What are the causes of back pain?

Tim Ferriss and various experts on his podcast have discussed numerous causes of back pain, highlighting that it is often a complex issue influenced by multiple factors:

1. Neurophysiology of Pain: Dr. Stefi Cohen emphasizes that pain isn't always tied to tissue damage. Diagnostic tests like MRIs and X-rays often reveal internal conditions that may not correlate directly with the pain experienced by individuals. For example, many people show degenerative changes or disc herniations without experiencing pain, which suggests that pain can be more subjective and not solely based on structural abnormalities 1.

2. Muscle Imbalances and Overactivity: The psoas muscle, in particular, is frequently implicated in exacerbating back pain. Because it attaches to the lumbar vertebrae and intervertebral discs, overactivity or tightness in the psoas can lead to significant discomfort and pain in the lower back. Manual therapy that targets the psoas and the iliacus muscles can provide symptomatic relief 2.

3. Postural Asymmetries and Poor Movement Patterns: Eric Cressey points out that poor motor control, poor thoracic spine mobility, and hip rotation issues can contribute to lower back pain. Loading aberrant movement patterns, especially those involving asymmetries like a shifted hip, can lead to chronic pain. This issue is particularly seen in athletes who may have developed compensatory movement patterns over time 3.

   
   1
   Rethinking Pain Perception
   00:55:00
   
   2
   Understanding Psoas Impact
   00:32:20
   
   3
   Lower Back Pain Insights
   00:30:00
   
   4
   Back Pain Insights
   00:15:28
   
   5
   Understanding Back Pain
   00:09:19
   
   6
   Anatomy Insights Unpacked
   00:04:37

4. Structural Findings Not Always Correlated with Pain: Imaging studies often show structural anomalies in asymptomatic individuals, such as disc bulges or protrusions. Tim Ferriss notes that pain in areas like the lower back might not always correlate with these findings, making it challenging to pinpoint the exact cause of back pain based on imaging alone 4.

5. Chronicity and Individual History: Chronic back pain often results from a combination of factors, including lifestyle, activity levels, and previous injuries. People may experience different types of back pain based on their activities, such as the difference between someone who performs a lot of manual labor and someone who spends extensive periods sitting 5.

6. Other Contributing Factors: Specific conditions such as stenosis (abnormal narrowing) can put pressure on nerves in the lumbar region, causing pain. The role of muscles like the quadratus lumborum is also highlighted, as they play crucial roles in maintaining posture and can be sources of back pain if not functioning properly 6.

Understanding these diverse causes can help in crafting a more precise and effective treatment plan, often necessitating a multifaceted approach involving physical therapy, movement modifications, and sometimes manual or corrective therapies.