Why Does It (Not) Hurt? Common Myths and Other Nonsense

After the previous article discussed the loose link between imaging findings and chronic pain, it's time to take on a few more common myths. So — is chronic pain caused by:

1. Bad Posture?

My pain is caused by not standing up straight enough, sitting with a hunched back, bending "the wrong way." Is that really so?

First, it's worth noting that we don't have one fixed posture. We don't actually move/sit/stand the same way every time [1].

Second, studies that have been done found no link between pain and a range of physical positions — for example, sustained bending of the back, prolonged standing or sitting, and more [2].

Julius Wolff and Henry Davis, two 19th-century surgeons, found (independently of each other) that the bones, muscles, tendons, and ligaments in our body strengthen according to the loads placed on them (what later became known as "Wolff's Law" and "Davis's Law"). In other words, the more physical load a person experiences, the more that area of the body strengthens over time.

If I was born with flat feet (the flattening of the arches once thought to be a risk factor for back and knee pain), then over a lifetime the different load on my feet, knees, and back caused those areas to strengthen accordingly. Just as, if you start walking barefoot, the skin on your feet becomes harder and stronger — the same happens on the inside!

The same goes for a curved back, Forward Head Posture, bow legs, and more. These are all normal variations of the human body, and they don't cause ongoing pain. The fact is, everyone who has one of these conditions did not suffer pain their whole life.

2. Weak Muscles?

My back is weak, I need to strengthen it! My pain is because I'm not flexible enough! Is that really so?

A systematic review of studies that followed people before and after they developed back and shoulder pain found no link between muscle endurance and strength, range of motion, and a variety of physical abilities and the development of pain [3].

In other words, there are people with weak muscles who don't develop pain, and there are very strong people who do. Muscle weakness is not related to pain!

3. My Pain Is Caused by the Weather / the Change of Seasons?

I won't dwell too long on this one, except to say that studies show it is indeed a myth. For example, studies that tested weather changes under lab conditions show that weather changes do not increase pain in patients with back, hip, knee, or head pain, and more [4].

If we approach this with common sense, we can think about how, every time we step in and out of a hot shower or an air-conditioned car, we experience a "change of seasons" far more dramatic than the weather — and, remarkably, those actions have not been found to be linked to pain.

So Why Does It Seem Like These Things Do Affect the Pain?

I've already described in previous articles the pain mechanism — created by the brain and tied to the level of danger we perceive (unconsciously). How many times have you heard the terms "correct posture" / "sit properly" and so on? Culture and media are full of such messages, hammered at us from every direction (often by various care providers).

A 50-year-old patient came to me with two years of back pain, and with a severe curvature of the spine (scoliosis) present since childhood. He told me that as a child many doctors said he'd probably suffer back pain when he grew up, because of the curvature — yet he never had significant back pain until two years ago. Does it make sense that the scoliosis started causing him pain only in the last two years? (Generally, scoliosis stabilizes in childhood and doesn't tend to worsen in adult life). It doesn't seem so to me — but of one thing I'm sure: after a few sessions his pain dropped significantly and disappeared, and no — I don't know how to "straighten" scoliosis (yet).

For that patient, the very expectation that he might have back pain because of the curvature — an expectation that had taken root over years — can be enough for his brain, at a certain point, to trigger back pain and keep it going over time. As part of the therapeutic process we found "cracks" in that belief, which allowed the brain to change that danger signal and undergo a neuroplastic shift that lowered the pain.

On how the brain causes pain and sustains it over time (what's called the "pain cycle") — in the next article!

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Disclaimer: The information in this article is for general knowledge only. It is not personal medical advice and is not a substitute for it. If you have any health problem, please consult a qualified health professional to evaluate it.