing, and force vectors across the hip-pelvis-lumbar axis.

• In chronic pain states, motor control gets disrupted, often leading to protective guarding and movement avoidance—both of which decrease load tolerance and increase pain sensitivity.

• Studies show that structured, progressive strength training restores cortical maps, enhances muscle timing (especially deep stabilizers like the multifidus and transverse abdominis), and reduces pain perception via descending inhibition.

Translation? You’re not fragile. You’re under-trained in the right patterns.

The SSL Takeaway

Pain is real—but it’s also a call to level up. You don’t need to be numbed or burned to get relief. You need:

• A clinical assessment that actually looks at how you move

• A strategy that progresses load, not avoids it

• A coach and clinician who gets what it means to live in a mountain athlete’s body

Bottom Line:

Steroids fade. Strength stays. If you want to reclaim your spine, it’s time to get off the table and into the gym—with intention, precision, and a team that actually trains for the long game.

Consult our Physio or Trainers Today