WHAT CAUSES BACK PAIN?

This is a VERY common question. There are a lot of myths. For example, “it’s because you are too tall!” (no, there is no evidence or reasonable explanation for this). Another example, “our spines aren’t designed to walk well on two legs …” (no evidence for this, either - quite a few quadrupeds get problems with their spines … ask any vet).

By the way, pain itself is caused either by what we call tissue damage such as a torn ligament (in which case inflammation occurs, and pain fibres communicate this to the brain), or by unusual behaviour of the spine being broadcast as pain by the spinal cord (even where there is no actual tissue damage).

But this article is not about the pain itself, but about what - in general - can go wrong with a spine and cause problems through life.

There are probably three to four decent explanations for spinal pain and problems - any of which on their own can cause problems (but don’t forget that some people may have more than one).

First, you may be born with a weakness (the great majority of people are not) that your spine is just going to have problems coping with, either when you are young, or which will come through during youth or even middle age. Examples of this are badly formed vertebrae at birth, or spines that twist as they grow (we call this scoliosis), or ligaments (that hold bones together) being too soft and stretchy.

Secondly, you can have a trauma; for example - falling down hard onto the ground, where joints and muscles are bruised and sore for a while. It’s a common myth that if the spine is bashed (e.g. in a car accident, or a child falling off a trampoline) then the spine must have gone back to normal functioning when the pain has gone. WRONG! Sometimes the spine CAN go back to normal on its own - but often (more often than not) it can’t. All that happens is that the spine figures out how to adapt to the new (worse) way of working following a trauma. So the pain has gone, but the spine does not work as well as it did. This may never cause pain in the future (in other words, the spine can successfully adapt to the problem) but it might well do so, and often as we get older and less fit, or as we take up new activities, the less good way of working can come back to haunt us. And of course, we can accumulate a series of traumas through our lifetime - they all add up! TIP for PARENTS: if your child or teenager has a trauma that causes pain for two days plus, but which then goes after a while, or just becomes a low grade ‘grumble’, then don’t assume their spine is working normally - get it checked out.

Thirdly, we may have a good and well developed spine, and we may never have had any significant trauma, but we just get less fit and less strong and less flexible as we get into middle age. So the healthy spine just doesn’t have enough energy or muscle power to maintain normal function - aches and pains then develop. Often treatment is NOT needed to help this - just an exercise program! TIP for PARENTS: do try to help your children reach adulthood as fit and strong as they can be … this will delay as long as possible the development of these middle aged aches and pains that inevitably happens to all of us if life and work get in the way of keeping fit and strong.

Lastly, ageing. We all get older, and however fit we keep ourselves, our ‘engines’ can mis-behave more easily and develop faults. Most people call these faults degeneration or ‘osteo-arthritis’. This explains why as we get older, we need to exercise (paradoxically perhaps) MORE frequently (though not as intensely) as we do in earlier decades of life, and also explains why we need more spinal treatment as we get older. Older generations of people thought it natural to get less active as they got older - now the newer ‘older’ generations are beginning to learn that daily exercise activity is essential as you enter your 60’s.

Indeed, a well-enough patient in his/her eighties needs to be doing some form of exercise EVERY day so as to keep moving properly.