Spinal pain is one of the most disabling health care disorders and commonly reported in dentists, with 50% reporting neck pain and 30% back pain. Historically spinal pain has been thought to be caused by damage or degeneration of the spine, weakness of the core muscles and or ‘poor’ posture. However there is little strong evidence to support these beliefs. In contrast there is growing evidence that spinal pain is complex and is influenced by a combination of factors such as: genetics, gender, poor sleep patterns, inactivity, stress, muscle tension and low mood. Persistent and disabling spinal pain is associated with unhelpful beliefs and behaviors that drive fear, distress, sensitization, protective guarding and avoidance. A cognitive functional approach provides a personalized evidence based understanding of spinal pain, pain control strategies to enable people to build confidence to engage with painful, feared and avoided valued activities, and addresses unhelpful lifestyle behaviors. There is growing evidence that this approach results in larger long-term benefits over traditional approaches.