What Causes Back Pain?

Specialists who treat back pain are missing something important. The back is like the spine of a corset that supports the trunk. A wise osteopath called Caroline Stone used to remind us, "Remember that people have a front." First we could ask, How does the back support the trunk? The backbone is a stack of bones called vertebrae. Muscles move the vertebrae but without the bones your body would collapse. Muscles attach to the bones by tendons. Ligaments are straps that join the vertebrae and limit movement. Tendons are more elastic than ligaments; they contain a protein called elastin. Ligaments contain more of a protein called collagen. You have 12 pairs of ribs hanging onto your back bones. The first rib start right at the top of your sternum (the breast bone), runs under your collar bone and round to the base of your neck. The last two ribs are attached to the spine but not to the breast bone. They are called floating ribs. The ribs protect your heart, lungs, stomach, spleen, liver and gall bladder, pancreas, kidneys, aorta (main blood vessel), veins and lymph glands. They give shape to your chest and support the breasts or pectoral muscles. Lower down the back your small intestine and colon have some folds of internal skin that attach to the back of the abdominal cavity. The folds of skin are called mesenteries, lit. 'middle intestines'. The bag around the abdomen is called the peritoneum, lit. 'stretched around'.

Any of these structures or organs could cause back pain. Some are more likely to cause pain than others. Ligaments for instance, are very pain-sensitive. Under an electron microscope they look like a matrix of fibres that crinkle and straighten but do not stretch very easily. In my experience the most common cause of back pain is muscle fatigue allowing the muscles weaken more on one side than the other. Muscle imbalance leads to ligament strain. Ligament strain leads to back pain. Of course there are lots of other causes. If you read a standard orthopaedic medical book they will tell you the causes that they see most commonly like disc injury, bone tumour, vertebral collapse, arthritis, bony spurs. In practice these causes are not very common. Other assumed causes like obesity, poor abdominal muscle stability are not common causes either. How often does a professional say, "lose weight and your back pain will go." It might be true of knee pain but not back pain. Muscle imbalance leading to pelvic asymmetry is a much more common cause of back pain. If the core abdominal muscles are out of balance back pain will get worse with pilates for instance.