Does this situation sound familiar to you?
One day, you’re going about your business, when suddenly—ow! Your back starts hurting. What gives? You were doing things you normally do.
Maybe you bent down to pick up your kid. Maybe it was while playing a game of pool. Maybe it was while you deadlifted or squatted. Or you sneezed.
The specific situation may vary, but the theme is the same: back pain started unexpectedly while you were going about your day.
Experiences like the above are common unfortunately. You were doing what you typically do when you started experiencing pain. And, what is one of the first things you think?
How did I hurt my back?
You’re curious what caused your lower back pain. You want answers. You want to fix the issue, so it never happens again.
This leads you into problem solving mode where you take a guess at what happened:
- my back hurts because I moved weird;
- my core is weak;
- the discs in my back are bad;
- my scoliosis is causing it;
- I slipped a disc; or,
- my spine is out of alignment and I need to get adjusted.
Let me inject a bit of good news: there’s a strong chance that none of the above caused your pain. A very, very likely chance.
And even if there was damage to your tissues—to your muscles, bones, tendons—it doesn’t guarantee that those things are causing your pain (more on this soon).
How do I know this? How can I say it with confidence? Because it’s what we know from tons and tons of research.
I’m going to say something now that you may think is a little ridiculous: lower back pain is a normal part of the human experience.
“So I’m supposed to be hurting?” you might be thinking. Not exactly. Allow me to explain.
A Quick Caveat
Saying lower back pain is a normal part of the human experience doesn’t mean that you should always be in pain; it doesn’t mean that you want to be in pain; and it doesn’t mean that there is no hope.
That’s absolutely not what I’m saying.
Pain sucks. It’s awful. Not only is it an unpleasant sensation, but it impacts our identity, or the type of person we are (more on this later).
I want to be clear as I can here: I’m not saying that back pain doesn’t suck, that it doesn’t impact your life in a big way, or that it’s not okay to feel how you feel.
If you feel angry because of lower back pain, that’s normal; if you feel upset, that’s normal; if you feel annoyed because of what you can’t do at the moment, that’s normal.
So, what makes me say lower back pain is a normal part of being human?
Lower Back Pain Is a Normal Part Of The Human Experience
Lower back pain is a normal part of the human experience because, at any given moment around the world, 7.3%—or 540 million people—are experiencing lower back pain (2).
I’m no mathologist, but that’s a lot of people.
And if 540 million is too big of number to wrap your head around, then let me say it another way.
Hadler et al. in 2007 said: “Like the ‘common cold,’ backache is an intermittent and remittent predicament of life. It is unlikely that a healthy adult will escape a year without at least 1 important episode of low back pain.” (5)
Unlikely that a healthy adult will escape a year without lower back pain. It’s common.
This doesn’t mean there is no hope, because there is (more on this soon). What it means is that we will all likely experience lower back pain numerous times throughout our lifetime. Also, we rarely know what causes it.
It’s been found that about 90% of lower back pain cases are non-specific (7). In other words, there is no specific cause; in other, other words, we don’t know why there is pain.
Pain is complex; it’s not as simple as “X is causing my lower back pain.”
It’s Likely Not A Tissue Issue
When we experience pain we were taught that something happened and it needs to get fixed.
Oh, your back hurts? Now you’re broken. You hurt your back.
A disc slipped; you have scoliosis; you have degenerative disc disease; you’re weak.
But saying back pain is caused by scoliosis—or any of the above reasons—is simply untrue.
Lower back pain isn’t as simple as X causes Y. Think about it. If your scoliosis was the sole reason for your back pain, and you’ve had scoliosis since you were born—wouldn’t you be in pain every minute of every day?
Here’s how I say this with confidence: we can have degeneration, or deterioration, in our discs and have no pain (2). Our discs show damage but there is no pain. And this degeneration is normal.
Brinjikji et al. found that, of the 20 year old’s in their study, the prevalence—or commonness—of disc degeneration was 37% (2).
37 percent!
And this is crucial: those 20 year old’s had no pain. None. At all.
Also, to give a little more context, let’s look at different prevalence rates for different ages. Disc degeneration prevalence was 52% for 30 year old’s, 68% for 40 year old’s, and 80% for 50 year old’s. So, disc degeneration is common as we age.
Think about it this way: we’re biological creatures. As such, we break down naturally over time. This is okay. Degeneration is part of the aging process.
If degeneration was the cause of pain we would all hurt all the time. That would suck. But it’s not the case.
We aren’t given this narrative; the narrative we receive is our discs have degenerated and that’s why our back hurts—that back pain is simple.
It’s not simple.
Pain is multifactorial—in other words, numerous factors impact how we experience pain: biology, sociology, and psychology (among other things).
Hartvigsen et al. described lower back pain in a helpful way: “Lower back pain is symptom, not a disease.” (6)
The authors are speaking to the fact that lower back pain is a symptom, that it is caused by many factors, and can’t be linked to just one pathology (which has to do with the cause and effect of diseases or injuries).
Thinking of it as a symptom helps us understand there are many things influencing our experience of pain. It’s not as simple as one part of our body showing “damage” and that being the cause of our pain.
Does this mean you’ll always be in pain?
That’s unlikely, because things will get better. Let’s chat about how I can say that with confidence.
It Will Get Better
This talk of lower back pain can seem like doom and gloom; like a sadness sandwich with a hopeless pickle on the side. That there is no hope.
To reiterate: saying lower back pain is a normal part of being human doesn’t mean that pain doesn’t suck, or that you just have to suffer through it.
There is hope.
The natural history for lower back pain is pretty good. Natural history has to do with how long it takes for things to feel better on their own.
For lower back pain, the natural history is about 6 weeks (3).
It’s likely that lower back pain will get significantly better within 6 weeks of pain emerging. That’s awesome! Things will get better on their own.
Does this mean we never experience it again? Unfortunately, no. Silva et al. found a 33% chance of recurrence of lower back pain within a year (4). So, we may experience lower back pain again. Remember: it is a normal part of the human experience.
But—and I want to stress this—it’s very likely that our lower back pain will significantly reduce within 6 weeks.
This is why it’s so important to continue to live our life as we usually do.
Let me explain.
Pain’s Impact On Our Identity
Our identity is who we are, who we believe ourselves to be.
This identity could be based on what we do for work, who we are in relation to others (think: a father, brother, etc.), or the hobbies we participate in.
Now, how does pain impact our identity?
Let’s look at a few examples. Lower back pain could make it harder for us to sit at our desk for work, thus impacting the quality of the work we do.
As a father or mother, we may not be able to bend over to pick up our child, to hold them in our arms.
If we think of ourselves as a baseball player, gym goer, hiker—pain impacts these identities as well.
These activities are part of what make us, us. We all possess numerous identities in different parts of our life and, when something like pain threatens those parts, we feel emotional pain too.
Therefore we should continue to do the things we love as best we can. We continue to go to the gym, to play with our kids, to go to work. Because our lower back pain will get better.
In the meantime, we act in ways that our congruent with our identity. We do parent things and gym things and work things.
This does not mean pain doesn’t make this tougher. It does.
Let’s say we can’t bend over to pick up our kids without pain. Lots of pain. So maybe we start by bending over just a few inches to pick up something off a table. Then, we pick something up from a slightly smaller table.
We slowly, over time, practice bending over to pick stuff up—and we do this because it is important for us to be able to do it as parents.
We act in ways that are congruent with our identity and what we value in life. The key is doing things that are tolerable to us on that given day. Tolerable in the sense of what movements and things we are comfortable doing. We start where we are to get where we want to go.
We work on bending over and picking things up to be the parent we want to be.
Part of our identity is that we’re a healthy person–being physically active matters to us because we value our health (there’s even some research that shows physical activity can help with pain (8)), so we stay as physically active as we can.
Put simply, ask yourself what type of person you want to be. Do what you can, as best as you can, to be the type of person you want to be—whether experiencing pain or not. Pain may change things and make it harder to be that person, but it does not mean you can’t be. It is just a challenge to overcome.
What this blog is NOT about
This blog is not saying that you should never see a physical therapist or doctor when you’re experiencing lower back pain. If you feel it would be helpful, especially if you’ve been experiencing pain for over 6 weeks, then go for it.
[Editor’s note: Keep in mind what Tommy said at the beginning of the blog: “The specific situation may vary, but the theme is the same: back pain started unexpectedly while you were going about your day.” If there was a specific, identifiable, event (i.e., a fall, a car accident, etc.) that led to your back pain, you should see a physical therapist or doctor]
That, just because it’s a normal part of being human, that it doesn’t suck. It does suck. And if it makes you feel angry, frustrated, or anything else, know that feeling that way is okay. It’s normal to feel all those things when in pain.
Lastly, here’s what this blog is saying: lower back pain is a normal part of being a human being in the world we live in and, even though it sucks and impacts our ability to live our lives as we would like to, it will likely get better on its own as we continue to stay physically active and be the person we want to be.
Sources:
- Barbell Medicine’s Course–Low Back Pain: Guiding The Path
- Brinjikji, Waleed, et al. “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.” American Journal of Neuroradiology4 (2015): 811-816.
- Costa, Luciola da C. Menezes, et al. “The prognosis of acute and persistent low-back pain: a meta-analysis.” Cmaj11 (2012): E613-E624.
- Da Silva, Tatiane et al. “Risk of Recurrence of Low Back Pain: A Systematic Review.” The Journal of orthopaedic and sports physical therapy 47,5 (2017): 305-313. doi:10.2519/jospt.2017.7415
- Hadler, Nortin M., Raymond C. Tait, and John T. Chibnall. “Back pain in the workplace.” Jama14 (2007): 1594-1596.
- Hartvigsen, Jan, et al. “What low back pain is and why we need to pay attention.” The Lancet10137 (2018): 2356-2367.
- Koes, B. W., MWm Van Tulder, and S. Thomas. “Diagnosis and treatment of low back pain.” Bmj7555 (2006): 1430-1434.
- Law, Laura Frey, and Kathleen A Sluka. “How does physical activity modulate pain?.” Pain 158,3 (2017): 369-370. doi:10.1097/j.pain.0000000000000792