What's Really Causing Your Back Pain

Herniated discs are often blamed, but most back pain is derived from weak or stiff muscles. So chances are, you might not need an MRI, surgery, or painkillers-just the right exercises and stretching, says Dr. Norman Marcus in End Back Pain Forever: A Groundbreaking Approach to Eliminate Your Suffering. Here's how to find the solution to your own aches.

I have seen many patients so wracked by pain that they wished they were dead, and some who actually attempted suicide before they saw me. So I am aware of the helplessness that you and millions like you feel when you first hobble into the doctor's office and exclaim, "Doctor, my back is killing me! I can't go on like this!"

Let me describe a common scenario: after some pokes and prods, the doctor says, "Go home, take an aspirin, lie down, and rest."

You do as the doctor says. But it does no good, and two days later, having missed work, you see the doctor again. "Well," says the doctor, "you have a case of nonspecific low back pain. We see a great deal of it."

The diagnosis sounds scientific, but it leaves you completely baffled and still wracked with pain.

"What does 'nonspecific low back pain' mean, Doctor?"

"It means that we don't know the cause."

"You don't know the cause?"

Should you ask more, you'll learn that nonspecific low back pain, also known by the acronym NSLBP, is so baffling that the International Association for the Study of Pain devoted an entire chapter to it in Functional Pain Syndromes:Presentation and Pathophysiology, a book for professionals published in 2009. The authors draw the frustrating conclusion that "it is exceedingly difficult to identify specific pathology underlying NSLBP." Of course, this is of no help to you or to anyone else.

"I can put you on strong medication to dull the pain," says the doctor. "It may be that your spine is the problem."

"Does that mean surgery?"

"It could. Surgeons do a million spinal operations a year."

Surgery on your spine is the last thing you want to do, but your back pain is horrendous. And, of course, you want to get better. So you say, "Can't we do an MRI or a CT scan to see if there's anything wrong with my spine?" MRI, or Magnetic Resonance Imaging, is a picture generated by magnetic fields, while a CT (computed tomography) scan is a picture generated by X-rays.

When you are shown the test results, the doctor points out that the images of your spine show that you have, say, a herniated disc (in which the cushion between two bony vertebrae is either protruding or has ruptured) or spinal stenosis (a narrowing of the spinal column that houses your spinal cord), or some other spinal anomaly-and that, apparently, is the cause of your pain.

But if it were true that the abnormality on the MRI or CT scan was indeed the cause of your pain, I wouldn't have written this book-because almost no one has a "normal" MRI or CT scan of the lower spine, and what is read as abnormal is frequently not the cause of your pain.

That bears repeating: when an MRI shows a herniated disc, it does not necessarily mean that the disc is causing your pain. Many people have a herniated or degenerated disc as a consequence of aging, and yet they have no back pain. Furthermore, it certainly does not mean that surgery is needed.

Actually, studies have shown that patients who get imaging tests increase their chance of undergoing an invasive treatment such as surgery or spinal nerve injections. Studies have also shown that when an MRI or CT scan for back pain indicates that something is "wrong" with the spine, patients are left to believe they will never truly be "normal" again, regardless of whether their pain is ever reduced or eliminated through any form of treatment. And bear in mind that as many as half of all spinal operations fail.

In fact, the primary source of 75 percent or more of all back pain is from the muscles, not the spine. In 2001 a study of more than twenty thousand patients at outpatient medical clinics in the United States found that sprains and strains of muscles and other soft tissue accounted for 70 percent to 80 percent of all back pain. This is strikingly similar to the findings of a study of three thousand patients with back pain conducted at Columbia Presbyterian Medical Center in New York City in 1946, which revealed that weak and stiff muscles were the source of pain in 83 percent of the participants.

It is truly astonishing that so many physicians who treat back pain have failed to make use of these findings. For years, medical schools have paid very little attention to the muscular system, even though muscles account for approximately half the weight of the body. Medical practice in recent decades has relied increasingly on high-tech imagery for diagnosis. Although high-tech imagery is certainly of great value-as is surgery, when required-neither X-rays nor MRIs nor CT scans are designed to detect the subtle nuances associated with muscle as a source of pain.

Try this: 7 Exercises to Relieve Low Back Pain

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