From my casual observation as a clinician, about 80% of people suffering from back pain fit a certain demographic profile:
- Age 35-60
- 10-20+ pounds overweight
- Works in manual labor or;
- White collar- prolonged sitting
- Sedentary or moderate physical activity
Of secondary association, there are these traits:
- History of past injury
- History of contact sports or sports involving jumping (i.e. gymnastics)
- Familial history of back pain
- Insufficient sleep
- Unbalanced diet: junk food, excess carbs, insufficient vegetables
Now of course there are people who have back pain who don’t have any of these characteristics, but those individuals are a very small minority.
If half of these factors apply to you, there is a good chance you have back pain in some form.
The problem with “non-specific” chronic back pain that is not associated with a single-event trauma like lifting something heavy is that, by the time you feel the pain, the internal structures that are causing it have degenerated to a point where it is difficult to completely resolve. And, males in general usually defer seeing a doctor or specialist when they feel the first signs of something wrong; they are more likely to ignore it until it gets to a level where it interferes with their activities in some way.
Non-specific low back pain is often difficult to diagnose because there are usually multiple things happening simultaneously:
- spondylosis (bony projections indicative of joint degeneration)
- stenosis (narrowing of spaces where nerves pass through)
- arthritis (inflammation within the joint surfaces)
- vertebral slippage (spondylolisthesis; retrolisthesis)
- disc degeneration
- ligament calcification
- sometimes osteopenia (loss of bone mass)
- sometimes paraspinal muscle spasms/ hypertonicity
- sometimes spontaneous fracture
The answer has big ramifications; after all, getting diagnosed with chronic pain due to lumbar degenerative disc disease at age 40 can be devastating if it means that you have to live the rest of your life with low back pain. We all want not just to live, but to live with vitality; right? We don’t want to go through life sitting down, watching everybody else have fun; we want to engage life and live it to its fullest.
What we do know is that once you develop osteophytes (spondylosis)– those bony spikes that protrude from the edges of vertebral structures– they do not resorb, no matter what. Thankfully, they are “slow growing,” and it is possible to stem that growth by doing things like losing weight if you’re overweight, eating healthy, exercising and strengthening your back and core muscles to improve support. But once they reach a certain point and obstruct nerve passageways, you’re looking at surgical intervention (spinal decompression surgery), which often works but also often causes new problems, or provides temporary results as the osteophytes resume growing.
But with discs, there is more hope. Discs are mostly water. If you can re-hydrate your discs and get them healthy, they will increase in thickness and in the process create more space between your vertebrae, potentially relieving pressure from pinched nerves and impacted facet joint surfaces. However, some people have passed the point of no return where the disc is functionally “dead” (looks solid black on MRI). In these situations, the vertebrae eventually fuse together which accelerates stenosis, requiring surgical decompression.
So, if you have chronic back pain, your alternatives are to engage in lifestyle modification habits that strengthen the body and promote healing; work with a chiropractor, physiatrist or other rehab specialist to see if improving joint movement and muscle balance are enough to resolve the problem; or consult with an orthopedic MD and see if you are a candidate for surgery.
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