The medical profession now understands that stress causes back pain and other illnesses. The mind-body connection is finally being mainstreamed.

I have been suffering from lower back pain and stiffness for a year and a half. I initially saw a private physiotherapist who massaged my back and gave me a booklet of exercises to follow. The exercises focused on stretching the various muscles around the back. I did them religiously at first, however, after several months, I couldn’t see any benefit and stopped.

So this week, a year on, and after a lengthy wait on the UK National Health Service, I saw another physiotherapist. Her approach was quite different and rather eye-opening. She had no interest in closely examining my back or manipulating any of the muscles. Instead, she asked me if I had experienced any stress lately, to which I explained that my dad had become ill and sadly died this year. I explained to her that the pain started at the same time as my dad was diagnosed: a link that I could see clearly at the time, however, I was puzzled as to why I could still not get rid of the pain eighteen months later, after my perceived levels of grief and stress have lowered.

A new approach to the causes of back pain

The physiotherapist showed me a chart displaying the standard causes of back pain and their relative importance. These factors were: tissue problems (the lowest contributory factor), environment (e.g. poor seating at work), health (underlying health conditions), social (e.g. relationships with family, friends, colleagues – equally important as a contributing factor to pain as health), sleep (are you getting your eight hours and waking up refreshed?) and psychological factors (e.g. other stress). The idea is that none of these factors alone will cause the pain, but when compounded (e.g. a small injury along with lack of sleep and lots of emotional stress), this is when problems begin.

This list, now standard thinking in the UK National Health Service (at least in physiotherapy), is a turnaround from years of approaching back pain and other causes of chronic pain from a purely physical point of view. Even now, many doctors, health providers and patients struggle to see the link between the brain and other parts of the body. A quick internet search on the causes of back pain will still find source after source listing only physical causes. But for those health professionals and patients that have been seeing the links between mind and body for years, the mainstreaming of this approach is a breath of fresh air. Given that all our nerves, and thus bodily functions begin in the brain, it does seem rather obvious that the brain might be a factor in a large number of health problems.  We all know that stress can cause you to feel nauseous before a big event, make your heart beat faster, and induce tight shoulders.  So why has it taken so long for the medical profession to see that stress causes back pain and other illnesses?

How stress causes back pain

Some scientists and health experts have been researching and publishing work on the stress-related hypothalamic-pituitary-adrenal (HPA) axis and its action in inducing pain and inflammation for many years. As a previous sufferer of chronic fatigue syndrome, I am no stranger to the HPA axis. Current thinking asserts that very acute or chronic stress can lead to an over-activation of your “fight of flight” response and lead the system involved in this, including the HPA axis, to over-trigger or become exhausted and under-function. Pain, chronic fatigue and other inflammatory conditions can all result.

What is the treatment?

And so what is the treatment? I was told that exercise of any type must be kept up and increased (this contradicts a private doctor I saw six months ago who told me to stop running – seriously affecting my fitness and wellbeing at the time). The advice is to push through the pain – stretch further and keep moving. The physiotherapy department offers weekly classes for back pain sufferers which include coaching on stress management and exercise. Since, I am already quite active but have let my daily mindfulness and journaling sessions slip lately, I have decided to focus on this. And now I know the cause of my backpain, I feel even more determined to focus on my wellbeing.                                                      Written by Sarah Morris

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Further reading (endorsed by UK NHS):

Understanding pain and what to do about it in less than 5 minutes
– Pain Australia –      Explain  Pain by D. Butler & L. Moseley
Why Zebras Don’t Get Ulcers
by R.M. Sapolsky
Why Things Hurt
– TEDx talks – Lorimer Moseley
Pain Toolkit –