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Is back pain a disease of civilization? A modern lifestyle disease?

 •  • by Paul Ingraham
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Is back pain actually a modern problem, a disease of civilization and modern lifestyles, like diabetes and heart attacks? Or is that just a cynical myth about the perils of modernity?

I started asking that in about 2005, a few years into my career as a massage therapist (and in the earliest stages of writing the first edition of this book). I had been busily telling my patients what every self-respecting alt-med practitioner was supposed to: sitting is evil, postural sloppiness is ruining us, your core is weak, and “primitive” people don’t have these problems.

I mean, duh, we evolved without chairs! Paleo-posture is obviously superior!

This seemed like a valuable pearl of slightly subversive wisdom that I could offer to my clients, something those “mainstream” doctors wouldn’t bestow upon them. Try to act more like a hunter-gatherer!

So practical! 🙄

As a side effect of my skepticism on other fronts, it occurred to me that I just had no idea if the claim was true. Do “primitive” people actually get less back pain? How did I think I knew that anyway? Because I had heard it, obviously.

But I needed data! I will now take you on a two-minute tour of the fifteen-year journey I took to get a somewhat firm answer to this question. Happily, there is one.

Failing to find the evidence

When I started looking for more direct and relevant evidence, I just failed. There’s not enough evidence about anything in musculoskeletal medicine, and virtually none about unusual populations. Body pain + basic cultures = thin results in a PubMed search.

I did find clear evidence that excessive sitting is not a major risk factor for back pain, and I publicly reversed my position on that topic. I also became a skeptic about the clinical significance of posture more generally. And I got convinced that “core weakness” doesn’t doom us to back pain (there’s a chapter in my low back pain book about that).

That was all suggestive, but I still did not know, specifically, about the prevalence of back pain in populations that don’t sit at desks all day. I needed even better, more directly relevant data. And I simply couldn’t find it. For ages. (To be fair to myself, I had a few other sub-topics to think about.)

Even better, more directly relevant data

Someone else did the work for me! Now I can just cite his work, like this: in 2017, James Steele, PhD, wrote a paper about how back pain is probably a human problem and not a modern human problem. See Steele 2017. He thoroughly reported on the evidence that I’d failed to find. Yahtzee! Thank you, James!

Surprise surprise, the data says that back pain is not a disease of civilization. Dr. Steele: “Low back pain is common to almost all populations examined and that outliers are easily explained by their reluctance to report pain and instead to rely on traditional healing methods.” The data isn’t perfect or complete (of course), but it’s good enough for high confidence. There’s either no difference at all, or not a major one.

Intriguingly, for Dr. Steele, this is all just a premise for an interesting hypothesis about how humans are just biologically vulnerable to back pain. But it’s a major premise and supported well. Indeed, looking at the evidence he assembled, I am humbled by my failure, circa 2010, to find, um, any of it.

So that’s that. Steele 2017 will be my go to reference for this point for a long time to come. Back pain isn’t a modern disease? Steele 2017. Primitive people get just as much back pain as programmers? Steele 2017. Back pain is huge annoyance for all kinds of humans? Steele 2017!

“An evolutionary hypothesis to explain the role of deconditioning in low back pain prevalence in humans”
Steele. Journal of Evolution and Health. Volume 1, Number . 01 2017.

Aren’t modern hunter-gatherer populations rather different from our prehistoric ancestors?

They probably are, and this is one good reason why Steele’s conclusion might not be the last word. The difference is definitely a big deal for certain kinds of research questions about “primitive” people.

However, I doubt it’s a big deal for this one. The popular belief and hope is that highly active lifestyles protect people from back pain — wherever they are found. And some modern populations certainly have dramatically more physically stimulating and challenging lifestyles than most people in industrialized nations.

This and other questions are addressed in greater detail in a new chapter of my back pain book.

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