Back pain and aging 

What is low back pain?

The exact cause of low back pain is often elusive. In most cases, the pain cannot be traced directly to a specific structure or anatomical abnormality. Only a small percentage of back pain has a clear cause, such as a herniated disc, spinal stenosis, spondylolisthesis, scoliosis or Bechterew's disease. These specific forms of low back pain can be clearly identified on an X-ray or MRI, but represent only a small fraction of all back pain complaints. Over 80-90% of all low back pain cannot be directly explained by imaging studies. This is not to say that it does not exist or that it is between your ears but cannot be confirmed through examination. 

Hernia

The most familiar form of specific low back pain is a herniated disc. This is a bulging 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

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

Scoliosis

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

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 be achieved to slow down the process considerably.

Young vs old: a paradox

 The idea that old age equals more physical complaints does not always apply to low back pain. Young people, even in their twenties and thirties, sometimes experience severe back pain, sometimes even more than older people. Interestingly, back pain is most common in people in their 30s and 40s. In those in their fifties and sixties, the number of complaints actually decreases, against the expectation that wear and tear and aging are the main causes of low back pain.

So the average thirty-something can be in a lot worse shape than someone in their 70s! 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, with a complicated word: multifactorial. 

Genetics versus your environment: the role of heredity

An interesting insight comes from research where twins were followed over time for an extended period of time. This study shows that genetics play a bigger role in getting low back pain than, say, the type of work you do. Twins with different occupations, from office jobs to construction workers, often experience similar levels of back pain. twin spine study this study shows that genetic predisposition plays a greater role than, for example, physical work. So from this we can conclude that physical work does not always have to be the reason for back pain later in life. Thus, a back will not show forms of wear and tear faster with heavy physical work. This is not to say that physical work plays no role at all in the development of low back pain.

Conclusion: an aging back is not always a painful back

While age is a factor in how our spine is doing, it is too simplistic to attribute all back pain to aging. Back pain is a complex condition with many possible causes, with genetics, lifestyle and environmental factors all playing a role. It is critical that we see back pain in its full context and approach each person as an individual. It is unclear what role age plays in nonspecific low back pain. In my opinion, we can actually see this as a reason that getting older is not an immediate negative for the low back. If this were the case we would see that low back pain would only increase with age and thus wear and tear on the spine. Instead of writing off back pain as an inevitable part of aging, it is essential for both young and older people to be mindful of their bodies. Evaluate their lifestyle and, if necessary, take steps to create space to see back pain prevented or recovered as best they can. These may include adjustments in work posture(variety!) or increasing overall workload capacity. If pain is persistent or severe, seek professional help and get informed about your options. 

Making an appointment