What caused my back pain?

dollwithbackpainOne of the trickiest questions I get asked is “what caused my back pain?” Or variations on that theme like “what caused my knee pain/foot pain/hip to hike/shoulder to droop/back to curve?”

It’s a great question, and the right answer seems like it should tell you what to do to fix the pain or alignment problem. It just feels like the right question to ask. After all, when you car starts making funky engine noises, you ask the mechanic “what caused the thingamajig to go bad all of a sudden?” When your toilet clogs, you ask the plumber “what caused the water to stop flowing?”

But with your body, it’s not really the right question. In fact, sometimes it can be downright irrelevant. Your body is significantly different from your clogged toilet and your noisy car. How?

It’s generally supposed to be able to heal itself. (If your toilet unclogs itself or your car fixes its own engine problems, you have my permission to stop reading.)

Even in the case of severe injuries, the body tries to heal itself to as close to normal as the severity of the injury and ongoing circumstances allow. You get a paper cut that hurts like Hell, but in a matter of days, the skin is all healed up and you can’t even tell where the injury was. You sprain your ankle playing soccer, but within a few weeks you’re able to walk pretty well again. You drink a 12 pack of beer in one sitting and have an angry everything for two days, but by the following week, your body’s managed to get things back to an acceptable level of function, and you’ve already forgotten how bad you felt (so you’re ready to drink again!).

Even with major insults that overwhelm regular regenerative capabilities, the body tries to heal up as best it can. Even if you have a hand chopped off, with the right amount of immediate care, your body will grow the skin back around that gaping wound (sorry, your hand will not grow back).

The body is supposed to be able to heal itself pretty well, so long as the right conditions are met. If you’re starving for nutrients, you may have trouble recovering from short periods of exercise. If you’re constantly ingesting massive quantities of alcohol, you may have trouble healing your liver.

So how does this apply to something like back pain? A common cause of back pain I see is not weak back musculature; it’s actually hopelessly weak hip/butt musculature. Without going into it in major detail (the topic deserves its own book and late-night informercial), the muscles of your hip/butt are responsible for helping you do things like bend over and tie your shoes, pick up boxes, and stand up from a chair and walk to the copier. When the hip/butt muscles don’t do their work, it gets shifted onto the hapless spinal muscles.

When the hapless spinal muscles have to do double duty, your pain-free range of motion gets severely reduced. As you bend forward, your spinal muscles put the brakes on, sometimes seizing up and telling you that you’ve gone far enough. Sometimes the extra work they’re doing is done asymmetrically and your vertebrae get tweaked enough to cause a disc to bulge or go whole hog and herniate right up against a nerve. Whatever the severity of pain, the spinal muscles were only the proximate cause of this first episode of pain.

Theoretically, your body should heal up and recover, right? But it doesn’t. You still feel stiff and uncomfortable, wary, tired, and frustrated. Why doesn’t your back pain just heal already?

Because now you have something your car and your toilet don’t get (or only very, very rarely get): a positive feedback loop. Your back pain limits how you move, which limits how well you can activate your hip/butt muscles, which makes it impossible for your back muscles to get back to proper balance, which gives you back pain, which limits how you move, which limits how well you can activate your hip/butt muscles, which makes it impossible for your back muscles to get back to proper balance, which gives you back pain…

Whew. I’m dizzy from just typing that. If you ask “what caused my back pain?” you’re asking really about just that first episode, but, as you can see, it’s largely irrelevant now. It’s about breaking the cycle that’s keeping you in pain.

This is just an example of how back pain gets perpetuated, and it most definitely can vary from individual to individual. In real life, the factors that can throw your body out of balance are too numerous to name; suffice it to say that anything you do repetitively can train in plenty of muscle imbalance.

To really get yourself out of pain and stiffness, you need to ask yourself, “What is stopping my body from being able to recover fully?”

This means examining your daily habits and weekly rituals. How do you sit in the car? How do you sit at work? How much targeted exercise are you getting? Are you able to ever relax your irritated muscles? Are you ever stimulating weak muscles to work or just reinforcing imbalances by playing your favorite sport without specific training? How is stress affecting your whole body? Are you eating well?

Identify the things that are putting you in the positive feedback loop of pain, then do everything you can to eliminate the factors that keep feeding the loop. This has to be done on a local and global scale in your body. If you aren’t sleeping enough, that is a macro-level issue with plenty of local effects throughout the body. If your gluteus medius doesn’t ever fire or can’t seem to support your body properly, that’s a local issue with global repercussions. Leave no stone unturned and no muscle untested. Try multiple approaches til you find the tool that works for you.

You wouldn’t leave your toilet clogged just because the plunger didn’t fix, so don’t leave your body hurting just because a back pain (or knee, shoulder, ankle, etc.) manual (or health professional) you tried didn’t get you out of pain.


About the Author

Matt Hsu is a trainer and orthopedic massage therapist. He fought a long battle with chronic pain all over his body and won. He blends the principles he learned in his journey, empirical observations with clients, and relevant research to help others get their lives back.

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