Why Chronic “Nonspecific” Back Pain Has Become An Epidemic — And What You Can Do About It

Chronic nonspecific back pain is an issue for a growing number of people in Ireland, many of whom feel frustrated, lost and hopeless. Some even battle depression as a result of their condition. Having gone through a laundry list of treatments without much relief, they are often filled with frustration, doubt and suspicion of any new approaches.

I’m writing this for those who have ever felt depressed, overwhelmed, frustrated, or that their lives have been put on hold as a result of back pain. This article can point you towards a real, lasting solution to your back pain by using the approaches I teach and practice.

The methods I employ, the Alexander Technique, and LearningMethods, are not well known. Yet there’s a huge amount I can offer for chronic back pain sufferers, in particular for those suffering from nonspecific back pain. I explain more on this below. But first, I’d like to introduce you to the medical research pointing to the real causes of nonspecific back pain, which explains why regular treatments often do not work.

The Birth Of A Back Pain Epidemic

Over the past forty years, since the MRI scan came into modern use, there has been a steady increase in the prevalence of chronic nonspecific back pain.

With the MRI, doctors and the public alike could see the tissues of the living spine for the first time. With this highly detailed view of our structure, new beliefs about the causes of back pain emerged. Before we had a window into our living structure, doctors and the public were more likely to attribute back pain to a sprained muscle than anything relating to the facet joints or disks. The catch-all term “lumbago” was often used for any low back pain. But now they would use an MRI scan and began to report to patients that their spine had bumps, bulges and other signs of use. They referred to them as “abnormalities”, “deterioration” or “wear and tear”.

With these new terms and new mental pictures, people began to believe that back pain was mostly caused by structural issues. Yet evidence gathered over decades of research mostly contradicts this belief. More than 70% of all lower back pain cases are not related to structural issues, but rather, even the most severe pain can be caused by harmless (and easily solvable) strains and compression in the soft tissues, such as the muscles.

I hope to show you that chronic back pain often fails to respond to medical treatment because it isn’t a medical issue. Rather, it’s most often caused by unnatural movement, poor posture, excessive muscle tension and emotional/psychological factors. And I hope to point you on a path which can give you better results in alleviating and overcoming this type of chronic back pain, often relatively quickly and easily, by tackling all of these factors at once.

More Chronic Back Pain Cases Than Ever, Fewer Responding to Medical Treatment

In 2009, a peer-reviewed manuscript, published in the American Journal of Family Medicine, titled “Overtreating Back Pain”, noted that medical treatment for back pain has been poorly validated and mostly ineffective. It called for an urgent re-assessment of their efficacy and safety.

Manuscript here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729142/

In their report, they cited studies indicating a 6-fold increase in the use of epidural injections, a 4-fold increase in the use of painkillers, a three-fold increase in the use of MRI scans for back pain, and a doubling of ‘spinal fusion’ operations.

While more people than ever were being diagnosed with back pain and given treatment, including intrusive operations that could lead to complications, these treatments were not accompanied by “population-level improvements in patient outcomes or disability rates”, meaning they were mostly useless.

This rise in chronic nonspecific back pain, unresponsive to treatment, started just as the MRI was introduced into hospitals and began to be used in the diagnosis of back pain. It was right at this time that there was an increase in our society’s perceptions of back pain as a spinal or structural issue.

The (Mis)Perceived Risks of Nonspecific Back Pain

Interestingly, only about 1-2% of all back pain cases have serious underlying issues requiring medical treatment. The MRI scan has been essential for accurately identifying these cases so they could be treated.

However, for the majority of the remaining 99% of all back pain cases, these scans find neither a serious underlying issue nor an apparent cause for the pain. With no clear cause for the pain to be found in scans, it’s referred to as “nonspecific”.

That’s not to say there is no reason for nonspecific back pain; it’s just that the scans cannot detect it. (Scans cannot detect muscle tension or pressures on soft tissues). However, in the process of using an MRI to screen for that 1% of serious underlying issues, many patients are told they have “wear and tear”, bulging disks and other “abnormalities” in their spines, even if these are not causing their pain.

As many people with chronic back pain will attest, their anxiety levels soared when they were first told of signs of “wear and tear”, “deterioration” or “abnormalities” in their spine. Even if these abnormalities did not cause their pain, the patient tended to believe, understandably, that if there were ‘abnormalities’, there must be something wrong. And if the doctor couldn’t see it, what could they be missing to cause such intense pain? With horrifying mental images of what was going on with their structure, a jolt of pain might push their mind to imagine unobserved cancer eating away at the bone or loose vertebrae on the verge of severing a nerve.

Many chronic back pain sufferers explain the series of events that led to their pain in ways strikingly similar to this:

“When I first got back pain. It was very bad. I knew people who became crippled or hospitalised as a result of back pain and my relative had died from cancer that he originally thought was back pain. So when I got the pain, I immediately started to worry that something serious could be going on for me too.
I went to the doctor and was referred for scans. They told me that my pain had no cause but that I had a bulging disk and signs of wear and tear in another part of my back
When I heard all that, I became worried that my spine was on the verge of serious damage. Quickly after this visit the pain got even worse. I became afraid to walk, or bend, or reach, in case I caused a serious injury. And that’s when the pain became truly terrible, and I started having anxiety.

Why would a back pain sufferer’s symptoms worsen after a scan?

A peer-reviewed study conducted in conjunction with the Perth School of Physiotherapy investigated the link between chronic back pain and our beliefs and fears.

Full study here: http://bmjopen.bmj.com/content/3/4/e002654.full

The study concluded that chronic back pain is, at least in part, an “iatrogenic disorder”, meaning that the chronic back pain epidemic has been created by our modern medical approach to treating the pain. The study isolated unhealthy beliefs about the condition of our spine as the main cause.

Here’s how they came to this conclusion.

For decades, Aboriginal communities have been notably free from the rising epidemic of back pain. While people in these communities did get back pain, it rarely became chronic and usually resolved itself within a few days or weeks.

In search of their ‘secret’, the researchers interviewed community members to identify differences in their behaviours and attitudes compared with more westernised populations. Their attitude and beliefs around back pain were remarkably different.
When asked about the condition of their spine during a bout of back pain, they said things like, “The pain was probably from a sprained muscle. It hurt like hell, but I just took it easy till it got better”. And almost invariably, within a few days or weeks, the pain disappeared by itself. These individuals rarely considered back pain a medical issue, but rather saw it as a terribly painful occurrence that would, like most things, resolve itself.

The research also explored the mindsets of Aboriginal community members who did suffer from chronic back pain. These individuals tended to share similar fear and beliefs about their spines as those in more westernised cultures like our own; They had negative beliefs about the health, strength and ability of their spines and talked about their pain in terms of structure, using language such as ‘worn facet joints’, ‘bulging discs’ and other medicalised descriptions of the spine.

The researchers concluded that those who had this structural mindset shared similar fears about what their pain meant. They tended to interpret the pain as meaning serious was happening in their structure, and their pain tended to become more intense and chronic.
In contrast, those who did not fear their pain, however intense, tended to recover more quickly and it rarely became chronic.

In addition to this study, a separate report focusing on the segment of Aboriginal community members who did suffer from chronic back pain in Aboriginal communities also concluded that increased pain and disability was likely a “result of Western biomedical influences”.
More here: http://onlinelibrary.wiley.com/doi/10.1002/j.1532-2149.2012.00128.x/full


From this, it’s hard not to conclude that chronic back pain incidences are often not what they seem.

I have worked with clients suffering from chronic pain and other issues, such as ME. The one thing they understandably resent is when anyone suggests that their pain is “all in their head”.

While these cultural beliefs around back pain can aggravate and cause pain, that does not mean the pain is “all in your head”. The pain is very real and very physical; it’s the result of physical changes including increased muscle tension and unnatural movement patterns.

However, these physical changes are generated by beliefs, including our fears and misunderstandings about our human system, which change how we move and create physical reactions such as tensing up in anticipation of pain.

Another peer-reviewed medical study exploring patients’ responses and reactions to pain concluded that many patients’ pain became chronic as a result of fear. When we fear hurting ourselves, the pain level can increase.

Read the Study here: http://www.sciencedirect.com/science/article/pii/S0304395999002420

When we feel fear, our body physically tenses. This creates additional pressures on already-painful tissues. When we fear hurting an area, we also get caught up in ‘muscle guarding’, where we “mind” an area by adding unnatural tensions and changing our posture unnaturally. All of these things are shown to change how people move and behave in their daily lives, more often than not increasing their pain levels.

As a direct result of back pain sufferers believing their pain meant something was going wrong with their spine and structure, they had a fear of their pain and tried to avoid it. We can all relate to this.  Fearing pain, we tense up. This is a contraction of muscles, often with massive forces, which can put additional pressures on already-sensitive tissues.
It’s enough to cause pain.
Then what happens? If that reaction generated more pain, we will become more afraid of having a similar experience. We can become even more tense, creating more pressure, escalating pain levels. Just as with anxiety attacks, this reaction can reinforce itself, snowballing until the physical pain becomes extreme and chronic.
Chronic nonspecific back pain is by no means ‘all in your head’, but I have found that teaching sufferers how to identify and change these emotional / psychological responses often leads to very significant improvements in their condition.

Chronic pain sufferers fear damaging their structure, and tend to perceive pain signals indicate further damage.

Because of this belief that pain equals something terrible, they tend to avoid anything that can cause pain. Including physical activities like walking and bending. Unfortunately this is the exact opposite of what is best for them. Research has shown that light activities done well are good for back pain, even if they can be sore at first.

Because of increased fear, chronic pain sufferers tend to tense muscles in what are known as “muscle guarding” patterns. When we’re afraid we’re going to hurt ourselves; we tighten up and change our gait in unnatural ways. We do this in an effort to ‘protect’ ourselves, but these unnatural changes to our movement and muscular tension can further compress already-painful and sensitive tissues, thereby worsening the pain. And as the pain becomes worse, it further feeds into the belief that something terrible is happening to the spine. These imagined mental images of things tearing and grinding can make sufferers tighten up even more.

With the best of intentions, back pain sufferers can inadvertently lock themselves in a vicious cycle.

Chronic back pain patients, when asked about their image of their spine, often describe bones crumbling, disks bursting, and things disintegrating. Because they tend to believe their pain means terrible things are happening to their spine and structure, their anxiety levels increase. And because they believe the pain means something terrible could happen, they become much more avoidant of activities and movements that might cause pain. Because they’re not moving, they get more tense, adding further strain and pain for these individuals. Studies were also performed in Britain, Canada and Norway, which found similar beliefs at large among the population

It’s for this reason that the study concluded that chronic back pain is a product of these negative beliefs and is, at least to some degree, “iatrogenic”, meaning that medical treatment can cause or exacerbate many of these cases.
Just as with the Aboriginal communities interviewed by researchers, in western cultures pre-1970, before the MRI scan became widely used, we did not know about these “abnormalities”. The public knew little about facet joints or disks. Doctors were more likely to diagnose their patient’s pain as a sprained muscle or “lumbago”. Patients were often prescribed rested and more often than not, just like the Aboriginal community, they recovered within a few days or weeks without issue.

But after the introduction of the MRI, our society began to develop new concepts about what was going on in our body. Instead of dismissing our back pain was down to a sprained muscle, we became increasingly more likely to blame a weak and vulnerable spine on the verge of catastrophic damage.

It’s a popular belief that spinal abnormalities are dangerous and cause back pain, but this belief is mostly untrue, except in rare cases when there has been an impact injury, a bulging disk or other structural abnormalities physically impinging upon a nerve or damaging the spinal cord. But aside from these rare instances, most back pain — up to 70% of cases — are not structural.

The reason this belief has become prevalent is that doctors saw these ‘abnormalities’, told their patients, and they then became afraid of hurting themselves, they started to get anxious and tense. The muscle tension added more pressure on already-sensitive tissues, increasing pain-levels and confirming to the patient that there is indeed something bad happening.

The Staggeringly high rate of ‘Abnormalities.’

A peer-reviewed study investigated the prevalence of spinal abnormalities in healthy people without any pain.

They tested 500 subjects. Of these, 20% of pain-free people in their twenties had signs of “disk degeneration”. And almost 90% of healthy, pain-free people in their sixties had spinal abnormalities. Despite these extremely high rates of abnormalities, zero of these five hundred subjects experienced pain. The researchers urged surgeons to “keep this in mind when interpreting MRI findings”. Clearly, something was not right.

If spinal abnormalities aren’t the cause of most cases of nonspecific chronic back pain, what can we do about it?

Spinal abnormalities are harmless for the vast majority of chronic back pain sufferers. It’s an inevitable course of events, just as our skin loses its elasticity and our hair thins, our strong, robust spines show signs of age-related deterioration. But such deterioration rarely causes problems.

As a teacher of both the Alexander Technique and LearningMethods, I work to help you regain your trust and confidence in your body’s ability to take care of itself. I can help you address multiple, often all the factors causing pain, even for “non-specific” back pain. These can include poor posture, excess muscle tension, and various unnatural movement patterns people can get into in an often-misguided effort to avoid further injury. In addition to this, I work on any anxiety around fear of injury, which can itself generate more physical tension, thereby further compressing sensitive tissues and adding to, sustaining, or causing, back pain.

When a client already has a belief that their pain is structural, they can find it difficult at first to change their views and trust their robust human system.

This is because there’s nothing like a feeling to make something feel real. If we feel pain and believe it’s caused by something sinister and terrible happening to our structure, the pain only reinforces that belief. I am there every step of the way to help my clients overcome this fear and learn to regain confidence in their bodies. They often report feeling the pain and tension melt away, and they begin to return to an active lifestyle, doing the things they love.

But of course, to engage in light activity, you need to trust your system and learn to change your reaction to pain. Pain can be scary — especially if you believe it means something bad is happening. But if you have had scans, ruled out serious underlying conditions and you’re still in doubt, get a second opinion. Then learn to trust that your issue is likely related to muscle tension and compressed tissues, which can be helped very effectively with a combination of Alexander Technique and LearningMethods.


How Effective is My Approach?

In 2008, the British Medical Journal published a peer-reviewed, controlled study of one of the methods I employ (the Alexander Technique), patients who combined my approach with light exercise were able to greatly reduce their pain.

The study concluded that my approach was the most cost effective method studied; patients achieved massive relief with only six sessions over a six-week period.
To test the claims that the Alexander Technique could offer long-term relief, the trial re-tested these patients 12 months after their sessions had ended and found they continued to benefit.
You can read the full study here: http://www.bmj.com/content/337/bmj.a884

The Alexander Technique, coupled with light exercise, was found to be the most cost-effective method for relieving back pain out of all approaches they tested. It’s for this reason that work with me includes learning how to move more naturally, so that movement will reduce and alleviate pain instead of aggravating it.

If you have had scans and were diagnosed with ‘nonspecific’ back pain, i.e. there are no serious underlying conditions causing your pain, then to solve your back pain you may simply need to  reduce the forces that compress sensitive tissues and cause pain. I will help you to achieve this by teaching you how to move more naturally, by effortlessly improving your posture, reducing any excess muscle tension and strain in your system,

Book an Alexander Technique Session Today

A one-hour session typically lasts 45-60 mins.
The cost per one-hour session is €75.
For long-term results, a minimum of six sessions is recommended.

Contact Andrew:

Email: andrew@amonaghan.net
(021) 4311977

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