Back pain by the numbers

There are some staggering statistics surrounding back pain and its presence in society. Back pain was found to be the leading global cause of disability [1,2]. Back pain does not discriminate; it affects people of all ages, with prevalence beginning to increase during teenage years, peaking in mid-life, and women report back pain at a higher rate than men across all age groups…okay, it might discriminate a little [3].

Hoy et al., 2012

So what is back pain? Put simply, back pain is a symptom or sensation associated with the structures of your posterior chain between your head and butt. Back pain is then somewhat of an umbrella term, with much of the research aimed at the low back, often neglecting neck and mid-back pain (our assessments are built to handle mid-back and neck pain too!).

The utility of back pain

Pain is rather annoying. So annoying that we spend massive amounts of time, attention, and money to get rid of it. There is a flip side, though. Pain is a signal. It tells us that something is wrong. This signal is not only crucial for survival but also adaptive for avoiding injuries. Take the people with congenital insensitivity to pain (CIP), for example - individuals with CIP have a genetic condition that prevents them from feeling physical pain [4]. Without the ability to feel pain, injuries can accumulate and go undetected, resulting in joint deformities and loss of function over time.

So if pain is a signal, and back pain is common, what is our back pain trying to tell us?

Well, clearly your back is screaming at you that something is wrong. The tricky thing about back pain is that triggers and the underlying cause of pain are not always logically connected. People often think there needs to be a specific event or an exact moment of injury that caused their pain. Tissues weaken slowly over time, lowering the threshold for injury, and in some cases, tissue damage and pain can result from innocuous daily tasks. This makes back pain confusing and difficult to ameliorate. What do I mean? Let’s imagine a scenario where someone starts a new job. After a few months of getting to know their coworkers, they build some friendships and get invited to a plyometrics exercise class that a few people from the office go to. Sure enough, they hurt their back in class and swear that burpees are dangerous for your back. In reality, the new job they started involved months of sitting in slouched positions, reaching for distant objects, and awkward postures. The exercise class is not the problem.

Back pain causality

The vast majority of low back pain cases are deemed ‘non-specific low back pain’, with many claiming that there is no way to identify the pain source. Others would disagree, such as Dr. Stuart McGill, who believes that there’s no such thing as non-specific back pain and that there’s always an underlying mechanical basis to pain. Spoken like a true spine biomechanist. I tend to agree. While I don’t believe that the source can always be identified through assessment, I support the logic that we should identify pain triggers, reduce exposure to them, and build core stability and strength.

That being said, some of the main contributors to back pain are*:

• Physically demanding work
  • Mostly from increased mechanical exposures to awkward postures and heavy workloads, not from being active
• Smoking
• Obesity
• Poor mental health
  • mainly depression through catastrophizing thoughts
• Other physical comorbidities

*Contributors sourced from Hartvigsen et al., 2018.

This leaves us with the signal vs noise analogy. The signal is what you can do, and the noise is everything that distracts you from the signal. If you’re in pain, focus on the factors that you can control. Work on getting your body weight into the healthy range, reduce extended periods of sedentary behaviour, eat a balanced diet, get adequate sleep, and build strength. Side note - powerlifter Mark Bell coined a phrase that I love:

Strength is never a weakness.

In the age of the internet, it’s not hard to find useless health hacks. No really…I just googled stupid health trends, and it’s bad. We’re talking about putting garlic in your underwear as a method of boosting fertility and “bone smashing” to cause bone growth that reshapes your face. Anyways, if you’re unsure of whether something is worth it to improve your back health, it probably is as long as you stick to the basics. If you want to cut through the fat, learn about your back pain, and skip the trial and error, complete one of our assessments at backagainassessments.com!

Best,

Mitch

References

1. Hoy et al., 2014: https://ard.eular.org/article/S0003-4967(24)14896-0/abstract
2. Hartvigsen et al., 2018: https://pubmed.ncbi.nlm.nih.gov/29573870/
3. Hoy et al., 2012: https://pubmed.ncbi.nlm.nih.gov/22231424/
4. Schon et al., 2018: https://www.ncbi.nlm.nih.gov/books/NBK481553/