Causes, Risk Factors and Prevention of Back Pain

The most important thing to understand is that the definitive cause of an individual’s back pain is difficult to identify. It has been estimated that a definite cause is evident about 20 percent of the time using tests like MRI of the lumbar (lower) spine. 

What Is Back Pain?

Back pain is part of life for most of us. At any given time about one in five people will be experiencing back pain. Around four in five of us will experience significant back pain during our lifetime.

THE EVOLUTION OF MAN TO AN ANIMAL THAT WALKS ON TWO LEGS HAS ALLOWED FOR MANY SURVIVAL ADVANTAGES. BUT IT ALSO COMES WITH SOME BAGGAGE. KEEPING US UPRIGHT ALSO MAKES US VULNERABLE TO PAIN ARISING FROM THE COMPLICATED MUSCULOSKELETAL SYSTEM THAT SUPPORTS US. 

Back Pain Physiology
Much of back pain arises from the very structures that hold us upright — the muscles, the bones, the joints and the intervertebral discs. Other structures that are not supportive may also present with back pain. This includes the kidneys, gallbladder, uterus and bladder.

The most common form of back pain comes and goes similar to the common cold. The cause is usually unclear, and the vast majority of the time it goes away without treatment. 

Back Pain as a "Part of Life"

Shockingly, the reason that back pain has become one of the major reasons that we report to a doctor or miss time at work is because we don’t think of back pain as “part of life” but rather as something broken or something needing to be fixed. This perceptual error has propelled back pain from a common symptom into a disease. This is a process called medicalization, and it is the cause of unnecessary cost, treatments and time out of work.

If you search the Internet, you will find many claims for the treatment of back pain. In reality, most cases of back pain don’t require treatment. Like the common cold or a headache, back pain will run its course and improve. The many health care providers that offer care for back pain end up costing us unnecessary dollars and perpetuating the notion that back pain needs treatment.

Ultimately, this undermines the sufferer’s confidence in managing his or her own pain. 

Patients Take Control

The best treatment for back pain is initiated, managed and maintained by the patient. It doesn’t involve any fancy treatment and consists mostly of restoring activities of daily living like walking, working, socializing and, ideally, core strengthening.

Although there are occasional presentations of back pain that require medical attention, the natural tendency of back pain is to improve. We now know that recurrence is also typical and that improvement is often not complete. There is also a small subset of patients whose pain becomes chronic. 

Strengthen the Core

It is my experience as a medical provider that strengthening the core muscles will limit the frequency, duration and intensity of the invariable recurrences that occur. It will also help to make recovery as complete as possible.

I can see how strengthening the core would seem counterintuitive to back pain sufferers. Such exercises would be expected to antagonize the back pain and are thus avoided. However, core strengthening is typically safe and effective, even in the face of back pain, particularly if it is done slowly and progressively. Some patients will need the aid of a professional to help with form and technique, but with a commitment to core strengthening, virtually all back pain sufferers will be able to take ownership of their own programs.


What Causes Back Pain?

There are many structures in the back that may be the cause of the pain. This includes all of the structures in and around the spine that contain nociceptors, which are tiny nerves responsible for transmitting pain. This includes the lumbar discs, the facet joint capsules, the sacroiliac joint, muscles, fascia, vertebral bodies and dura. It also includes abdominal and pelvic structures, such as the uterus, bowels, aorta, kidneys and ureter.

It is common for health care providers to search for the cause of back pain with X-rays, CT scans or MRIs. These tests can be misleading because they may reveal abnormalities that aren’t necessarily causing the pain, leading to unnecessary treatments that are expensive and associated with risks.

One common example is when an MRI reveals a herniated disc in the low back, therefore the patient assumes this is the cause of his back pain. However, we now know that herniated discs seen on an MRI are often not painful. But, once this patient is aware of the herniated disc, he will tend to be more guarded in his actions and see himself in a vulnerable light. These psychological and behavioral alterations can also be a source of pain. Thus, pursuit of the diagnosis can not only be misleading, but can actually contribute to the back pain. 

Risk Factors of Back Pain

Because back pain is both common and recurrent, the most important risk factor by far is a previous history of back pain. Other risk factors are much less important and hard to pin down. They may include a family history of back pain, smoking and a job that involves very heavy lifting.

Despite popular belief, the following are not risk factors for back pain: being overweight, degenerative disc disease, the physical pounding of exercise and having a physical job or cumulative damage from a long physical career. It has been my observation that sitting is more destructive than most forms of lifting and carrying. 

Acute vs. Chronic Pain

Although the words “acute” and “chronic” suggest that the pain is characterized by its duration, the distinction and meaning has come to signify something more nuanced.

Acute pain is when a pain is sharp for a short period of time, and then the pain goes away either with or without treatment.

Chronic pain is when the pain has been present for more than six months. Also, whatever initiated the pain has either healed or had sufficient time to heal. The reason for the persistence of the pain is difficult to pinpoint, and the role of the brain as the source of persistence is inferred.

Prevention

There has been an enormous effort in the field of ergonomics to study workplace environments with the hope of modifying them (chairs and desks) to lessen back pain occurrences. In my opinion, however, the best way to reduce back pain at the workplace is not through ergonomics, it’s to improve the overall job satisfaction of the workers because stress is a big contributor to back pain.

Source: LiveStrong

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As always, this blog does not substitue medical advice. If you are suffering from back pain, please seek advice from a health professional.

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