Low-back pain (LBP) pathology and pain have previously been connected with physical strain. The coping was therefore characterized by ''be careful!'' messages. In the 1990s it was shown that these physical loads virtually did not mean anything regarding disc degeneration, although loads may create LBP episodes. Genetic aspects and the demonstration in 2006 that Modic changes (MC) generally correlated with LBP changed our perception, especially because antibiotics seemed to be effective in MC. Moreover, the role of cytokines is becoming increasingly clear. The following years will be very exciting.