Back Pain

Back pain, as a general or non-specific diagnosis, is an issue that can affect 60-70% of people in


Back pain, as a general or non-specific diagnosis, is an issue that can affect 60-70% of people in their lifetime according to the National Institute of Health.  If we include specifically diagnosed back conditions those numbers increase to approximately 80%.  Hence, we have many clients questioning their back pain and how it may relate to our lower body mechanics.  Back pain, like most conditions, has multiple layers: structural, injury specific, or ergonomic.  In rare cases it can be related to more serious underlying conditions*.

Back pain is an issue that can affect 60-70% of people in their lifetime.

The lower vertebrae of the spine depends heavily on the stability of the truck and pelvis. Thus, pain is common in the lower back, or the lower thoracic spine, and most commonly in the lumbar and sacral spine. When we consider the body’s centre of mass, this would be roughly the L4/L5 vertebrae, which is a crucial segment of the body. Function in this area is pivotal to maintain balance and alignment as we move this centre of mass from one place to another in infinite patterns.

Majority of back pain sufferers will experience discomfort in lumbar and sacral spine.  When we consider the body’s centre of mass, this would be roughly the L4/L5 vertebrae, which is a crucial segment of the body. Function in this area is pivotal to maintain balance and alignment as we move this centre of mass from one place to another in infinite patterns.

Typically, back pain is diagnosed as an acute injury or degenerative condition, both of which can be easily aggravated.  Repetitive strain, improper movement patterns, structural weakness and imbalance can all exacerbate these underlying pain conditions.  By assessing posture, movement and the ability to align (naturally or with the assistance of shoes, insoles or bracing), the goal is to encourage the body to move more efficiently through the spine.  There is an infinite amount of research relating to workplace ergonomics, movement during sport, various therapies for treatment, and education relating to the function of the spine. 

*Serious underlying conditions are rare to see within a pedorthic scope, but warrant investigation by a surgeon or specialist. These rare conditions could include: infections, tumors, inflammatory disease in the joints such as spondyloarthritis, neurological damage, osteoporosis or genetic/congenital conditions. 


Age.  More commonly affects adults 30 years and older due to loss of connective tissue elasticity, bone density or attributed injuries.

Repetitive strain.  Typical in the ubiquitous ‘weekend warrior’ who plays hard but doesn’t necessarily prioritise other factors such as mobility, flexibility or poor posture.  This tends to cause or aggravate back pain.  Another example would be shovelling snow after first snow fall, or the first golf outing of the spring. ‘Too much, too soon’ can happen easily.

Weight gain.  Pain can often lead to lower levels of activity which can contribute to weight gain.  Waist and hip circumference is known to contribute to pain as it places more direct load stress on the lower back.

Muscular imbalance, joint instability.  Muscles and joints develop differently for everyone and will change throughout life. For this reason, there are many reasons that function of the foot and arch, knee and hip, neck and shoulders can all contribute to poor function of the spine.

Sedentarism.  Work ergonomics, commuting by car, and too much sitting time restricts the spine and pelvis, as well as other surrounding areas like the neck, chest, shoulders. This creates tension throughout the body including the spine. Sitting could be considered an occupational risk factor (see number 6!) This is a problem that is increasingly affecting children and adolescents sitting in school or on their ‘tech’ and prompts the need to encourage every age to move more and sit less.

Occupational risk factors.  Carrying a mail delivery bag, loading a truck, or scanning food items at a cashier station can all create a strain to the body in a way that aggravates the spine. However, sitting at a desk can be equally stressful to the spine.  Deskbound Kelly Starrett is an excellent resource to troubleshoot modern work ergonomics!

Poor posture and position.  Alongside sitting, driving or hunching over desks, our walking and standing posture can also be problematic. Poorly shaped footwear such as high heels combine with the aforementioned factors to create misalignment. High heels tilt the pelvis forward, curve the back, and overload the knee, ankle, and foot. This causes the spine to behave more like a tilting Jenga tower rather than the mechanical marvel it’s designed to be.

Left: body posture stands at 90 degrees.  Center: If body column were rigid, on medium 2 inch heel, angle would be reduced to 70 degrees.  Right: to prevent falling over and to regain 90 degree angle, the body column must make adjustments.

Mental health factors.  We accumulate stress from various sources, which can build up in the nervous system and manifest in pain throughout the body.  It’s a dual directional influence, as chronic pain can create psychological stress and stress can aggravate pain.  Our somatic body (soma meaning whole) is the physiological link between how we feel mentally and what we feel physically, and this influences the nature of our pain.  We can’t take our mind and spirit out of the body!  It's a whole package!


Studies, infographics and research meta-analyses abound regarding what does or doesn’t help to treat back pain. Considering many unique individual variations, treating back pain becomes another n=1 experiment.  For example, custom orthotics can be a valuable treatment option in the short or long term, and can significantly improve pain levels in some clients. However, for others they may provide only minimal relief. To achieve the best results, it is best to look closely at the causes of the back pain, and not the symptoms alone. 

Time off doesn’t truly fix back pain.


Physiotherapy, exercise therapy.  Starting with an understanding of how to correct imbalances associated with the back is essential. Fundamental requirements of a functional spine are outlined by big names like Dr. Stuart McGill (we highly recommend his book, Back Mechanic and his 'Big 3' Back exercises here) and performing basic rehabilitation exercises to improve the supporting structure to the spine is key!

Mobility, range of motion, massage.  Movement of the spine through it’s ranges of motion should be encouraged as part of daily mobility practice. Whether manual therapy with a professional, or your own foam roller and yoga practice, the spine desperately needs to get functional through motion. Immobilization (even if to protect because of pain) is not a viable long term approach.

Heat, cold.  Both have their benefits at certain phases of the pain cycle. While ongoing cold therapy is not well proven to help past the short term, it can be a nice sensation to cool painful tissue. However, because cold therapy vaso-constricts blood flow to the tissues, it causes more tightness to develop which can lead to more pain. In contrast, heat therapy can help relax muscles near tender areas by stimulating blood flow through vaso-dilation. This can provide relief for spasm and muscle tightness and allow more joint mobility.

Functional exercise (Yoga, pilates, Qi-Gong or tai-chi).  Long standing practices such as yoga have been researched to be a viable strategy for management and relief of pain. Variability in results are highly individual and based critically on frequency and dose. Check out our articles on mobility (here) and flexibility (here, here) for more info on how and why these practices can help you. Studies show modest benefits overall, and at a low financial cost. Many esoteric but effective programs such as Feldenkrais (, Egoscue ( and Pilates (link below Ryan) have many anecdotal benefits and certainly are worth investigating. A word of caution: in cases of serious back conditions, these alternative practices should be approached with the cooperation and oversight of a specialist.

Spinal manipulation/mobilization.  Manual therapies via chiropractors, osteopaths or certified manual therapists tend to produce good results. Again, results are highly dependent on the individual, as well as the frequency and degree of attention received. This form of treatment comes with a financial cost, which can be limiting for some. We would suggest it is most effective when combined with ongoing self care routines.

Modality treatment.  This can include muscle stimulation via electric current (TENS), ultrasound, acupuncture, cupping, or other treatments often incorporated within physiotherapy. All of these aim to improve circulation, nerve function, and energetic fluidity, while reducing inflammation and tissue restriction to stimulate healing. These treatments are likely to work better in combination with self care, exercise and lifestyle management strategies.

Orthopaedic devices.  Bracing, orthotics, taping, and support aids (like walking sticks, canes) certainly can be helpful over the short term.  They can also provide better posture and position while being used, which can help arrange the leaning ‘Jenga tower’ with more scaffolding around it. Chronic use is individually determined, but should be evaluated with the goal of identifying and resolving root cause. The shortcoming of orthopaedic devices is that they don’t create lasting changes depending on the cause(s) of back issues, so end up being more of a temporary fix.

Ergonomic evaluation or occupational therapy.  Professional evaluation of workspace suitability with regards to height, comfort, function and efficacy goes a long way. Variable work desks, specialty chairs or keyboards, and even programming movements within a workday (yoga breaks, walking step goals) can do wonders to improve desk work tolerance. Shift work or manual tasks that cause repetitive strain can be evaluated to find better solutions to avoid problems.


Back pain in modern western society appears endemic, with no clear cut solution that fits everyone. The body changes so quickly, for better or worse, based on what is going on in an individual’s life. As occupational stressors, training habits, weight, age, and mental health fluctuate, so can problems in the back. We often see ‘the fix’ as a moving target. By getting to know what works for you from all the angles of supported care, this offers a chance for that target to be easier to hit.

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