What Causes Back Pain?
There are many things that cause back pain and on the surface, it is a complex question. So to make things easier let’s break it down and think of it in two parts. We will discuss what we mean by the question, ‘what causes pain?’ and try to help you understand your body better.
Part 1 - The Pain Generator
This is what people often think of when they ask what causes pain in somewhere. It is the bit of body that hurts and gives you the experience of pain. Examples of these include:
Muscle that has been strained
Ligament that has undergone a sprain
Bones - in the spine these are called the vertebrae
The joints of the spine called facet joints
Discs which can be damaged
The nerve (either the spinal cord or the individual nerve as it exits the spine
The Uncomfortable Truth
Understand which of the above structures is generating pain is only a very small part of the puzzle. It is the what but not the why. If you want to resolve a problem then you need to know two very important things - what has happened and why has it happened.
The truth is, knowing what is generating the pain is not enough to fix it. How many times have you heard stories of people receiving treatment for something like back pain that has not fixed the problem. This might be a massage to a muscle that helps a little before wearing off, or a steroid injection that works for 6 weeks before its effects begin to fade. This is because they have only considered the what, not the why.
If you want to answer the question - what causes back pain, then I assume that this is because you want to know what it is you need to fix. Knowing what generates the pain is helpful but only part of the story, so what else do we have to consider in order to fix it?
Part 2 - The All Important Why
The most overlooked and misunderstood aspect of back pain, why is it there? Why is the structure we identified in part 1 causing pain signals to shoot up to the brain?
The answer to this is the first step in fixing anyone’s back pain. Without it and we are just shooting in the dark, hoping that a treatment or a drug gets lucky. So I am going to break this down into 3 groups
Injury group - This is the most obvious answer to why. You sustained an injury. This could be a fall from a bike, a car accident or sprinting when a muscle suddenly goes pop. Your body sustained something, a force that was more that the tissue could tolerate. As you came off the bike the ankle twisted and this was enough to sprain the ligament. Or the car accident was powerful enough to break the bone.
Mechanics - often thought of as the compensation group. Where the body is not moving/working effectively as one and due to one area not working adequately, another has to do more in response. This is a tricky group to understand as every person will be different. Two people may have very similar lower back muscle driven pain, but one needs treatment for their knee, the other needs treatment on their upper back. It is obvious if you think about it - we are all different, why would we all need the same treatment.
Misinterpretation group - this is the sneaky one that is far more common that people think and despite it being talked about heavily in the medical world, so few patients actually associate with it. I have called it the misinterpretation group but a more accurate term would be neuropathic pain. It is an issue with the nerves which are designed to pass messages from our body to our brain. You get a tap on the shoulder, the nerve passes that sensation to the brain and you ‘feel it’. Sometimes this usually very effective communication method gets its wires crossed and pain signals are felt in your brain despite nothing being physically wrong in the back
Which group do you fall in? Did you start in group 1 and over time have moved into group 3? Does this help you see why a certain treatment didn’t work, or it was only temporary?
Summary
Understanding what causes back pain is down to two things - what and why. The what can be the same but if all three imaginary patients have a different why then they will need completely different treatments? This is one of the main reasons why a, ‘back pain class or a study comparing two type of treatments’ have such varied (often poor) results. They group people on what, not why. If you have back pain or any other pain for that matter that you have not been able to resolve, get in touch and let us help understand it better and give you a plan that takes the full picture into account.
