Low back pain accounts for considerable problems when we consider its impact on people’s lives. It ranks the highest in terms of disability over any other condition globally (Hoy, March and Brooks et al, 2014). The same research group estimate that the current estimated prevalence will increase substantially over the coming years. It certainly deserves our attention but it does so with scrutiny.
What’s Causing the Pain?
This is probably the most interesting aspect of low back pain that clinicians and researchers need to study and interpret. It’s best done so via comparing a population of pain-free individuals to those who are in pain. Based on this approach we can try estimate what structures in the back are most likely to be blamed for issues. However, the human body being the human body throws a few curve balls… Structurally speaking we see very interesting things. Firstly, please have a look at the following graph with thanks to Mr Adam Meakins produced in a blog post in 2017 (@adammeakins, The Sports Physio):
As you can see issues with the “dreaded discs” among others are hugely prevalent in people WHO HAVE NO PAIN. This also increases as we age in keeping with the findings of Hoy, March and Brooks’ (2014).
Further to this, when we look at clinical studies that count for serious pathologies and quantify their numbers, a very interesting picture is painted.
1-2% of low back pain is related to serious or sinister problems that require medical attention. (Henschke et al, 2007).
5-10% are due to a specific cause with or without nerve pain (Koes et al, 2010).
Based on this we can identify that a considerable chunk of these people suffer from a multi-faceted and complex issue without a discernible structural cause.
So What’s Happening?
We’ve all become accustomed to hearing that we need to “mind your back” or “protect the spine” doing general day to day activities that we’ve been doing for millennia. One can bet (with reasonable odds) that our ancestors weren’t terribly concerned about their discs when threshing corn or ploughing fields in the traditional methods. There has been an element of mental conditioning going on for a long time now that is driven by faulty beliefs, certain agendas and a lack of understanding in the topic. So it begs to ask the question – how strong are our backs?
Stemper and colleagues (2010) studied the mechanical properties of discs and found that it can take between 460lbs and 740lbs of force to reduce a disc height by 1mm in cadaver discs. The older discs needed more force. In living conditions we also have a considerable force coming from our supporting musculature. So in essence our backs are impressively strong!
So what’s happening in the large majority of cases is the old use it or lose it principle and tissue sensitivity? Without getting too complex (that’ll come in another blog post) it is best to liken the supporting structures to a sponge. The cartilage that anchors and supports our discs are a-vascular and a-neural meaning there’s no transport mechanism to nourish it and remove waste products. It relies on a constant flow of water in and out of the tissue. What drives this is not rest and protection but loading and exercise. By engaging and using these structures you encourage healthy adaption and tolerance to your day to day activities. If you don’t utilise them a cascade of events begin and problems can only surmount from there.
Your Take Home Message
Low back pain can cause great disability but it doesn’t necessarily have to provided we can identify the cases that aren’t serious – we know how to do this and thankfully they aren’t frequent.
Rest, avoidance, and inactivity are all drivers of persistent problems and need to be stamped out or worked on in the majority of cases.
Taking account of all of the above people need to understand their episode of back pain with an individually centred basis. Your complaint is not another’s. Your experience is not someone else’s. It will play by its own rules.
With the help of a professional who understands all of the above you can act on it, minimise the risk of it disabling you and continue meaningful activities that enrich your life and keep your back and body healthy. Tennis, golf, swimming, walking, and hiking to name but a few are all valid and meaningful ways to keep this system working well. Not keeping active would be a missed opportunity.
Thanks for reading and please don’t hesitate to reach out if you have any questions or issues with your own back, feel free to contact me or one of our team at (046) 9062265 or info@mcenteephysio.com and we can identify how we can help you.
Mark
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Mark Elmes
Physiotherapist, Strength & Conditioning Coach
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References
Brinjikji W, Luetmer PH, Comstock B et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiology. 2015 Apr;36(4):811-6.
Henschke N, Maher CG, Refshauge KM. Screening for malignancy in low back pain patients: a systematic review. Eur Spine J. 2007;16(10):1673–1679.
Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases. 2014;73:968-974.
Koes, B.W., van Tulder, M., Lin, CW.C. et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010 19: 2075.
Meakins, A (2017). A picture is not always worth a thousand words, Jan 2017. Last accessed Wed 20 Nov 2019. https://www.thesports.physio/2017/01/10/a-picture-is-not-always-worth-a-thousand-words/
Stemper BD, Board D, Yoganandan N, Wolfla CE. Biomechanical properties of human thoracic spine disc segments. J Craniovertebr Junction Spine. 2010;1(1):18–22.