Jordan graduated with a Master’s in Physical Therapy from McGill University. While studying under world class rehab science researchers, he conducted research with the aim of changing the school’s cur...
Roughly 80% of people will suffer at least one severe bout of debilitating back pain in their life. At any given time, around 7.5% of people globally are suffering from back pain. Low back pain is THE leading cause of musculoskeletal pain and disability globally, as well as being the primary cause of reduced sport/hobby participation AND work participation. (Wu et al., 2020) Needless to say, back pain is common and it is life altering. Most of you reading this have dealt with back pain at least once, and many of you are probably in pain right now.
Being the most common cause for pain and disability, there are MANY options out there, and you’ve likely already tried a few. Meds, massage, acupuncture, manipulations, ART, PNF, Electro stim, TENS, Ultrasound, Shockwave, Physio, Chiro, Osteo, etc. etc. etc… But they don’t really seem to work. If they did work, back pain wouldn’t be the leading cause of musculoskeletal pain across the globe. So why do so many people still use these methods?
Well, simply put, many of them are great at providing relief. And sometimes, relief is incredibly valuable; a short time in the day where you feel good and are relatively pain free. Sometimes that is enough to help you begin to get better. But most of the time, the pain comes back later, doesn’t it? Why is that?
Well, most of these treatment methods don’t solve the problem. These methods at best affect the symptoms associated with back pain without treating the root cause. Back cracks are shown to cause temporary relaxation of surrounding tissues as well as temporary pain relief, but the joints don’t go out of place (that’s a whole other discussion), this isn’t the cause. TENS temporarily provides conflicting stimuli to your nervous system that causes some people to feel buzzing instead of pain, but this doesn’t fix the problem because as soon as you turn it off, the pain comes back. Acupuncture causes your brain to release endorphins which can give great relief for a few hours, but once those neurotransmitters get reabsorbed, the pain comes back. Opioids weaken nerve impulses, but for many people the nerve impulses themselves aren’t the cause of pain either, and who wants to be on opioids forever? I’ve seen too many patients be prescribed opioids only to have minimal relief. Massage helps calm down tense muscles in the back for a while, which provides tons of relief… but the pain comes back because the cause of your pain isn’t tense muscles, they are a symptom of the pain itself, like the back trying to “protect” itself.
Relief is important, and I am not trying to speak negatively about any professional that uses these methods. Sometimes a bit of relief is all it takes to get you back on your feet, and get back to feeling confident enough to be physically active and get better. But for many people, relief is not enough.
I’ll be completely honest with you: no one REALLY knows for sure. Research has shown that only 5-7% of cases of low back pain are related to pathoanatomy (Dhillon, 2016). What this means is only 5-7% of cases of low back pain have findings in the clinic and by imaging that clearly go together showing a physical cause of your pain–something actually needing to be fixed or healed inside of you. This does not mean that 93-95% of cases can’t be properly diagnosed or found on MRI. What it means is that pain is complicated. Pain isn’t just a biological process–while it is in part, of course. To keep it simple, pain is a human experience that most likely symbolizes a perceived threat to oneself. This means that if you are seeing something as threatening, dangerous or uncomfortable consciously or even subconsciously, it will likely lead to you having a painful experience. Pain is affected by biological processes, but also psychological and social factors.
Biological factors are seemingly the least complex to conceptualize. If you break a bone, it likely will, and should hurt. Paper cuts hurt, tearing a muscle hurts, getting a bruise hurts. And there are real, measurable physiological changes that are detected by the brain and contribute to the pain experience.
What gets more complex is understanding psychological and social factors. So let's look at an example. Who do you think is more likely to have worse pain?
Person A) Just rolled their ankle pretty bad, but works from home at a computer, is comfortable financially, and has a loving family capable of helping out.
Person B) A competitive track and field athlete who comes from a disenfranchised background, was about to go to a qualifying competition next week that could’ve landed them a university scholarship, just rolled their ankle just as bad as person A.
Before you continue to read on, assuming you know one person is in more pain, what does your gut tell you? Who has it worse?
Who is in worse pain? It’s impossible to know for sure, but you and I are both human, and as such we can intuitively say that Person B is clearly more likely to have a worse experience, even though they had the exact same injury… Why is that? Why do we intuitively think that?
It’s because Person B’s injury is more threatening. Person A will likely be fine in a couple weeks, their home, food and family are not likely to be at risk due to this injury. It’s painful and annoying, but their family is there to help, they wont lose their job and they know subconsciously that they’ll be fine. Person B however is now worried they won’t be able to compete, it affects their professional identity “who am I if I can’t run?”, it is threatening their ability to secure a scholarship, get an education and move up in life and provide for themselves and their family. Is that a guarantee? No, obviously not. But you can see how it would be easy to jump to those conclusions in their shoes.
This is why back pain is so complex. 95% of the time, it’s not related to anything being broken in your body. That’s why you should always be weary of people telling you some specific structure is wrong with you and is causing your pain. Steer clear from people promising a quick fix for your pain. As enticing as it is, as much as you would like to be pain free, you know these things don’t work. Most of the time, your back pain is your brain perceiving a threat to your existence–as silly as that may sound. Poor sleep, increased stress, struggling with mental health, with your personal and professional identity, food scarcity, monetary issues, lack of physical activity… All of these factors contribute to worsening your back pain experience. I don’t want you to worry about these things and think you’ll be stuck with back pain for the rest of your life. I just want you to understand that all of those factors are much more likely to be the source of your pain than you think, or at the very least, they are contributing to worsening your pain.
My role is to firstly rule out any serious potential red flags that would require a hospital visit–the pathoanatomy stuff we talked about earlier.
Once that is out of the way, I start by listening to your story, A to Z. When did it start? Why do you think it happened? What made it worse? What made it better? What struggles are happening in your life?
Then we move on to a physical assessment to check many different things like strength, range of motion, etc. I will also try to find a directional preference. What is really involved with finding a directional preference will be explained in later articles and during your assessment, but in short, I will try to help you find a direction in which your back (or even your hips, knees and legs) gets relief through repetitive movement.
From there, my goal is to combine the physical as well as the psychological and social findings to help create a strategy specifically tailored to your condition, your wants, needs, goals and beliefs. I will help you find strategies to manage the factors that are contributing to your back pain that you can control but may find difficult to deal with. I will also likely help you create a plan to be more physically active as this is one of the main best treatment methods for low back pain (Gordon et al., 2016). Don’t worry, my goal isn’t to make you do boring exercises. I will work with you to find an exercise routine that works for you and that you find fun and interesting. My goal is to give you the tools you need so that you feel empowered to manage your pain mostly by yourself, with the methods backed by the most current research. I will always be available if you need me, but my primary goal is to help you get to the point where you do not need me at all!
Dhillon KS. Spinal Fusion for Chronic Low Back Pain: A 'Magic Bullet' or Wishful Thinking? Malays Orthop J. 2016 Mar;10(1):61-68. PMID: 28435551; PMCID: PMC5333707.
Gordon R, Bloxham S. A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain. Healthcare (Basel). 2016 Apr 25;4(2):22. doi: 10.3390/healthcare4020022. PMID: 27417610; PMCID: PMC4934575.
Wu, A., March, L., Zheng, X., Huang, J., Wang, X., Zhao, J., Blyth, F. M., Smith, E., Buchbinder, R., & Hoy, D. (2020). Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Annals of translational medicine, 8(6), 299. https://doi.org/10.21037/atm.2020.02.175