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What really causes back pain?

Back pain is an enigma.  It's one of the leading causes of disability in the world. On top of that, musculoskeletal injuries in general are becoming one of the biggest costs in healthcare.  

One of the main reasons back pain is so devasting and costly is disagreement on what causes back pain.  It's not uncommon for patients to be told their back pain is due to anatomical imperfections, muscle imbalances, or faulty biomechanics. 

What can we confidently say causes back pain? Well, we can look to our nervous system. Since pain is nothing more than a stimulus sent to our brain within our nervous system, we can safely assume pain must be caused by something that the receptors of our nervous system can pick up. 

The main receptor types in our nervous system broadly categorized by what set them off are as follows:

Mechanoreceptors - nerve cells that detect physical pressures like compression, tension, and movement

Chemoreceptors - Sense the presence of chemicals

Thermoreceptors - Detect changes in temperature

Photoreceptors - detect incoming light 


So, pain must be created by one of these things: Mechanical force, chemicals, heat, or light.  Being that our eyes are the only place we have photoreceptors, we can pretty much rule light out as a cause of back pain. The only time the temperature of our back really changes is with a fever, so unless there is an infection, temperature doesn't really cause back pain either.

That leaves us with mechanical force and chemicals. And they play off one another.  Mechanical forces, like compression or tension, create a threat to tissues.  We've evolved to want to avoid death by being crushed or torn limb from limb, and our nervous system has warning signals agains that.  So even forces that may cause that type of tissue damage can send pain signals before that damage actually occurs, as a warning signal.  Chemicals come into play once that tissue damage has taken place. We know it as inflammation, but it chemical pain is actually a result of enzymes, electrolytes, and other chemicals spilling out of a cell after it has been broken by tissue damage. 

Suprisingly, most back pain is NOT primarily driven by inflammation.  This helps explain why it is so hard for doctors to agree on what causes back pain, as mechanical forces cannot be seen on x-rays or MRI's.  It also aligns with findings that steroid injections for back and joint pain may help in the short term but have little effect over time. 

So, what sort of things may cause pain?  Things that cause compression and tension.  Things like forces of gravity with posture, compression or tension due to repeated movements, or damage to tissue from these forces.  What doesn't?  Things like "not activating" certain muscles, spinal alignment, or muscle imbalances. 

If you have any questions about what may be causing your back pains, contact our office to find out!



Dr. Todd Peterson, DC, Cert MDT. Dr. Todd Peterson Dr. Todd Peterson is a chiropractor and certified provider for Mechanical Diagnosis & Therapy (MDT, aka the McKenzie Method). Dr. Peterson played football at the University of Nebraska, where he was a 4 year letter winner and Academic All American. He briefly played professional football in 2009 before returning to Chiropractic School in 2010. He earned his doctor of chiropractic (DC) degree from National University of Health Sciences in 2013, graduating with Magna Cum Laude honors.

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