Some studies in the US show that almost ⅔ adults with chronic lower back pain have used narcotics over the previous month, and ⅓ had advanced imaging tests done in the previous year. In contrast, barely 3% had given formal spine rehab a try.
"Non-specific" back pain is often pointed out as a reason for pain management failure. But approaching the cause of pain allows classifying patients into different categories. Discogenic pain, for example, responds quite differently to ligamentous damage, or facet-based problems.
Like many other health-related phenomena, the relationship of tissue loading to injury risk is a U-shaped function. There is a moderate optimum we want to reach, and not exceed.
Sufficient loading is needed to get stronger, but excessive levels will weaken the tissues.