Prolonged lower back and neck pain can be avoided with the right advice on pain management and not over-protecting the injury. Painful tissue in the spine can be desensitized with the right advice and movement therapy. Pilates equipment allows this to be achieved while managing pain. Passive modalities such as massage and manual therapy can help pain management in the early phase. Avoidance of pain or fear of movement can cause a chronic pain response and then guarded movement patterns. Catching these behaviours early is key to a faster and normal healing process. Physiotherapy research supports movement based therapies over passive manipulation.