Physical therapy & back pain

I guess it's down to age.

Many physical discomforts increase with age. We hear it often enough in our practice. "It must be due to old age." However, in backache this is not quite the case. From a certain age, our bodies are subject to wear and tear without exception. Just as we get wrinkles and gray hair, our body is also aging on the inside. Around the age of 40, it is almost impossible not to see signs of aging, i.e. wear and tear of the spine, on an X-ray.

Intervertebral discs decrease in volume, the layer of cartilage of the smaller joints in the back become thinner and the space where the nerves exit becomes smaller and can lead to irritation of the nerve. The longer a person lives, the more extensive all the signs of aging on a X-ray. There is no escape from this, unfortunately.

Fysio Fitaal in Tilburg physiotherapy for low back pain
So what is low back pain? 

In most cases, the exact reason for low back pain cannot be explained from a structure or particular anatomy. Only a very small proportion of backache has a clear cause and the rest - over 80 to as many as 90% simply cannot be explained. This is not to say that it does not exist but there is no way to confirm it through, for example, an X-ray, MRI or other imaging examination. The counterpart of these a-specific complaints are specific low back complaints. Here below is an example of these specific forms of low back pain: 

Fysio Fitaal in Tilburg physiotherapy for low back pain

The most common type of specific low back pain is a hernia. This is a bulge of the intervertebral disc, we call it in the medical world a herniated nucleus pulposi. Additional symptoms of a herniated disc can be leg pain. This occurs when the bulge puts enough pressure on the root of the nerve going into the leg. These symptoms often consist of tingling, pain and loss of muscle strength. 

Spinal stenosis

This is a narrowing of the spinal canal that also causes pressure on the spinal cord and/or nerve root. This can lead to lower back pain, numbness in the legs and, in severe cases, loss of balance. 


Spondylolisthesis occurs when the vertebra shifts and moves out of position. This often puts pressure on the nerve and causes low back pain.


A scoliosis is an abnormal curvature of the spine. Again, pay close attention to abnormal because there is always some abnormality, even in people without back problems. 


Bechterew is a chronic condition that mainly affects the joints low down in the spine. This leads to pain and stiffness in the lower back and, in severe cases, can cause the spine to stiffen. Also called a bamboo spine, vertebrae literally grow (fuse) together. The exact cause is not known, but genetic factors seem to play a major role. When detected early enough results can still be achieved to slow down the process considerably.

These are some examples of specific low back pain. The percentage of specific back pain requiring acute medical care is only 1-2% of all cases.

Young vs. old

It is generally believed that the older people get the more physical discomfort exists. Partially the truth but not quite the case with lower back pain. Younger people, people in their thirties or even people in their twenties often experience hefty back pain. Even in large numbers and with great impact on social costs such as absenteeism and health care costs, for example. 

When we look even more extensively at age we see that most back pain occurs in people in their thirties and forties. In people in their fifties and sixties we see a very clear decrease in the number of people with back problems. Just the opposite of what you would expect if complaints were caused by wear and tear and aging.

Physio Fitaal in Tilburg for low back pain

So the average thirty-something can be a lot worse off than the average sixty-something! So not just explained by wear and tear. And although not immune, people in or after their sixties suffer relatively little from low back pain.  Now it is true that the chances of very nasty forms of back pain do increase with age. Back pain due to a tumor, bone fractures or aortic aneurysms are rare in younger people and much more common in the elderly. Thus, there is little relationship between pain and wear and tear in a general sense. This is not very well known but also not a complete surprise. We do know by now that back pain is a correlation of many different factors, using a complicated word: multifactorial

Ruben Luijkx

Owner Physio Vital
Physical therapist, MSC. Manuel therapy

With a solid foundation in scientific knowledge, Ruben combines the latest insights with his practical experience to ensure the best results. As owner of Physio Fitaal, Ruben has created a patient-centered environment that works with innovative techniques and a data-driven approach. Whether you are an elite athlete looking to return to the field or someone recovering from knee surgery, Ruben will guide you to a full recovery, with attention to your individual needs and goals.

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