If you don’t have back pain, someone close to you does. One half of all working Americans report back pain. And 80% of us will struggle with back pain at some point in their life.1 Most people will get better quickly, yet a few will develop into a chronic pain pattern.
As an individual who had her own significant back injury with a challenging recovery, I am motivated to spread the good news of how I got better. As a practitioner who sees people diagnosed with Failed Back Syndrome, which means the surgery didn’t work as well as planned, I have a passion for helping people return to healthy function, surgery or not. As someone who saw a friend paralyzed from the waist down after a spinal fusion surgery and with spinal fusion surgeries on the rise, I believe it is very important to prevent this surgery whenever possible. In my next article, I am going to dive into the keys for a healthy back. First, we need some important research-based fact finding.
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You have an amazing ability to get better. Most people “heal” themselves every day from all kinds of assaults to the system. A small percentage of people will struggle with back pain for more than twelve weeks and be classified with chronic back pain. In these cases, the body is overwhelmed and needs some help getting “back on track.” Even with severe back pain, I have seen significant improvements for the majority of people once the right approach is in place.
Causes are more unknown than known. It is popular to say the reason someone has back pain is poor core strength, bad alignment or suboptimal posture. See any rehab professional, personal trainer or body worker and you will likely get one of these reasons as the cause for your back pain. This makes little sense from a larger view. I see people with incredible core strength that have back pain. I see people with great posture who have back pain. And I see people with horrible alignment or poor alignment but no back pain. Working with a biomechanical lens is helpful, but when it is the only lens, the results may be limited.
MRI or x-ray results are misleading. “When it comes to diagnosing most back pain, MRI machines are at least as useless as Monty Python’s medical machinery that goes ‘bing.’” offers Paul Ingraham2 in a sentence I wish I had written. Studies show that structural deformities are poorly correlated with pain.3
A good percentage of people with herniated discs, bulging discs, scoliosis, and even stenosis walk around without pain. And not all people with back pain have a structural issue.4 That is enough to make many people scratch their head. Surely there must be a clear structural issue that causes back pain! To make matters worse, getting an MRI leads to more procedures and incorrect conclusions about next steps including ineffective or unnecessary surgeries.5
This doesn’t mean we shouldn’t consider structural realities in the equation, but it does mean we should refrain from deciding we are doomed to have pain because of something found in the spine. This simply isn’t true.
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Surgery is not better.
In comparing spinal fusion as a treatment to cognitive behavioral therapy (CBT), CBT came out ahead. Research on physical therapy shows similar results.6 Given the potential side effects of surgery (which can include nerve damage, paralysis or more surgeries) it seems it should be avoided whenever possible. Is surgery sometimes mandatory? Yes. Is it a VASTLY overused as a solution? Yes.
Your Brain Has a Lot to Do With Your Pain
Any approach to chronic back pain that doesn’t include how your brain is producing pain is missing something. This deserves an entire article all of its own. And I can’t recommend enough the first couple of chapters of The Brain’s Way of Healing by Norman Doidge, M.D. to get a good understanding of this topic without blaming yourself or thinking anyone is saying it is all in your head if you have chronic pain.
A multidisciplinary approach including biopsychosocial interventions has been shown to be most promising.7 Chronic back pain can be quite debilitating. And still, the majority of people that I see do get better even when the problem has been present for many years. There is ample reason to have hope that you can live with more comfort and less pain. Maybe you feel you have tried everything there is to try. I don’t think so. So do read the next article coming soon: Mysteries to a Healthy Back Revealed.
1 2. Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98.
2 Ingraham, P. MRI and X-Ray Often Worse than Useless for Back Pain, updated October 17 2016 (first published 2007), accessed 12/08/16.
3 Deyo RA, Weinstein DO. Low Back Pain. N Engl J Med. 2001 Feb;344(5):363–70.
4 Brinjikji W, Luetmer PH, Comstock B, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811–6.
5 Webster BS, Bauer AZ, Choi Y, Cifuentes M, Pransky GS. Iatrogenic consequences of early magnetic resonance imaging in acute, work-related, disabling low back pain. Spine (Phila Pa 1976). 2013 Oct;38(22):1939–
6 Mirza, S, Deyo, R, et al. Systematic Review of Randomized Trials Comparing Lumbar Fusion Surgery to Nonoperative Care for Treatment of Chronic Back Pain Spine 2007 Apr 1:32(7):816-823.
7 Guzmán J, Esmail R, Karjalainen K, Malmivaara A et al. Multidisciplinary rehabilitation for chronic low back pain: systematic review BMJ 2001; 322:1511