Back Pain Made Simple: Just the Facts

The Cleveland Clinic Journal of Medicine has a helpful, authoritative review of back pain, its causes, and advised treatments. Back pain is the second most common reason for doctor visits (after the common cold). I recommend sending it to anyone dealing with back pain.

Some of the key points:

  • Most back pain has no recognizable cause and is therefore termed “mechanical” or “musculoskeletal.” Underlying systemic disease is rare.
  • Most episodes of back pain are not preventable.
  • Confounding psychosocial issues are common.
  • A careful, informed history and physical examination are invaluable; diagnostic studies, however sophisticated, are never a substitute. Defer them for specific indications.
  • Encouragement of activity is benign and perhaps salutary for back pain and is desirable for general physical and mental health. Evidence to support bed rest is scant.
  • Few if any treatments have been proven effective for low back pain.
  • Low back pain should be understood as a remittent, intermittent predicament of life. Its cause is indeterminate, but its course is predictable. Its link to work-related injury is tenuous and confounded by psychosocial issues, including workers’ compensation. It challenges function, compromises performance, and calls for empathy and understanding.

I would highlight the fact that exercise is helpful. (You should also exercise when you have the common cold, by the way.)

The last point about empathy and understanding rings true. Last October I woke up one morning with searing, unexplainable lower back pain. It dominated my existence for a couple weeks and I was able to do almost nothing else. I grew more understanding of what some must deal with on a daily basis.

Also, I never do exercises in the gym that come anywhere close to hurting my back. This includes squats. Unless you're extremely well instructed on how to use the weights, avoid back-related movement and stick with bodyweight exercises.

(h/t Andy McKenzie for the pointer)

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