Studies of people from countries from around the world tell us that you are just as likely to have a sore back in Bolivia as you are in Nepal or England or Australia. However, you are much less likely to be disabled by your sore back in Bolivia or Nepal. Why?

One answer is that people in highly-developed countries are more likely than their less developed counterparts to respond to soreness with under-use and over-care.

In our community, we often think of work activities as causing problems, particularly musculoskeletal problems. Yet research says that under-activity presents a significant health risk. As anyone who’s recently hit the slopes after months of city-bound, wintery inactivity knows, being sedentary and then doing unaccustomed activity can result in soreness.

One of the challenges is finding a happy medium. This can be especially tough in some workplaces. A job that is highly repetitive with little rotation is more likely to produce musculoskeletal problems, particularly if workers aren’t happy with some aspect of the workplace or job and feel that they have a low level of control.

Despite the difficulties, most research says we should be telling people with common neck or back problems to return to normal activities sooner rather than later. The evidence suggests that remaining active is an important part of treatment for musculoskeletal problems. As treating practitioners, this is the advice we should be passing on to our patients.

But in everyday practice, patients are commonly advised to be careful and avoid certain activities. “Be active,” they are told, but “be careful.” This might seem like good, sensible advice, but the consequences can be a rehab nightmare.

Last week I saw a lady who had experienced an acute neck strain on one particular day some months ago, and continued to have soreness still. She works in a job that is administrative and requires her to regularly handle largish files. Although she is only in her twenties, when I saw her she was holding her neck very stiffly and avoiding turning her head in case it caused increased pain.

She was receiving gentle, passive treatment, and her physiotherapist had recently told her that she was not yet ready to do exercises, despite the fact that the episode of acute pain was some months past.

This is just sort of person we should be telling to return to her usual activities as soon as possible. For her type of neck problem, returning to normal activities has been shown to produce better outcomes and normalise the situation. Her well-meaning physiotherapist was giving her confusing messages. She had started walking to get some exercise, but was not really sure if she have been. She thought the physio had told her not to do weight-bearing exercise.

This is a real case of “use it or lose it”. The more she protects her neck, the more the muscles will stiffen up, prolonging her pain and workplace problems. This lady needs confidence that she does not have a serious problem: confidence that with time, a few exercises and the resumption of everyday activities, her problem will settle. She needs confidence that she will be able to return to her usual job.

“Under-use” of muscles is a significant contributor to musculoskeletal problems. Under-use perpetuates physical problems.

If I, as a doctor, had a similar neck condition, I would be back to everyday activities quick smart. I doubt the physiotherapist who warned against activity and exercise would approach her own problem that way, and it is certainly not an approach used for the people who get the best care: professional athletes.

Being careful is often harmful and we need to get that message across to treating practitioners.