There are many causes of back pain, both developmental and congenital. In Sarah Key's most popular book 'The Back Sufferers' Bible' she proposes how a non-pathological, still reversible, simple 'function fault' back problem can become a chronic cause of back pain.
Sarah also explains that once the cause of back pain progresses from simple to more complex, it becomes less reversible and much more difficult for you to work your way out of.
The vast majority (over 90%) of lower back pain cases go by the name of 'low back pain of unknown aetiology' or 'non-specific low back pain', or just simply 'simple back pain'. With these cases, there there is no commonly accepted diagnostic model and no nuts-and-bolts explanation for the causes of back pain. This is both good and bad news.
With non-specific back pain all objective investigations (the clinical picture, spinal movements, MRIs, CTs X-rays and blood tests) reveal nothing extraordinary. You may be in agony, yet the common response is: 'We don't really know why'. You may like to read a brilliant summary of the parlous state of both diagnostics and therapeutics of back pain discussed in Scientific American, August 1998, a prescient article that is still pretty well true today.
The Hypothesis of Reversible Discogenic Low back Pain
With sustained compression the lumbar discs lose fluid. Cumulative dehydration causes bunching down of the tough lattice mesh of the outer disc wall (annulus fibrosis) making the low lumbar discs less compliant and more vulnerable to incidental jarring and wrenching with everyday movement.
Micro-damage of the outer disc wall causes its own sort of ‘disc pain’. This part of the disc is ligamentous and the only part to have both a blood and nerve supply - though a scant one and to the disc periphery only.
Disc blood supply is limited outer layers of the disc wall. This is the only part of the disc to 'feel' pain - but having blood it is also the 'repairable' part. (Adams)
Even minor damage to the outer ligamentous 'skin' of an otherwise healthy disc can create a local inflammatory response - and pain. This is the most likely explanation for non-specific back pain - and the first clue in solving the universal mystery of 'simple' back pain .
You can see this process described here in a 2012 edition of the journal 'Physical Therapy Reviews' paper co-authored by Sarah and eminent spinal researchers from University of Bristol UK, Professor Michael Adams, and Dr Manos Stefanakis, now at University of Nicosia, Cyprus.
You may be interested to click here, to see what Professor Adams says about using a proper scientific approach to understanding the causes of back pain, where he also says it should be 'explained, not explained away'.
Understanding how the back feels pain and the structures involved is an important part of getting better. You can watch Sarah Key describing this important information face-to-face on video. See here to download
If you'd prefer to see the spinal anatomy explained on a simple, short video that you download to keep, click here to view The Basics of How a Healthy Spine Works. Complicated as the human spine is, Sarah explains it simply and makes it all seem easy.
The most common cause of pain in the vast majority of cases of back pain is sensitivity of the outer 'skin' of the disc. You can download the short video of Sarah explaining things here: Why a Spinal Segment Starts Causing Pain
Disc dehydration can initiate a cascade of degenerative breakdown of the affected spinal segment. It can pass through facet arthropathy (Stage 2) acute facet locking (Stage 3) prolapsed intervertebral disc (Stage 4) and lumbar instability (Stage 5). You can see Sarah briefly describe each stage and its signs & symptoms in a short downloadable video.
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