Why Does Your Back Hurt?

One of the number one things that people with back pain want to know when I work with them is "Why does my back hurt?" Answering this is not always easy and research would tell us that the reason for a back pain episode and particularly pain that does not go away, is rather complex. In fact, many of the long held beliefs about why people have back pain have been shown to not be true. In this article, I would like to explain some of the things that we now think contribute to back pain and particularly, ongoing pain. 

Although it would be great if we could specifically identify the reason for ongoing back pain, and fix it, the reality, as shown by the millions of people in the world suffering from ongoing back pain and failed interventions to "fix it," is that there is rarely one specific thing causing a person's back pain. In fact, 90% of back pain is what we would call "non-specific" back pain-meaning a specific, structural reason for the pain cannot be identified. This is good news, because a change in structure does not have to be made to get out of pain. The other good news is that most non-specific back pain will get better on its own, or with some good education/advice and the appropriate treatment and movement. ​

But, what happens, when it does not get better on its own? This is where things start to falter and reasons are given for the ongoing pain which like are not true. I have written about some of these things in the past. Posture is commonly blamed, but research really does not support this: www.promotiongb.com/blog/back-pain-and-posture
​Sometimes, people are told that something in their back is out of place and this is the reason for their pain. Again, this has not been show to be true: www.promotiongb.com/blog/back-pain-is-something-out-of-place
​And then there are the beliefs that back pain is caused by degenerative disc disease, disc bulges, how we lift, and even how we sleep:
www.promotiongb.com/blog/low-back-imaging-how-useful-is-it
www.promotiongb.com/blog/what-happens-to-herniated-discs   
​www.promotiongb.com/blog/is-it-ok-to-bend-my-back 
​www.promotiongb.com/blog/sleeping-position-and-back-pain   

​So, if the evidence is weak that these things cause or maintain ongoing back pain, then what does? The research would tell us that ongoing back pain is likely multi-factorial and and that we need to look at it and treat it from a biopsychosocial perspective. But, what does this exactly mean for you (or me as someone that helps people with back pain)? It means that the "whole" person needs to be considered with back pain. 

The "Bio" portion can include such things as the mechanism of injury (if there is one), activity levels/conditioning/strength/endurance, sleep, how a person moves (or doesn't move), certain positions that may be aggravating, activity modification, and any other thing that relates to the physical condition of the body that can be changed. This is where, many health care practitioners (physical therapists, chiropractors, massage therapists, personal trainers, etc) spend all their time trying to help patients. The problem with this is that more and more research for ongoing pain conditions is showing that the psychosocial aspect of an individual can also play a significant role in whether or not, or even how quickly, a person recovers from a back pain episode. 

The "Psycho" portion can include a person's beliefs and attitudes about their body and pain. It can also include worry, fear, uncertainty and anxiety about their condition. How well a person is coping with their pain,  how they expect to recover, how much they feel they can control their symptom, and whether they previously or currently have depression have also been shown to affect recovery. 

Lastly, the "Social" portion can include such things as their relationships with friends and family, job satisfaction, how much emotional support you have, and how much have you kept up with doing the things in public that make you happy. I find many people who have had back pain for a long time, have stopped doing things with friends and family because of the pain and we work for ways to get them more connected again. 

As you can see from the picture to the left, how much the "Bio," "Psycho," and "Social" aspects affect a person is very individualized (Image by Ben Cormack) and likely different for each person. But, to help a person who is experiencing pain, all of these aspects need to be considered as a contributor to an ongoing painful episode. If only the "Bio" is managed, it may make recovery a bit more challenging. 

In my comprehensive assessment of a person struggling with back pain, my aim to to listen attentively and perform a detailed assessment so that all factors that can be contributing to their ongoing pain can be addressed if needed, to help them move forward and have a better understanding about their back and get back to living the life they enjoy. 

Feel free to contact me with any questions.

Thanks for reading,
​Bob