You Don’t Have a ‘Bad Back’

I hear it a lot in my specialty: “Doc, I just have a bad back.” And sometimes it’s true. But most of the time, this couldn’t be further from the truth. In reality, you have a superhero for a back. It doesn’t hurt because it’s bad, but rather it hurts from years of trying to compensate for what really is bad in your body. Maybe you have injured shoulders or an unbalanced and twisted pelvis. Or maybe your head is way too far forward from years of working at the computer. Either way, these areas are throwing off your body’s natural balance and equilibrium. They are disrupting the tensions in your body that are responsible for keeping your structure stable and healthy. Your lower back, acting as the keystone of your body, is trying its hardest to reinstate that balance and equilibrium. It’s fighting the good fight so that you can stay relatively functional, even in the setting of myriad dysfunctions. In short, your back is being your champion.

The problem is that while your shoulders, pelvis, or neck gave up a long time ago, your back is still struggling to keep you from tipping over or to keep your eyes level with the horizon, as your brain requires. The pain you’re feeling is the side-effect of this struggle. Your lower back muscles are as tense as steel cords, and they hurt because of it. Ultimately, as the years march on, even your greatest fighter begins to lose the fight. Its structure begins to give, and discs begin herniating. The bones wear and start impinging on your spinal nerves, giving you symptoms like sciatica and weakness. You visit your family doctor who sends you for imaging of your back. Sure enough, the MRI comes back showing quite a bit of wear-and-tear, herniated discs, and nerve impingement. You are told that you have “the back of an 80-year-old” at the age of 40. You ask why, given no real history of trauma, and are told that you “just have a bad back.”

But studies have found that if you randomly scan healthy, pain-free individuals, nearly 1 in 4 will have some deterioration in their backs. Again, backs are the keystones of our bodies, and our evermore sedentary lifestyles are hard on them. We develop imbalances that make their job of stability and structure more and more difficult. This inevitably leads to wear-and-tear, but that doesn’t mean the problem is the back. That’s just where it can sometimes hurt the most.

The best analogy is two people carrying a heavy object. Both are straining, but eventually one drops their end. The pain for that person instantly goes away, but the discomfort magnifies for the individual still holding on, as they are now carrying the full weight of the heavy object. As a physician, my initial goal isn’t to make the individual still holding the object feel better with medications and pep talks. My job is to convince the other person to pick their end back up. Only when that is no longer possible do I consider focusing on just relieving the struggle of the remaining lifter. At that point, it isn’t ideal, but it is the best anybody can do.

The above analogy underlines the biggest difference between having your back pain treated by your family doctor versus an osteopathic musculoskeletal specialist. While most doctors can help relieve the pain of the person still holding on to the heavy object, I have trained for years in the art of getting the other lifter to pick their end back up. Of course, the reality is even more complicated. Think of 50 people lifting a weirdly shaped object. Several have let go, others are starting to let go, and some are still completely fine. Now I must figure out who is who before I can even try to get them to pick their ends back up. But this is a job I do happily, because it can result in a level of relief and restoration of function that you were previously told wasn’t possible, because, well…you just “have a bad back.”

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