Is Back Pain Normal?
by Don Hoang, PT, DPT, MFDc
updated 8/10/2022
Chances are, if you are reading this, you may have had back pain at some point. Back pain comes in different forms, from an acute sharp strain to a more chronic nagging ache that you learn to “live with.” It can be a twinge if you “move wrong” or the most debilitating thing that occupies your mind 24/7. You were probably told you were moving a wrong way, it’s due to arthritis, or it’s because of your posture, etc. Probably not likely. What if I told you back pain can be normal, and it is just a part of life? Let me explain.
Pain is a normal perception from our brain; think of it as our ally and not our enemy. It’s a normal stress signal to the brain that tells us to give extra attention to the area of pain, like when you step on a Lego piece. Sometimes, with chronic pain, it can change some of the pain pathways in our brain and nervous system; this is called neuroplasticity. Our central nervous system can become wired to make the body feel continuous pain, even in the absence of structural or tissue damage.
Now, the back is very complex. It has a bunch of vertebrae stacked together with rubbery shock pads in between, and held together by tons of ligaments, tendons, and muscles. And don’t forget the 31 pairs of nerves rooted to the spinal cord that come out of the back and down to your toes. So yes, complex.
Pain is also complex in nature and isn’t always caused by one factor, such as a mechanical dysfunction, pinched nerves, or a “thrown out disc”. In fact, a systematic review showed that in over 3000 asymptomatic individuals (aka no pain), up to 30-37% of young adults in their 20s and 84-96% of older adults in their 80s had some abnormal findings on their imaging, whether it was disc degeneration or disc bulge (1). Meaning you can bet that on your next x-ray or MRI, you might find something in your spine, but it doesn’t mean that’s the cause of your pain (if you even have pain to begin with). Sometimes, pain comes from an oversensitive nervous system, along with lack of sleep, lack of exercise, poor diet, anxiety and stress. Long story short, back pain is complicated, but it does not have to be complicated.
Back to what I was saying earlier. When I say back pain can be normal, I don’t mean that everyone is eventually going to have chronic back pain and should have to learn to live with it. Most of us will have some sort of pain, whether it is in the back or somewhere else in the body. It can be from repetitive stress, putting our bodies through rigorous demands (like construction or maintenance workers), or just from being sedentary. Interestingly, similar low back pain prevalence rates have also been reported between working and nonworking populations (2).
So what do you do if you experience back pain? Here are a few tips to manage it:
Keep calm and carry on. No really, it is not the end of the world, so don’t go into a state of panic and worry because this psychological behavior can affect and prolong your pain. Research shows that most back pain episodes naturally heal on their own without treatment.
Keep moving. Develop active pain coping strategies. Keep moving within tolerable limits. Try keeping your exercises light, whether that is deloading down to body weight exercises, yoga, stretching, elliptical, stationary biking, or even walking in a pool. Movement is your best antidote for managing back pain.
Know your body’s resilience and capabilities. Your body is a master at healing itself when it can. You are stronger and more capable than you think. Try not to think that you are fragile and broken.
Resume your normal daily routine and activities as soon as you can, even when still experiencing some pain.
It’s also important to not only keep track of the pain, but also any improvements in activity levels. If you notice you can walk 15 more minutes, even with back pain, compared to your first episode of back pain, then that is a win!
If you want to work on moving better through your back pain, schedule an appointment below!
References
W. Brinjikji, P.H. Luetmer, B. Comstock, B.W. Bresnahan, L.E. Chen, R.A. Deyo, S. Halabi, J.A. Turner, A.L. Avins, K. James, J.T. Wald, D.F. Kallmes, J.G. Jarvik. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology Apr 2015, 36 (4) 811-816
Delitto, A., George S.Z., Van Dillen, L., Whitman, J.M., Sowa, G., Shekelle, P., Denninger, T.R., and Godges, J.J. Low Back Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy 2012, 42:4, A1-A57
