Do you know the truth about your back?
Let’s check it out:
What did you say? Backs are actually amazingly well-designed. The vertebrae are linked together by strong ligaments, supported by powerful muscles, and yet they’re flexible enough to let you curl into a wee ball or twist to look behind or reach high above your head. They take an enormous amount of force to break and they allow us to have an upright position, protected soft organs, and have information flow to and from all parts of our body.
I think the back is cool.
What’s scary isn’t how our backs are constructed, but how we’ve been fooled into thinking that we need to protect our delicate backs, that we shouldn’t move when we have a sore back, that we should avoid bending, twisting, moving and we should be incredibly careful to keep our backs straight.
There are some very sticky words and expressions we’ve learned about our backs. Mostly we’ve learned that backs are very easily injured, and that we need to worry when we feel sore. We’ve probably all had education from someone saying “don’t use your back like a crane”, “bend your knees and not your back”, “sit up straight, don’t slouch, it’s bad for your back”. We’ve probably all heard people say “I’ve put my back out”, or “I have a bad back”, or even “her disks slipped out”.
OUCH!
What’s worse, we’ve probably all been told to rest when we feel pain in our backs. That we should “avoid heavy lifting” when our backs are sore. But what happens when it hurts and we’re not even picking anything up? How heavy is “too heavy”? Why does it seem to hurt more when we rest?
The truth is, backs are probably not as much of a problem as we think. What might be more of a problem is worrying about our backs, trying hard to protect our backs from “danger”, and in the process, becoming incredibly awkward when we move, or not moving at all.
While backs are often where we hurt, structural damage isn’t as common as we might think. Given that most people will have a bout of back pain in their lifetime (up to 90% of people in some studies), I keep wondering if perhaps we could think of back pain as a lot like having a headache. A headache of the back. We don’t think of head pain as “head injury”, we think of it as a headache – we usually take a bit of pain relief, go for a walk, de-stress, and it’ll settle down. Occasionally a headache is a sign of something more serious – but most of the time it’s a nuisance and a wakeup call to take more care of our wellbeing.
If we could think of back pain in the same way, I think we might be better off. What would it be like if we thought of back pain as “just a nuisance”, or “I’m a bit stressed”, or even “I need to go for a walk”?
What if, instead of thinking about our fragile, delicate, easily-injured back, we could think of it as flexible, strong and resilient?
Then we’d move, walk, exercise, swim, dance, relax, stretch without worry, and I’ll bet our backs would feel better for it.
Healthskills for people living with chronic pain 
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Nice posting…
I use the similarity you speak of in the clinic…Headache and LBP…do you tell people with a headache they have a head problem or a bad head? No. Then why do you say you have a back problem or bad back?
Great idea! It’s a nice analogy, and I hope it helps people learn how powerful language is.
Great insights, Bronnie. The back (and its supporting core musculature) is designed to keep in motion to deal with the stress of opposing gravity. Most of our modern back pain can probably be traced to sitting, where we have to hold our back up but don’t vary our posture. We’re focused on postural variation while sitting to try address this @ core-flex.com Best long-term solution for back pain: movement and optimism!
I guess I agree to a certain extent but given the prevalence of back pain is similar in developed as well as developing countries, I’m not 100% sure. To me the relevance of back pain is rather less than the relevance of disability associated with back pain, and that’s more about beliefs/attitudes/social practices than the presence or absence of pain, or even pain intensity. Movement is fantastic – but it doesn’t necessarily abolish the pain, and that’s OK. Like I said, pain in the back is similar to pain in the head – sometimes we get it simply as a wake-up call to address something out of balance in life. Maybe for one person it’s all about movement, but for another it could be about developing effective relaxation techniques, while for another it could be that they need to set limits on what they’re prepared to do – multitudinal options out there! But there’s nothing bad about learning to move confidently and gracefully.
Agreed, there are many ways to release stress from our system, and the mental stress can do far more damage in the long run. Regarding the prevalence of LBP in the developing world and amongst rural vs. urban populations, a 1997 study by Dr. Ernest Volinn found some surprising results: “The considerably lower rates (of LBP) among populations of low‐income farmers compared with rates of the affluent populations of selected northern European countries indicate that, contrary to the hypothesis proposed here, hard physical labor itself is not necessarily related to low back pain. The higher rates in urban low‐income populations as compared with rates in rural low‐income populations and the sharply higher rates among workers in enclosed workshops of low‐income countries suggest a disturbing trend: low back pain prevalence may be on the rise among vast numbers of workers as urbanization and rapid industrialization proceed.” http://journals.lww.com/spinejournal/Abstract/1997/08010/The_Epidemiology_of_Low_Back_Pain_in_the_Rest_of.13.aspx
Some more recent epidemiological studies show pretty similar rates of back pain, but vastly different rates for reporting back pain, and for subsequent disability between developing and developed countries. So it seems that what differs isn’t so much the prevalence but the treatment seeking and disability associated with it. See for example: Low back pain among textile workers: a cross-sectional study. Paudyal P. Ayres JG. Semple S. Macfarlane GJ. Occupational Medicine (Oxford). 63(2):129-34, 2013 Mar. and Low back pain in Iran: a growing need to adapt and implement evidence-based practice in developing countries. Mousavi SJ. Akbari ME. Mehdian H. Mobini B. Montazeri A. Akbarnia B. Parnianpour M. Spine. 36(10):E638-46, 2011 May 1.
i think i am detecting the bias of your audience in your survey results 🙂
You may well be right! 😉
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I felt like I was taking a psych test with the subjective answers for multiple choice. Still, I really liked this post. I especially the metaphor of the “sticky back,” whether it’s sticky beliefs that keep us from taking steps to make our back pain better or the more literal metaphor of the back that hurts because it’s sticking to itself from inactivity. I think these are key insights for a lot of people.