Where the heck is my back pain coming from?
What I was taught in PT school was that back pain was mechanical. It was coming from a muscle imbalance, tight hamstrings, tissue damage, a weak core, an unstable lumbar spine, etc. This directed treatment around a biomedical approach.
However, over the last 10 years there has been a significant shift in the way that low back pain is treated and approached. Additionally, this shift has been more profoundly researched in the study of low back pain, specifically. This is the biopsychosocial model of addressing this epidemic. There has been an immense amount of research on the connection between low back pain and psychological factors, social factors, beliefs about pain, pain catastophization, poor nutrition, lack of sleep, and co-morbid conditions. These factors are affecting patients therapeutic outcome AND their risk of long-term disability. Low back pain goes far beyond tissue damage!
For example, a patient has a higher risk of developing low back pain if they are dealing with depression. Patients whom are living with excess stress about finances, losing their job, or poor work satisfaction are more likely to experience low back pain. These are some examples of the social and psychological factors that must be addressed within a treatment plan.
Beliefs about pain and pain catastrophization also have been shown to play a role in persistent low back pain. It has been shown that the brain observes the world around us and makes predictions about how things are going to feel. It adapts to what we become used to and mimics the thoughts, feelings and beliefs beginning at early childhood with the observation of our parents. Similar coping styles are observed in children that resemble those of the adult.
So, if you witnessed your mother or father deal with debilitating, persistent low back pain for the greater part of your childhood, you may be more likely to experience this level of debilitating pain.
We also respond to others in pain with neuropsychological reactions, including anxiety and distress. If you are to watch someone experience a horrific bout of back pain, you will then begin to have negative thoughts during any back pain that you may experience in the future. Similarly, responding in dramatic fashion to a current bout of back pain can truly make it worse!
One thing that I am NOT eluding to is that back pain is “all in your head”. There are absolute circumstances when a tissue overuse condition can occur and may be CONTRIBUTING to the symptoms, but the CAUSE and EFFECT is not black and white. Back pain is complex and 110% multi-factorial. All factors discussed above SHOULD be talked about and addressed to truly get to the root of the issue.