Back Pain Nation: What Experience Should Be Teaching Us

“80% of the world’s population will experience back pain at some point in their lives.”

When it comes to back pain, this is easily the most widely quoted statistic in the mainstream media.  And while the majority of this pain will be the result of specific injuries (many times caused by auto, workplace or sports-related accidents) that will eventually heal, much of it will not be.  Instead, nearly half is likely to be chronic pain—persistent or recurring pain that is caused over time by a combination of genetics, day-to-day lifestyle choices and general wear-and-tear.

Back pain is very widespread, and much of it is either chronic or recurring.  A research team from Washington State University recently used data from the 2010 Quality of Life Supplement of the National Health Interview Survey to investigate the prevalence of pain in America.  Based on that data, the team estimated that 59.5 million American adults (out of a total adult population of 207.7 million) had experienced lower back pain during the 3-month period examined in the study.  Of these people, more than 40% were thought to have persistent pain.

While there’s no single reason for back pain, many of the root causes can be traced back to our own day-to-day behaviors.  From a clinical point of view, back pain can occur for a variety of reasons, including muscle strains and spasms, damaged or herniated discs, spinal stenosis, arthritis and spondylolisthesis.  However, we’ve learned a great deal about some of the underlying causes as well:

• Genetics.  Researchers from Kings College in London have detected a link between variations in the PARK2 gene and rates of lumbar disc degeneration, which is one of the most common causes of low back pain.
• Bad Ergonomics and Poor Posture.  From badly designed or adjusted workstations to heavy backpacks and over-use of mobile devices, our environment can place unusual stresses on our spines, which in turn can re-shape our posture.  Over time, these postural changes then affect how we carry our body weight, potentially causing back pain and reduced mobility.
•  Inactivity and Weakened Core Muscles.  Long periods sitting—in cars, at the office and on the sofa at home—gradually cause structural changes in our bodies.  In particular, lack of exercise weakens our “core” abdominal, back and pelvic muscles, which provide strength, balance and stability to our bodies while at rest or in motion.
• Weight Gain.  Additional weight places more wear and tear on the body’s entire musculoskeletal system, but especially on the back, hips and knees.
• Improper Form.  Whether you’re doing physical work or exercising to stay fit, good form is important.  Bad form—especially when repeated often—increases the risk of injury.

Diagnosis and treatment of back pain can be tricky, but there are a number of “best practices” that patients should be aware of.  By the most conservative estimates, Americans spend at least $50 billion each year to treat back pain.  But by more comprehensive estimates, the cost is almost double that—between $85 billion and $100 billion per year.  Unfortunately, much of that spending fails to translate into relief for patients.  What have we learned?

• Imaging alone shouldn’t justify back surgery. While advanced imaging technologies can be powerful tools, they also have their limitations when it comes to diagnosing back pain.  By the time a patient reaches middle age, it is not uncommon for doctors to see signs of disc degeneration in that patient’s X-rays or MRIs.  However, just because these signs appear does not necessarily mean that a particular bulge is actually the cause of the pain.
• Surgeries involve risks and expense that should make them a last resort for most patients. While surgery can help, it has to be the right procedure for the right patient.  .
• In most cases, staying as active as possible—not bed rest—is the prescription for a faster, more complete recovery. Physical activity promotes blood flow to the spine and preserves both strength and range of motion.
• Structured exercise programs can be very useful in supporting recovery and in preventing future injuries, especially if it combined with pain management therapy and training.

Whenever there are problems with the back, visiting your chiropractor is the most logical first step in a conservative care approach. Studies have shown that chiropractic care is typically more effective than conventional medical care and receives higher satisfaction ratings from patients.