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Chronic back pain doesn't have anything to do with structures in the back. Its strongest link is with anxiety and depression. Meanwhile people suffering from chronic pain get told 'it's all in your mind,' or that there's nothing wrong with them.

That is about the worst thing you can say to someone with chronic pain. When you see a doctor and they tell you your problem is all in your mind, it makes you want to scream. But with chronic back pain, it’s not a question of it being ‘in your mind’ – it’s in your brain. And it doesn’t mean there’s nothing wrong with your back – just that the problem with your back isn’t the cause of the pain.

If you have back pain, you probably have a pretty good idea of what caused it

Maybe it’s an old injury, maybe it happened when you were pregnant. Or you hurt your back playing football and it’s never been the same. It’s a golf injury, because your swing is unbalanced. You used to swim, so maybe… Others will observe that they have bad posture, slouch at their desks, don’t get enough exercise. We all have our reasons.
Then you go to see a health professional, and they have a feel and a poke (‘palpate,’ as they usually prefer to say), and sometimes recommend a scan.

So you have a scan. And the scan comes back with some damage to a couple of spinal bones, or a herniated disk. Soft tissue imaging shows a couple of ligaments that don’t look that great. Or you have a serious muscular imbalance. Well, OK, we’re making progress.

At least now you know what the problem is, right?

Nope.

Here’s what’s really happened. You have pain, and some old injuries, and some bad habits. You go to see a doctor and he finds some structural decay or damage. So now you have pain, damage and bad habits. So far not a great day, I grant you – but the point is this:

There’s no causal relationship

I have old injuries, bad habits and probably some structural damage. But I don’t have chronic back pain.

Great, a sample size of one. How convincing.

I agree. So let’s hear from Max Zurtin at the School of Physiotherapy in Perth, Western Australia. He seems pretty clear: ‘it is extremely difficult to alter the potentially disabling belief among the lay public that low back pain has a structural mechanical cause.’ Mr. Zurtin is pretty clear that this isn’t the case. He’s a lot more qualified than I am (no kidding!), but again, the word of just one person.

What do the figures show?

Remember when I said I had no structural damage? Well, maybe… and maybe I’m one of the 40% of apparently healthy people walking around with one or more herniated disks.

Up to 93% of us have at least one bulging disk, and 56% of us have tears in the connective tissues around our spines.

Add those figures up and you’ll see they overlap – they add up to way more than a hundred. 

Lots of apparently healthy people are walking around with connective tissue tears, bulging disks and herniated disks.

I bet they all have bad posture and old injuries too.

What they don’t have is chronic back pain.

So here’s the first thing we need to understand: chronic back pain doesn’t come from damage to the back. Maybe yours does – specific cases are hard to extrapolate from general data and your mileage is bound to differ. But probably it doesn’t.

Where is the pain generated, then?

We tend to think that pain comes from the nerves in the arms and legs, trunk and head – we’re hurt, the nerves tell the brain ‘pain!’ and it pulls your arm out of the fire. That’s mostly true with acute pain; with chronic pain it isn’t true at all. Chronic pain is in the brain.

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