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What Is Back Pain?

By Patrick Roth, M.D. ; Updated August 14, 2017

Back pain is part of life for most of us. At any given time about one in five people will be experiencing back pain. Around four in five of us will experience significant back pain during our lifetime.

The evolution of man to an animal that walks on two legs has allowed for many survival advantages. But it also comes with some baggage. Keeping us upright also makes us vulnerable to pain arising from the complicated musculoskeletal system that supports us.

Back Pain Physiology

Much of back pain arises from the very structures that hold us upright — the muscles, the bones, the joints and the intervertebral discs. Other structures that are not supportive may also present with back pain. This includes the kidneys, gallbladder, uterus and bladder.

The most common form of back pain comes and goes similar to the common cold. The cause is usually unclear, and the vast majority of the time it goes away without treatment.

Back Pain as a "Part of Life"

Shockingly, the reason that back pain has become one of the major reasons that we report to a doctor or miss time at work is because we don’t think of back pain as “part of life” but rather as something broken or something needing to be fixed. This perceptual error has propelled back pain from a common symptom into a disease. This is a process called medicalization, and it is the cause of unnecessary cost, treatments and time out of work.

If you search the Internet, you will find many claims for the treatment of back pain. In reality, most cases of back pain don’t require treatment. Like the common cold or a headache, back pain will run its course and improve. The many health care providers that offer care for back pain end up costing us unnecessary dollars and perpetuating the notion that back pain needs treatment.

Ultimately, this undermines the sufferer’s confidence in managing his or her own pain.

Patients Take Control

The best treatment for back pain is initiated, managed and maintained by the patient. It doesn’t involve any fancy treatment and consists mostly of restoring activities of daily living like walking, working, socializing and, ideally, core strengthening.

Although there are occasional presentations of back pain that require medical attention, the natural tendency of back pain is to improve. We now know that recurrence is also typical and that improvement is often not complete. There is also a small subset of patients whose pain becomes chronic.

Strengthen the Core

It is my experience as a medical provider that strengthening the core muscles will limit the frequency, duration and intensity of the invariable recurrences that occur. It will also help to make recovery as complete as possible.

I can see how strengthening the core would seem counterintuitive to back pain sufferers. Such exercises would be expected to antagonize the back pain and are thus avoided. However, core strengthening is typically safe and effective, even in the face of back pain, particularly if it is done slowly and progressively. Some patients will need the aid of a professional to help with form and technique, but with a commitment to core strengthening, virtually all back pain sufferers will be able to take ownership of their own programs.

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