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  • Dr. Elliott Perkins

The (Real) Truth about Back Pain – (it's not what we thought)

Updated: Jul 24, 2020


Low back pain is the #1 cause of disability worldwide. Despite having advanced technology like MRIs and CT Scans, surgeries and medicines; the rates are only going up. So, what is going on? Is back pain some mysterious disease, or is it perhaps that in our attempt to fix it, we've only been making the problem worse?


First, a bit of statistics.


Upwards of 80% of people experience low back pain in their life. In fact, roughly 1 in 5 people are experiencing low back pain currently! It is an extremely common condition. What about what causes it?


Only one percent of back pain disorders arise from real serious stuff; things like tumors, fractures and systemic diseases. And only 5% are from a disc herniation causing some sort of nerve compression. So 90-95% of back pain disorders do not have any diagnosis that we can see on a scan!


Decades ago, people would have been diagnosed with “lumbago” (which is basically Latin for “your back hurts”). We would call back pain what it is: back pain! but now we have these incredibly advanced tools like MRIs and CT Scans that pick up so called “abnormalities” in almost everybody. If you scan anyone’s spine, 90% have some form of “degenerative disc disease” around 50% have “disc bulges”. By trying to identify the “cause” of back pain we have created this belief that the majority of back pain is the result these so called “abnormal” findings seen on the scans.


The fact of the matter is; these findings are not indicative of back pain!


Now we have this belief that back pain is caused by these “damaged” structures. What do we do? We start treating our spine like it is damaged. Like it’s fragile. As if our back doesn’t heal. We tell people “keep your back straight” “don’t bend your spine or you’ll throw your back out”, “fix your posture”. These are things that people already do when they are in pain! So, the problem persists.


Then what’s next? We start using injections (which don’t work) and start doing fusion surgeries (which also don’t work) in an attempt to try to fix this “damaged” spine!

But spines aren’t fragile, and there is no “damage” to “fix”. But by trying to do so we start to believe it.


We have this belief system that back pain is all about structure. We try to treat the symptom of pain, and we frankly aren’t doing a very good job of it. Pain is complex, because humans are complex. And the rates of back pain continue to go up.


So, what’s the deal? If nothing is damaged, why does my back hurt so much? Is it all in my head?


No. your pain is very real, and you aren’t making it up.


We have multiple components of the pain experience at play. We have physical factors that can contribute – e.g. muscle guarding, adopting rigid, protective postures and movements (that only end up placing more stress on sensitive parts of the spine). This interplays with other emotional and psychological factors. If someone is stressed or not sleeping well because of their back pain, or if they suffer from depression or anxiety. These factors can all amplify the pain experience, which in turn causes more sensitivity in the spinal structures.


If you believe that your joints are “worn out” or your back has “damage” because of what you saw on a scan, it develops a mindset of fragility. You start thinking that if you keep using your spine its going to wear out more. Which simply isn’t true!


You stop moving in a way that is natural and fluid, start adapting “protective” postures which only aggravate pain more, and you stop doing the activities and things in your life that give you joy. This only decreases your quality of life and adds to the stress already present. You become afraid to exercise out of fear of hurting their back, which has negative consequences on your overall physical and mental health!


You become afraid to do things that will help and start doing more of the things that only feed the problem.


We need to change the way we think about back pain.


Back pain is not caused by our spines being damaged and having pain does not mean we have a structural injury. movement is good! Exercise is healthy and protective! Our spines are strong, stable, and adaptable and we can trust it to move, lift, run and jump.

Your back is not ‘worn out’. There is no ‘wear and tear’ regardless of what the x-ray report says. Those findings are normal age-related changes. Think of them as “wrinkles on the inside”!


You can build the capacity within yourself to understand your pain in the context of your life and break the pain cycle.


Please reach out if you have any questions. I can provide more learning resources or provide professional help to get you back to where you want to be.

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