The Cause Of, And Solution To, Back Pain

There are too many myths about what causes back pain, and far too many treatments for back pain to ignore (most of which are a waste of time and money).

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Today I wanted to give a more in-depth look at causes and solutions to lower back pain. I have previously written about this in a more general sense, but I really feel like this topic deserves more attention. There are too many myths about what causes back pain, and far too many treatments for back pain to ignore (most of which are a waste of time and money). So let’s dive into some surprising factors causing pain, and some practical tips on how to deal with it!
Why Do I Hurt?!?!
I’ll start by saying that 80% of people will experience an episode of back pain during their lifetime. So it’s good to know you’re not alone in wondering what’s going on with your back. But the reason behind your back pain is surprisingly complicated. Aside from acute sprains and strains, the exact diagnosis of the root cause of the problem is often never made, or made incorrectly.
Imaging
We know that using techniques such as X-ray and MRI are often ineffective at catching the true problem (1). This is because most people, HEALTHY pain free people, already have some form of disc or spine degeneration (2). This simple fact can be very misleading when doctors are trying to interpret radiographic findings. The only exception to this rule seems to be for SI joint dysfunction, but even that has some major issues (3). Ultimately, this means that there is no evidence that back pain is caused by a bone or joint in the back being out of place, some change in spinal alignment, or your pelvis being out of alignment. . But on the bright side, we know that more pain does not always mean more damage! Here are two great podcasts going over in detail what types of examinations are often used, and which ones actually workONE TWO.
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Back Pain Exacerbates Itself
Often times pain can make someone afraid to move. This is called kinesiophobia and when it comes to back pain it can be terribly detrimental. This is because movement is key to preventing pain and getting your back better! We know that bending and lifting is not a problem, but rather that muscular fatigue during these tasks can be what causes back pain (4). And we know that stress and a lack of sleep can also cause low back pain (5,6). And if you read my previous post on back pain, you will know that sitting too long can cause back pain. So I hope by now you can see how back pain can make itself worse over time, and that it may not be caused by any physical issue that you may already have to begin with.
What To Do About That Back
DON’TS
Because there is generally no specific cause of back pain, there really is no specific way to treat it. However, we do have a good idea of what works and what doesn’t work. Let’s start with what’s on everyone’s minds… the core. Core training, is often the go to fix for back pain because one would think that a stable back/spine is what’s needed to fix a back problem. But as we know the spine is often not the problem so core training (e.g. targeted core training or Pilates) is not the solution (7). We also know that surgery,  orthotics, or focusing on “perfect posture”are not helpful as well. Finally, alternative methods such as massagetrigger point therapyglucosamine, and back crackin don’t work either (8)
DO’S
One great way to address the pain is by not freaking out and going to your doctor right away. The majority of people who experience back pain have their problems go away within 2-6 weeks of it’s onset. Even the dreaded disc herniation goes away on it’s own over time. Exercise your whole body to see the greatest benefits for both back pain and general health. Aside from making sure you have a strong tooshie (gluteus medius), there is no specific form of exercise that works the best but it seems that total body strength training does the trick (9). If you’re not up for that, then WALK!!! Walking has been shown to be just as effective, and walking backwards may even be a better way to go (10).
The key in all of this is to make sure you get a lot of exercise. Because when it comes down to it, it’s the quantity NOT the quality of exercise that you get that will solve your issues (10).
References
1. Chou, R., Qaseem, A., Snow, V., Casey, D., J. Thomas Cross, J., Shekelle, P.. . American Pain Society Low Back Pain Guidelines Panel. (2007). Diagnosis and treatment of low back pain: A joint clinical practice guideline from the american college of physicians and the american pain society. Annals of Internal Medicine, 147(7), 478.
2. Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A.. . Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American Journal of Neuroradiology, 36(4), 811-816. doi:10.3174/ajnr.A4173
3. Laslett, M. (2008). Evidence-based diagnosis and treatment of the painful sacroiliac joint. The Journal of Manual & Manipulative Therapy, 16(3), 142-152. doi:10.1179/jmt.2008.16.3.142
4. Seyed Hoseinpoor, T., Kahrizi, S., Mobini, B., & Naji, M. (2015). A comparison of abdominal muscle thickness changes after a lifting task in subjects with and without chronic low-back pain. Human Factors: The Journal of Human Factors and Ergonomics Society, 57(2), 208-217. doi:10.1177/0018720814544213
5. Truchon, M., Côté, D., Schmouth, M., Leblond, J., Fillion, L., & Dionne, C. (2010). Validation of an adaptation of the stress process model for predicting low back pain related long-term disability outcomes: A cohort study. Spine, 35(13), 1307. doi:10.1097/BRS.0b013e3181c03d06
6. Alsaadi, S. M., McAuley, J. H., Hush, J. M., Lo, S., Lin, C. C., Williams, C. M., & Maher, C. G. (2014). Poor sleep quality is strongly associated with subsequent pain intensity in patients with acute low back pain: Sleep quality and pain intensity. Arthritis & Rheumatology, 66(5), 1388-1394. doi:10.1002/art.38329
7. Wang, X., Zheng, J., Yu, Z., Bi, X., Lou, S., Liu, J.. . Chen, P. (2012). A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PloS One, 7(12), e52082.
8. Hegedus, E. J., Goode, A., Butler, R. J., & Slaven, E. (2011). The neurophysiological effects of a single session of spinal joint mobilization: Does the effect last? The Journal of Manual & Manipulative Therapy, 19(3), 143-151. doi:10.1179/2042618611Y.0000000003
9. Cooper, N. A., Scavo, K. M., Strickland, K. J., Tipayamongkol, N., Nicholson, J. D., Bewyer, D. C., & Sluka, K. A. (2016). Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. European Spine Journal, 25(4), 1258-1265. doi:10.1007/s00586-015-4027-6
10. Ferreira, M. L., Smeets, R. J. E. M., Kamper, S. J., Ferreira, P. H., & Machado, L. A. C. (2010). Can we explain heterogeneity among randomized clinical trials of exercise for chronic back pain? A meta-regression analysis of randomized controlled trials. Physical Therapy, 90(10), 1383-1403. doi:10.2522/ptj.20090332

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