How to prevent chronic back pain

The tough thing about treating back pain is that it's rarely caused by an issue in your back. When I ask patients where it hurts they never point to their hip flexors or their hamstrings. They're also quick to tell me their MRI showed a degenerated disc, so of course you could only draw one conclusion. It’s a reasonable hypothesis, but it's incomplete because the cause of back pain is more nuanced than imaging or pointing can identify.

For years in my mid-twenties, I was part of the group of 80% of Americans experiencing back pain. An MRI showed a bulged disc between L5-S1 so I assumed the disc was the issue and went along with the treatment plan to adjust my misaligned spine. Every three months, the pain would slowly intensify again, leading me back to my chiropractor to try to fix the problem. In all those visits, I only found temporary relief. This lasted for three years before an epiphany in medical school changed my treatment plan.

It turns out that a bulged or herniated disc is only associated with low back pain, not necessarily causative.

Just look at what this summary says:

“In many instances, the herniation of the disc does not cause that patient any pain. Herniated discs are often seen on MRIs of asymptomatic patients.”

In other words, two people can have the same disc problem, but only one of them is in pain.

Why it matters to diagnose a specific cause

The reason why I spent years chasing my tail trying to fix my back was because I wasn't treating the root cause of the injury–I was treating the symptoms, which rarely provides long-term relief.

When you accept that not all disc issues are painful, regardless of what the MRI says, you're forced to find a different cause to treat. And when you treat the root cause of an injury you can prevent the acute pain from progressing to a chronic issue.

Unexpected causes

Take anterior pelvic tilt (APT), for example. This occurs when your pelvis rotates in a forward position, causing an abnormal curve in your lumbar spine. As you can imagine, this hurts. The cause of APT is attributed to a combination of tight hip flexors (the psoas muscles) and weak glutes and hamstrings, but what causes tight hips and weak thighs? More sitting than moving, for one, as well as poor posture. In this case, a sedentary lifestyle is the root cause of the pain, regardless of what the MRI says.

Another common root cause of chronic back pain is psychological stress. Pain and stress have a complicated relationship, but Dr. John Sarno has a thorough explanation in his book Healing Back Pain: The Mind-Body Connection.

“People often say that they have a very stressful job and that’s why they’re tense. But if they weren’t conscientious about doing a good job, if they weren’t trying to succeed, achieve, and excel, they wouldn’t generate tension. Often such people are highly competitive and determined to get ahead. Typically, they are more critical of themselves than others are of them.”

In my case, it was a combination of all of the above. After all, pain is influenced by medical, cognitive, emotional, and even environmental issues, so it makes sense that healing requires you to address more than your spine. Blaming a herniated disc may let you off the hook from stretching, but it's not going to loosen your tight hips, or fix whatever is actually causing the pain.