By Jonathan Chu, MD
Interventional Pain Medicine
PM&R

After seeing many thousands of patients as an interventional pain medicine doctor, it became very easy over time to identify patterns and trends when it comes to pain.

Why is it that some people are able to make it to their sixties and seventies with minimal pain, maintaining very active and enjoyable lifestyles, while others are nearly debilitated with unrelenting pain as early as their thirties and forties?

Is it just that some people are just lucky?

Perhaps some individuals are just blessed with great genetics and an easy life?

While genetics and prior injuries undeniably play a factor in the development of pain—there are a myriad of other factors that are absolutely within your control to change.

Key Factors that Lead to Pain

To start, let’s talk about the fundamental characteristics that I often observe in those suffering from persistent pain.

They are:

Deconditioning

Weakness in supporting muscle groups

Stiffness and poor range of motion

Poor body mechanics

Obesity

These are all things you definitely do not want.

Let’s break it down.

You have to understand that most of the joints of the body are supported by a complex network of musculature.

For this article we’ll focus on the low back as our example, since this is the most common region where people suffer pain. However, keep in mind that these over-arching principles also apply to most other joints, such as the hips and knees.  

Imagine the bones of your spine (vertebrae) as a stack of blocks. As you move through your day, several layers of musculature work constantly to keep your spine upright.

There are small but extremely important muscles at the deepest level known as the multifidi and the rotatores.

Superficial to that, there are much larger muscles such as the quadratus lumborum, the erector spinae, and the latissimus dorsi.

In front of the spine, the abdominal musculature also provides critical support.

All of these incredible muscles work in concert to brace your spine all through the day, allowing you to bend and twist and perform a variety of other motions.

If these muscles are weak and deconditioned, the spine has lackluster support and protection. In this scenario, many structures of the spine, such as the intervertebral discs and facets, become more vulnerable to injury.

Unfortunately, in our modern culture, dominated with sedentary work, the majority of people have weakened core musculature supporting their spine.

These muscles are meant to serve as strong scaffolding for the spine, and yet for most people these muscles have become, for lack of better words, feeble and puny.

Furthermore, most people have very poor range of motion and mobility. I have seen so many patients who had tremendous restriction in several of their major joints, having difficulty with even the most basic movements.

Their muscles and connective tissues became over-tensioned, restricting their ability to move easily or properly.

Again, this is a consequence of our modern sedentary lifestyle.

When your joints are not regularly taken through their normal range of motion, they tend to get stiff and tight—it’s common sense. Over time, this chronic tension of the muscles, fascia, and connective tissue builds up, and this places additional stresses onto the spine…leading to more pain.

This ties into the next point: most people go through their day with very poor body mechanics.

Walk through any public space and pay closer attention to how people are sitting.

More often than not, you’ll find the majority of people hunched over their phones and laptops with unnatural postures. People often do this for hours at a time.

While at work, observe how most people lift heavy objects. They will often round their backs, placing excess pressure on their intervertebral discs.

Poor ergonomics and body mechanics can be tolerated for short periods of time. The spine is designed to be a very tough structure.

However, when subjected to these unnatural stresses over years, with injurious motions repeated thousands upon thousands of times…then eventually something will give.

Lastly, I want to talk about weight.

It is something that so many people struggle with, and may be one of the most difficult things to improve. But when it comes to pain, it is definitely worth the effort.

It’s been demonstrated by many studies that obesity correlates with increased rates of low back pain, especially facet joint pain and radiculopathy (pinched nerve pain).

From a mechanical standpoint, it is isn’t difficult to see why.

The spine and other joints are designed to sustain a certain degree of mechanical loading.

They are designed to support a natural and healthy bodyweight.

Being very resilient structures, they can tolerate being overloaded for a short period of time. However, when overburdened for months and years, these structures will eventually begin to break down.

Imagine young marine recruits during training. They are all in the prime of life with perfect spinal anatomy. Yet when they are forced to march for miles with rucksacks full of equipment weighing 60 to 70 pounds, every single one experiences a temporary backache afterwards (as well as aching knees and feet).

If even young men in peak physical condition develop back pain from carrying excess weight, it’s not surprising at all that so many overweight patients suffer from such terrible pain.

Key Factors that Prevent Pain

So does that mean that you should just focus on doing the opposite of everything described above?

For the most part…yes.

But let me delve into greater detail.

Just as I’ve seen many commonalities among patients who struggle endlessly with their pain, there are also commonalities I’ve seen among those recover fully from their pain flare-ups, and return easily to a rewarding and healthy life.

These are the patients who seldom need to return to the doctor again after they overcome their initial pain flare—because they are just too busy out enjoying life.

What’s is it about these patients? How were they able to bounce back so easily? How are they able to ward off future bouts of pain?

In the simplest terms, I can describe them like this:

Fit, flexible, and robust.

Most of them have done a great job of maintaining a healthy weight through the years. Or, if not, they make the effort to get down to a healthier weight after experiencing their first bout of serious back pain.

Most have kept up their activity levels up through the years. As a result, they have good general fitness, and they have the endurance to do well in physical therapy.

Then, they have the discipline to integrate the exercises they learn in therapy into their everyday lives.

They work to build up the critical muscles of the core surrounding the spine, creating a dynamic support network that protects their spine throughout the day.

They take the stretches they learn in PT seriously. By consistently working on their range of motion, they make their bodies limber and supple. Over time, they begin to move freely, easily, and naturally.

In addition to the targeted exercises for their back, they engage in regular low impact cardiovascular exercise. This is not only great for heart and lung health, but also has tremendous benefit for spine health as well. It boosts blood flow and nutrient supply to the soft tissues surrounding the spine, easing stiffness and promoting healing.

Quite simply…they put in the effort to become physically robust.

Unfortunately, it is a common tendency among many patients trapped in chronic pain to avoid exercise and activity.

It’s quite a natural response—I understand it completely.

When you’re experiencing constant pain, the last thing you want to do is exercise. You barely want to get out of bed, much less do stretching and core strengthening.

But the problem is that this leads to worsening weakness and deconditioning. Worsening stiffness.

Which leads to even more pain.

And the negative cycle continues on and on.

Sadly, I see so many patients trapped in this negative spiral.

I’ve seen many patients who have suffered from chronic pain for years look as though they are literally withering away.

If you find yourself in that situation…make a vow to yourself today to break that negative cycle.

Make the critical mindset shift.

You no longer want to be weak, debilitated, and in chronic pain.

You want to become active and strong again.

Change will not happen overnight. It is not going to be easy.

But I want you to start working with your doctor and physical therapist to take small daily steps in the right direction.

Every day I want you to move just 1% closer to the goal of becoming fitter, more flexible, and more robust. And gradually…you’ll see your pain begin to improve, and those improvements are going to compound. And hopefully, before you know it, one day you will have built a body that is strong, flexible, and pain-free. Thanks so much for watching everyone.

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Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. American Journal of Epidemiology. 2010 Jan 15;171(2):135-54.

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