Back Pain Part 1: A Little ~Natural~ History

Back pain: over 600 MILLION (yes, MILLION) people suffer from it. Check out this video Dr. Hannah put together talking about the prevalence of back pain and the societal shifts that need to occur in our beliefs and actions surrounding it. 

A common narrative surrounding back pain perpetuates troubling stigmas, with individuals often perceiving their backs as fragile or injured. Consequently, any associated back pain is interpreted as evidence of tissue damage, which is not always the case. The solution and shift we encourage here at Made 2 Move? Empowering people, through movement- towards stronger, more capable, and more resilient backs. 

The above video started with dedicating just a few minutes everyday to moving our spines. NOW what if those movements have become tolerable and are going smoothly? How can we begin to load and strengthen the back? 

What is Non-Specific Low Back Pain (NSLBP)?

A little bit of history, prevalence, and prognosis about NSLBP before we get into the nitty gritty of targeted back exercises in the gym.

90% of people who experience back pain experience non specific low back pain (NSLBP), meaning “it isn’t possible to identify a specific disease or structural reason to explain the pain” (WHO 2023). This means there isn’t a mechanical or structural issue with the spine, tissues, or structures surrounding the spine. This is reassuring, but also unsettling as it leaves clients in a frustrating space that often sounds like: “Okay, there’s nothing ‘wrong’ with my back except the FACT THAT IT’S PAINFUL!” This is where Made 2 Move comes in- to help you navigate this pain. 

What is Natural History?

One promising point surrounding low back pain is the natural history of the condition for acute or episodic NSLBP. What does this concept of natural history mean?

• Natural history refers to “the progression of a disease process in an individual over time, in the absence of treatment…If this patient does not receive any type of treatment or intervention, what is the probability of their diagnosis resolving on its own?” (Hughen 2022). 

• While the wording of “disease process,” doesn’t necessarily apply to low back pain, the definition of natural history holds true. Essentially, natural history is nature taking its course. If a person has a musculoskeletal condition such as low back or knee pain (or even a sickness like the common cold or strep throat) and does absolutely nothing about it, what is the expected time frame, prognosis, and future look like for its resolution? 

Previous research has noted that the natural history of non-specific low back pain, in the acute or episodic sense, is relatively favorable. When you hear acute or episodic, think of pulling a muscle in your back at the gym or tweaking your back while picking up something funky. In these cases we see a favorable natural history, as “90% of patients recover in 6 weeks without loss of function…[with] residual, less severe, back pain often persisting for 1 to 3 months” (Majid 2008). 

Another 2012 article noted, “LBP is considered, rather, to be a recurring or persistent condition with a fluctuating course over time” (Lemeunier 2012). 

At Made 2 Move, we love that we can generally count on 6 weeks (give or take) as a pretty standard time frame for these acute cases of back pain to resolve. However, this “residual” and “persistent” part doesn’t sit well with us. Who wants to deal with recurring, pesky pain that fluctuates unpredictably? 

That’s why our aim through PT is different than most. Our goal is to increase your tolerance, get to the root of where the back pain may be stemming from, and build up your capacity and overall threshold. We are NOT here to just provide passive treatments or “quick fixes” that may aid in symptom reduction but do nothing for long term change. 

So How Can We Tackle NSLBP? 

So for our episodic, acute low back pain, natural history reassures us that the outlook is favorable, NOT that this back pain is inevitable, irreversible, indicates damage, or is something you are going to struggle with forever. 

For those who have been struggling with back pain for years, there is often an associated fear of the next time they’re going to “throw their back out” and it be more painful and limiting than the last two times it happened. This residual, unpredictable pain is where back pain becomes chronic, even more self limiting, and seemingly insurmountable. This is where it can be valuable to get curious. If it is something that happens often: Why is this happening and what can I do about it? 

At Made 2 Move, we aim to be the conduit between letting natural history take its course and finding ways to move around the pain and minimize its likelihood of recurrence. We do this by finding entry points to tolerable movements and building up your capacity for all back movements from there. 

Is it the volume? Is it the load? Is it the type of movement? Are other variables (sleep, nutrition, rest + recovery) playing a role? These are the types of questions and factors we will dive into with you when working around back pain at Made 2 Move. Ready to build a super strong and resilient back? Reach out to frontdesk@made2movept.com today to set up an initial evaluation!