Oxford University Press's
Academic Insights for the Thinking World

Scientific method and back pain

Do you have back pain? Statistics show you likely do. Or you have had it in the past or will in the future. Back pain can be a million different things, and you can get it an equal number of ways. Until you’ve suffered it, you don’t realise how disruptive it can be.

Trying to fix back pain is a superb way to make people understand the power of scientific method and how to use it. In many ways, we all use scientific method in daily life. We just do it intuitively, under-the-hood. Like when you cook a recipe the first time and decide it isn’t quite to your taste. You try again, making modifications. You like the second one better.

You’ve just cooked two experiments and interpreted the results. You made objective measurements with your taste buds; this informal approach works as well as a particle accelerator in this context. Iterative trials and judgements of empirical data are core to the scientific method. (Plus, anyone who has spent time in the lab will attest to the fact that much of lab work is exactly akin to cooking. Get and follow a recipe. Repeat.)

Scientific method is a simply a centuries-old, proven way of collecting empirical evidence for or against a particular idea. In scientific parlance, the idea is called a hypothesis. It’s a hypothesis since you can’t say yet it’s true or not. To eventually deem it correct, you need objective evidence (evidence that is repeatable). It isn’t an opinion, but an observable fact. Best of all, science is self-correcting. Countless hypotheses ticked off as ‘true’ have been modified or even thrown out under the weight of new evidence.

So, how does this help us solve back pain? Why the link to scientific method? Because your ability to follow it might be just what you need. You are best-placed to understand your body. Careful observation of what causes your pain, and relieves it, and how things are progressing during treatment, will prove crucial to getting back on track.

Aristotle, 384 BCE – 322 BCE. “As regards his method, Aristotle is recognized as the inventor of scientific method because of his refined analysis of logical implications contained in demonstrative discourse, which goes well beyond natural logic and does not owe anything to the ones who philosophized before him.” – Riccardo Pozzo. (Bust of Aristotle. Marble, Roman copy after a Greek bronze original by Lysippos from 330 BC; the alabaster mantle is a modern addition. Photographed by Jastrow (2006). Public domain via Wikimedia Commons.)

Applying rigorous scientific method to your back predicament can often mean the difference between chronic pain and relief. Many sufferers give up and just live with the pain. They don’t progress through the options well enough to reverse what is an unexpectedly, tricky problem.

Back pain is often not simple to fix for many reasons that all have to do with the nature of the human body. This machine is wonderfully complex and has all kinds of safety features, some of which can interfere with fixing yourself. Your body will try to protect muscles from being used. While this is super while you are injured, once healed, you need to use these muscles, or they will atrophy and the supporting muscles that have taken over in their stead while likely become even more stressed.

The back is full of moving parts. Many work in groups and chains. Pain in your neck can be related to problems in your lower back. Whether the bottoms of your feet are flexible can help contribute to whether or not you can touch the floor with your fingers. The muscles in your arches link to your calves, to your hamstrings, and up into your back and then to your arms. The whole chain can seize up at any point, hindering flexibility. When you lose flexibility, you invite pain.

Back pain due to muscles can often be caused what we call ‘referred pain’. The pain you feel can often be the result of problems six inches or more away from the point you touch on your back that hurts. Entire maps of referred pain from trigger points in muscles can be found and might help you navigate your twinges and aches. Often, many trigger points can conspire to work together as one or more initial injuries get protected, straining neighbouring muscles. Like a traffic jam often starts with just one car putting on the brakes, you can end up with a massive snarl of cars, or inflamed trigger points.

Your pain could be due to bones, ligaments, muscles, or more rarely, another condition, including bacterial infections. Just like skin needs time to heal, so do these heavy-duty structural parts of your anatomy. The right type of relief might be working, but the pain will still be there for a while. Just like failing to take a full course of antibiotics, stopping short is a common cause of failure to fix back problems.

If one piece of your anatomy is damaged by injury, misuse, or overuse, it can cause other parts around it to fail too. They take too much of a load they aren’t explicitly designed to hold. Now you have any number of secondary issues too. The more aggravated the jam of problems becomes, the more you have to fix.

You might also get loads of conflicting advice. Should you push into the pain or avoid it? This decision will depend on how fresh the injury is. You shouldn’t exacerbate a wound trying to heal up, but once it has recovered, pushing into the pain to stretch what has become too tight can be what you need. Stretching is often as important as building muscle.

Fixing a long-term back problem often involves working through layers of problems to get to the underlying cause. How many of us have harboured aches and pains that we just ignore? Like a bag of trash, they just decay over time. Many of us only reach out for help once it’s unbearable. We should all learn to take out the trash bad as soon as its full, not waiting for it to fester and draw flies.

You could also be suffering more than one problem. Symptoms can even contradict each other. Things that are good for one injury can flare up a competing one. A final factor to keep at the forefront of your mind is that back pain can involve a long process of healing.

All of the above reasons can make unravelling the origin of back pain head-bangingly confusing. The first critical step is to develop your working hypothesis, or in medical terms, a diagnosis. In an ideal situation, you nail the problem immediately and get it fixed on the same day you visit your expert. I’m thinking about times that your bones are misaligned. YouTube abounds with videos of chiropractors cracking people’s joints. Until you see examples, you don’t quite believe how painful the starting condition of a misalignment can be and how immediate the benefits are of getting it corrected. People often go from excruciating pain and immobility to ‘fixed’ in seconds.

But snap-fixes are rare.

Just getting a diagnosis can be problematic. You might go to a range of potential experts for a diagnosis, depending on your means, situation, experiences, and pains. Paths towards help could include the doctor, physical therapist, chiropractor, masseuse, yoga instructor, or another knowledgeable person.

If the issue is bone alignment and you go to a physical therapist, there is only so much they can do. If it’s in your muscles and you go to a chiropractor, there is only so much they can do. If you go to a doctor, they will often just refer you to the physical therapist. If the physical therapist diagnoses a leg length difference you’ll be right back to the doctor for a referral to get a CT scan to confirm it. Then back to the physical therapist. If you have a mix of problems, you’ll have to jump around.

With the right diagnosis, you take action. You assess the action to see if it helped. The hypothesis proves correct if applying the fix reduces the pain. If not, you start again.

All of this reminds us that medicine doesn’t know everything yet. Science is constantly self-correcting and while new information collects, different hypotheses can be deemed ‘the truth’. Pelvic tilts used to be all the rage. Now a neutral pelvis is common advice. You’ll often have to inform yourself, use common sense, a lot of trial and error, and do your best.

A good practitioner at any level should willingly admit there is still much that medicine needs to learn. If she does, you know you are in good hands. Make yourself a part of your therapy, and use scientific method to help you.

Ideally, in the future, there will be “Scientific method back pain centres.” You’d be seen by a group of experts and shuttled to the right expert or combination of experts to help you. At the same time, you’d be taught scientific method and encourage to take your health into your own hands. The expert teams at such an idealistic centre would also expect to learn from patients, charting what didn’t work as actively as what did.

Featured image credit: Backache. © BrianAJackson via iStock.

Recent Comments

There are currently no comments.