Seems fairly rare to hear of someone having a knee, etc that bothers them for years provided it’s been properly treated. But hear about “bad backs” that people fight for decades.
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I worked under a world renowned neurosurgeon who specialized in spine surgery, specifically scoliosis, but we treated every spine pathology you can think of.
The real reason is because we can’t always ‘fix’ nerve pain. Muscle pain can be treated with muscle relaxants & PT, which usually resolves over time. What we call ‘mechanical’ back pain, such as arthritis (bones rubbing together) can be treated with advil/NSAIDS, & very successful surgeries, that generally resolve until very old age.
But nerve pain, while it can be treated with medication, PT, surgery, & other forms of both conservative & invasive therapy, is very pesky & tends to stick around. To elaborate, nerve pain is pain generated by current or prior compression of given nerve. Depending on the severity of the compression, the duration of the compression, & the person’s overall health, nerve pain can resolve on its own or be permanent & incurable.
We do not know the exact mechanism behind nerve pain on the micro-physiological level. We know it’s due to some irritation around the nerve itself, but we’re unable to determine what exactly is occurring, & thus a ‘cure’ is almost impossible. Hope this helps, let me know if you have other questions!
Actually knees are quite problematic. There’s a slippery coating where the bottom of your upper leg and top of your lower leg face each other. That slippery coating can get worn away over time and it doesn’t come back, (think the eraser on a wooden pencil). People have knee replacement surgeries all the time. Can’t replace the back.
Most back pain is caused by the front – big belly causing posture issues to compensate for the front loading.
That’s not at all true about knees, for the record. They’re actually notoriously slow healing, and you’ll often experience pain for several months or years after an injury is nominally repaired.
I tore some ligaments in my knee in my early 30s (tripping off a curb in a grocery store parking lot, of all things), then reinjured the same knee almost exactly a year to the day after that (tripping in the backyard while raking), and then again almost exactly two years after that (tripping over the raised edge of an irregular sidewalk while walking the dog). Yes, I am very clumsy.
I saw very good specialists and did a few rounds with a fantastic physical therapist, and though it’s been theorized that I might have been left with a rough area on the back of my kneecap (very hard to see in any type of scan), there’s no evidence of any lasting damage. I was still, ~12-15 years on, in a spectacular amount of pain kneeling on the sofa tonight to fish a dirty baby bottle out from underneath.
There are good answers but I would add to the other comments that albeit some people do feel it’s guilt-tripping them, the reality is that a lot of back pain cases are due to lifestyle and lifestyle is notoriously hard to fix. It’s easier – albeit also more expensive – to do a quick surgery on the knee to fix a meniscus tear than it is to get someone to start exercising and stop sitting with a bad posture.
But yes, it’s also true that the spine is harder to operate on. There are lots of nerves, the spine bears a lot of weight and needs to be very mobile, etc.
It’s a consequence of evolution. A lot of people like to think that humanity is the pinnacle of evolution, that somehow humanity is an inevitable consequence of the diversity of life. This is not the case. Backs are a perfect example of why.
Way back when, a good few million years ago before the first human was born, our genetic predecessors were here. They walked in a manner similar to modern monkeys and gorillas, so their spine tended to be much more horizontal. We walk upright, but our backs haven’t quite yet caught up. So, problems tend to occur with our backs a lot more frequently than other parts of our body; our backs aren’t designed to do what we want them to do.
So, to answer your question, bad backs happen because evolution shafted us. But, on the bright side, no other species gets to enjoy some good rigatoni.
And also the fact that neural pain can have multiple underlying reasons ie psychologicial or emotional factors
There’s a ton of answers on here that are focused on pain being related to damaged tissue, compressed nerves, etc. One thing that’s helped me a ton with all kinds of pain is understanding that pain is biological, psychological, and also social. (look up the bio-psycho-social model of pain). And so it can be treated better by addressing all those aspects. For instance, if you have low back pain and everyone tells you, oh don’t pick up anything heavy! Don’t bend over! Then you’ve been given a social cue that doing those things will make your pain worse, and then you have an expectation that will happen, and then you will be hyper aware of any feelings you have when you bend over or pick something up. But does bending over or picking something up actually physically damage your back? Actually “hurt” you? In many (most?) cases, probably not. Your pain has been made worse by psycho-social factors.
The “pain = mechanical damage” model seems especially oversimplified for low back pain. A huge number of pain-free people will show abnormalities in imaging of the low back. And a huge number of people with back pain will show nothing wrong in imagining. That doesn’t mean their pain isn’t real or can’t be treated.
Does that mean it’s “all in your head” and you can just stop feeling pain because you want to? No, absolutely not. It just means that to appropriately treat pain, you should address all the factors that go into it.
Short answer: Your back is connected to everything else in your body directly.
**Meaning, you cannot isolate it like an arm, leg, hand, foot, or even your head & neck. So unless you literally spend weeks in bed or in some sci-fi fluid suspension tank, you cannot give your back the time to rest, relax & heal like you can a sprained wrist or ankle, or even an broken limb.
What we’re learning now about chronic back pain is that in many cases it’s actually about changes in your brain. Say you hurt your back lifting something. Your nerves sense pain and send that information to your brain which registers “pain”. In some people for reasons we don’t fully understand, the nerves then adapt to that sensation, so they will send the signal with less and less input so that your brain registers “pain” even when there is no painful stimuli. If that is the case, your spine can be healed but you will still sense pain. The process of rewriting the brain after this adaptation has occurred is complex and takes a multidisciplinary team to accomplish as well as a a good amount of time and investment from the patient themselves so it’s tough to pull off.
There are some things we know contribute to this, like certain personality types and having a traumatic mechanism of injury. Pain science is a relatively new field and a lot of cool research is being done!
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