What is the gut-disc axis?

The gut-disc axis is a proposed biological pathway linking gut health to intervertebral disc health and low back pain.

In simple terms, it suggests that:

– The gut microbiome influences immune and inflammatory processes
– These inflammatory signals may affect spinal tissues, including intervertebral discs (the substance that sits between each vertebrae)
– Over time, this may contribute to pain sensitisation and persistent low back pain

While still an emerging concept, it aligns with broader research showing that chronic pain is influenced by whole-body inflammatory and neurological processes, not just local tissue changes.

Why researchers are looking beyond the spine for back pain causes

Traditionally, low back pain management has focused on disc degeneration, joint or muscle injury and nerve compression visible on imaging, however, many people with chronic low back pain have:

– Normal or only mild imaging findings
– Persistent pain that does not match structural changes
– Fluctuating symptoms influenced by stress, lifestyle, and general health

This has led researchers and clinicians to investigate systemic contributors to pain, including inflammation and gut health.

What this study found

This pilot study compared 28 people with chronic low back pain, with 28 healthy, matched controls

Importantly, participants with low back pain did not have advanced spinal degeneration, meaning their pain was not explained by severe structural changes alone.

Researchers analysed stool samples to understand what the participants gut microbiome environment was like.

Key findings: gut microbiome differences in chronic low back pain

1. Reduced gut microbial diversity

People with chronic low back pain showed lower gut microbial diversity compared to healthy individuals.

Lower diversity is commonly associated with:

– Increased systemic inflammation
– Reduced resilience of the gut microbiome
– Greater risk of chronic disease

This suggests a less balanced gut environment in people experiencing persistent pain.

2. Increased pro-inflammatory bacteria

The study found higher levels of bacterial groups linked to inflammation, including:

– Proteobacteria
– Desulfobacterota
– Prevotella

These bacteria have been associated in other research with immune activation and inflammatory signalling.

3. Reduced beneficial bacteria

Lower levels of beneficial, gut-protective bacteria were also observed, including:

– Bacteroidota
– Parabacteroides

These bacteria are involved in maintaining the gut lining, producing anti-inflammatory compounds and reducing inflammation levels and supporting immune regulation.

How could gut health influence back pain?

The proposed mechanism involves several steps:

1. Gut imbalance (dysbiosis) – Changes in gut bacteria reduce protective functions and increase inflammatory activity.

2. Increased intestinal permeability – A weakened gut barrier may allow bacterial products to enter the bloodstream.

3. Systemic inflammation – The immune system responds by releasing inflammatory chemicals throughout the body.

4. Effects on spinal tissues -These inflammatory signals may, sensitise pain pathways – making you more prone to feeling pain, increase inflammation around spinal structures and influence your spines disc health.

5. Persistent pain cycle – over time, this may contribute to chronic low back pain, even in the absence of major structural abnormalities.

What this means for people with chronic low back pain

For patients attending physiotherapy, exercise physiology, or allied health services at Thriving Lives Co in Cairns, this research reinforces an important clinical message; chronic low back pain is often influenced by multiple systems in the body and not just the spine.

This aligns with modern pain science and the biopsychosocial model used in contemporary practice – where we focus on the whole person in a holistic approach.

It helps explain why effective management often includes:

– Graded exercise therapy
– Education about your body, pain, stress, inflammation and general health
– Stress and sleep management
– Lifestyle modification

Can you treat low back pain by targeting gut health?

Yes & no – this research reinforces our messaging around the importance of holistic health to support your bodies internal environment, which may reduce inflammation levels and reduce your level of pain. It isn’t the sole treatment of your back pain, but at times may be worth exploring:

– Dietary interventions to support microbiome diversity
– Probiotic or prebiotic strategies
– Exercise programs that influence systemic inflammation
– Stress reduction strategies (which also affect gut function)

Importantly, these approaches are best considered adjuncts to evidence-based physiotherapy and exercise rehabilitation-not replacements. Meaning they form a small piece of a larger puzzle.

The take-home message

This study adds to growing evidence that chronic low back pain is not purely a structural problem.

Instead, it may involve:

– Immune system activation
– Gut microbiome changes
– Nervous system sensitisation
– Lifestyle and behavioural factors

The emerging gut–disc axis hypothesis provides new insight into understanding the complexities of chronic pain, and how we can best support individuals to thrive by targeting the whole system.

How Thriving Lives Co in Cairns approaches low back pain

At Thriving Lives Co, our multidisciplinary team integrates:

– Physiotherapy
– Exercise physiology
– Occupational therapy
– Psychology

This allows us to address low back pain from multiple perspectives, including:

– Movement and strength
– Load management
– Pain education
– Psychological and behavioural factors
– Lifestyle influences on recovery

This aligns closely with modern research suggesting chronic pain is a system-wide condition, not just a local tissue issue.

Conclusion

The relationship between gut health and chronic low back pain remains an emerging area of research suggesting that gut health may play a role in chronic low back pain through systemic inflammation and immune pathways.

While still in early stages, this study provides further evidence that effective management of chronic pain may require a whole-body, multidisciplinary approach – consistent with the model of care used at Thriving Lives Co. If you’re in need of assistance with back pain, whether in Cairns locally, or online – reach out to find out more or make a booking.

Research source:
Sima S, et al. (2026). Patients With Chronic Low Back Pain Without Advanced Disk Degeneration Exhibit Gut Microbiome Dysbiosis: Evidence From an Age-, Sex-, and BMI-Matched Pilot Study. JOR Spine, 9(2), e70174.

Kadell Pearce
Physiotherapist
Thriving Lives Co. 
Bungalow, Cairns