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I have some exciting new research about the cause of low back pain (LBP) to share with you today!
If you’ve been following my work for a while (or if you stay current with modern pain science!), you likely know that the general public has many outdated beliefs about LBP. 😐
It’s well-established scientific consensus that LBP is a multifactorial experience that’s influenced by a complex interplay of biological, psychological, and social factors. However, the general public still tends to believe that it’s all about movement, biomechanics, and tissue damage.
In other words, although LBP is a biopsychosocial phenomenon, most people – including yoga teachers! – continue to focus on factors like posture, alignment, weak muscles, and how we load the spine.
Does this mean load doesn’t matter for low back pain? 🤔
So we know that LBP is complex and multidimensional. But does this mean that load and biomechanics don’t play a role at all?
A recent research paper published in January helps to address this question!
These researchers set out to investigate whether loading the spine plays a causal role in the onset and persistence of non-specific LBP (NSLBP).
They conducted a type of knowledge synthesis called a scoping review. They used a special framework to assess causality across a wide selection of studies that looked at load and LBP.
And what did they find?
They found that there was insufficient evidence to support load as a primary cause of NSLBP!
In other words, the general public’s belief that LBP is primarily caused by structural factors such as posture, loading, and tissue damage is not supported by scientific evidence on LBP.
But check out this extra interesting insight!
This research paper does suggest that some individuals who already have LBP may have a nervous system adaptation that makes them more sensitive to non-harmful loading of the spine.
In these specific cases, temporarily reducing load may help reduce LBP.
But this has to do with sensory and perception factors – it’s not because reducing loading physically “protects” the tissues and structure of the spine.
(Does that distinction make sense? It’s an important one!)
To reiterate: This point is about people who already have LBP. This isn’t about load causing the initial onset of LBP, but rather about adjusting load to modulate nervous system responses in those already experiencing LBP.
All in all, the belief that load is a primary causal factor in NSLBP is not supported by research.
Here are a couple of quotes I thought you’d appreciate from this paper:
“Further research on causal explanations for NSLBP should consider factors beyond spinal structures and load, and may benefit from the extensive body of evidence on factors related to the biopsychosocial model, which includes factors such as neuroimmune interactions, neuroplastic changes, experience, beliefs, expectations, and contextual or societal factors.”
And:
“All pain is real: this study does not change that. However, our findings question the role of traditional ergonomics and other unidimensional solutions for a complex multidimensional phenomenon such as back pain.”
As always, I find that pain science offers us a positive and movement optimistic perspective on the body!
When we understand that how we move and align our bodies is not a primary cause of pain, we can break free from the outdated and unsupported movement “rules” and alignment-shaming we’re often taught. This applies both in the yoga world and in our society in general.
The body and pain simply don’t work that way – whoo hoo!
Furthermore, if the cause of pain is multifactorial, this means there are many possible actions we can take to address and change pain. And more options are always a win in my book!
