When thinking about back pain, we have long been trained by the medical system to think about disc and bone abnormalities. If we can just find the disc that’s bulging, we can fix the problem. If we can find the nerve that’s being pressed on by the disc that’s out of place, we can put the disc in the right place with surgery and take away all the pain. If we can find the vertebrae that are causing the disc to degenerate, we can stop the painful disease process.
But this line of thinking, while occasionally successful (and then only partially), misses this point: chronic and recurrent back pain is the result of a chain of events.
Imagine we have a row of 10 domino tiles lined up. With the flick of a finger, we knock the first tile over, which proceeds to knock over the rest, one by one until they all fall down.
We could say that the second to last domino caused the very last domino to fall, couldn’t we?
“If not for that second to last domino, that last domino wouldn’t have fallen!” we could comfortably and factually exclaim.
But, while true, that statement does not address the reality of the situation. The first domino, the second domino, and the third domino (and so on) were all part of a chain of events — started by the flick of a finger — that led to the falling of the last domino.
This is the same situation with back pain. A process takes place that starts domino tiles falling. By the time the pain is debilitating, you’ve allowed many tiles to fall. Interventions focused on herniations, disc bulges, etc. are often focusing on the second to last domino. It’s the clearest, closest cause of the problem.
But discs do not suddenly decide to go bad, nor do vertebrae one day resolve to crush discs for no good reason. There are no viruses or bacteria that cause these things to happen. There is a process in play.
Patterns in our daily lives set us up for pain. Injuries that we have never fully acknowledged and allowed to heal properly hamper healthy movement patterns that put painful processes in place. Sitting for 18 hours a day weakens certain muscles and forces others to do double duty.
When we recognize these kinds of patterns and make efforts to change them, we can really make progress in getting all the pieces back in place, rather than fighting with the second to last domino and wondering why, despite our best efforts, everything is still out of whack.