Ouch, My Back's Gone Out Again!

How many times have you heard someone with a sore back say, “Oh, my back is out again?  When clients say this to me they usually mean that some component of their back has shifted to a new and uncomfortable position.  These people believe their pain will be relieved when this component is put back where it should be.

This is wrong on both counts.  Malalignment of the spine and other bony structures in the neck or pelvis, if they exist at all, do not correlate well with pain.  That is, people with back pain typically do not show any deviations in positions of discs, joints and bones, and those few who have such deviations usually experience no more back pain than anyone else.  

If a chiropractor, osteopath or physiotherapist intervenes to manipulate the spine, some temporary relief may be achieved but the evidence is that the bony structures are relatively unchanged after these procedures.  

This strongly suggests that any reduction in pain results from other factors like lowered muscle tone, reduced fear and anxiety and the expectation of improvement.

Similarly, surgery to “correct” spinal deviations presumed to be associated with back pain is rarely attempted or required.  When it is, the results are seldom better in the medium to longer term than non-surgical interventions like exercise.

It is tempting to see back pain as resulting from some structural defect or imbalance.  But our bodies are wonderfully adaptable and robust and it is far more likely that mechanical factors are only part of the story.  We’ll look at these other factors in the next instalment in this series on back pain myths.