Lower back pain: causes, treatment and prevention

I recognized the name, he’s written Back Mechanic which seems like a very good book. Back pain prevention seem a very nice healthspan improving thing.


I did not listen to it, but chronic pain in neck, shoulders and lower back is mostly psychosomatic in nature.

Nope it is likely not. That doesn’t make any sense. McGill seems to be a pioneer, like the Peter Attia of the spine world. I recommend you read the book back mechanic a bit.


I agree with @AnUser on this.

I had back pain for two years after I tweaked it/ strained it from a kid jumping on my back. I let it rest for a number of months and took it easy, thinking it needed rest. That didn’t do anything… my sleep suffered, and it just didn’t get better. The doctor’s didn’t have much in the way of help. Then one day I mentioned it to a friend who his a physical therapist. She gave me some exercises that built up some counteracting muscles - and within two months I was back to normal and pain free.

I’m a much bigger believer in physical therapists now.


Even if it is psychosomatic first line of treatment is physical therapy.

But some were more radical.


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I don’t see why it would be psychosomatic if there was a mechanical injury like for RapAdmin.
Also if you read the book back mechanic you will realize how ridiculous the ‘psychosomatic’ argument is. I guess that’s from doctors that can’t do anything since it’s not their area of expertise.


Hi SCTA123

I respectfully disagree that “most back pain is psychosomatic”.

Here’s one definition for Psychosomatic Pain and Pain Management. Psychosomatic pain is a pain disorder that is induced by excessive stress or mental issues. The pain originates from an issue in the psyche, such as depression, anxiety or different levels of stress, and then spreads to the muscular skeletal system of your body.

If you listen to McGill’s podcast interview with Attia, he addresses this point just past half way.

The spine is extraordinary biological engineering but we developed from four legs before homo erectus. Our spine is amazing but it is a well understood weak point with many potential points of failure. Almost everyone will suffer back issues at sometime in our life.


You might as well say that all pain is psychosomatic. Yes, pain signals originating anywhere in the body are mediated by the brain, and the brain is the seat of the mind, but that is far from saying that all pain is in the mind. Pain is your body’s way of telling you that something is wrong and needs to be corrected.

Anyway, to address the subject of lower back pain. I had a compressed nerve in the spine that, after many months, finally responded to prednisone, cortisone injections, and physical therapy. I am now pain free. But the condition would not have responded to placebo or hypnotism.

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In my understanding psychosomatic disorder is a physical illness or symptoms believed to be caused by psychological factors.

In a way you could, as all pain is subjective and mediated trough psychological processes.

But let me propose a theory how can anxiety and depressive symptoms that originate in psychological and emotional sphere lead to somatic changes as in your case @Tim. When we are anxious / depressive we have elevated muscular tonus, raised stiffness and reduced elasticity of the fascial tissue etc. If this persist for certain period of time and remains unaddressed it will cause somatic changes, even permanent damage to tissue due to stiffness and compression.

But this is what I believe and might not be what others beleive. Still chronic pain patients have prevalent psychological comorbidities. A back surgeon I know routinely sends his patients for psychological and psychiatric evaluation and in his own words more than half of people I operate on, don’t need any surgery. But it helps with the pain.



No doubt many people are hypochondriacs and some suffer from imaginary pain, as opposed to phantom pain, which is a legitimate medical condition. But if I presented to an MD with severe back pain and he sent me to a psychiatrist, I would probably cuss him out and look for another doctor. Doctors aren’t infallible and many are infatuated with their degree and position of authority. I would bet that, to use your words, “more than half” of all doctors aren’t as capable as they think they are. But I’d say that the most common malady afflicting those in the profession is greed.

Psychosomatic pain is not imaginary. It is real. There are real somatic changes possible. It is just casually linked to psyche. That is all I want to say on this subject. And I have terrible psychosomatic headaches, pain medication of course helps and so do other medical prophylactic interventions but so does managing my stress. And I would not dismiss one or the other form of treatment. I take both gladly.

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I believe you. Hives can be caused by psychological stress. Lime disease and chronic fatigue syndrome were once considered to be caused by hysteria. We probably don’t know more than we know about the inner workings of the mind and the body. I hope you find relief from your pain.

I agree with @scta132 & @Tim; & also with the counters; it’s both.

Of course there is back pain caused by physical injuries that allopathic medicine cannot heal, like a broken spine; other physical injuries it can heal, or at least treat the symptoms; & weak abdominals, excess weight, bad posture can physically strain lower back muscles, so need to be corrected, etc.

Many back injuries, particularly soft tissue, do heal, & once healed we need to tell our CNS its ok now, to stop avoiding the area, stop compensating & go back to using all muscles equally (this can be reinforced with exercises instructed by a PT or other therapist).

A great deal of chronic back pain though is thought to be “psychosomatic”.
For some this word has negative connotations, but it’s really not.
Stress, for example, is acknowledged as “a killer”, with many physical symptoms.
It is 100% psychosomatic.
It is created by our mind, & does not otherwise exist.

It appears many chronic back pain issues are caused by stress.

My favourite book on this is The Divided Mind, by John Sarno (MD).


" John E. Sarno, M.D., is Professor of Clinical Rehabilitation Medicine, New York University School of Medicine, and attending physician at the Howard A. Rusk Institute of Rehabilitation Medicine, New York University Medical Center "

He started treating back pain that allopathic medicine either could not cure at all, or could only temporarily “cure”, as it would inevitably return. Eventually allopathic back experts would refer all their difficult or “incurable” cases to him.

He also treats schizophrenics that have different physical diseases & symptoms that appear for different personalities, & completely disappear when the personality changes.

I read it many years ago, & stopped viewing the word psychosomatic as negative.
I decided I do not get headaches (an easy start, as I think mine were tension related).
Not one, ever, since. If I feel anything starting (rarely), I firmly remind myself & it stops.

Dr Sarno has written several others, such as ‘Healing Back Pain: The Mind-Body Connection’.
(update: which I just realised is the same book that @scta123 referenced)


There are a myriad of causes for lower back pain, posture, bad mattress, etc. and the list goes on.

Oddly I was experiencing lower back pain from taking Flomax. I did not associate the problem with Flomax until I stopped taking it. It only occurs in ~4% of users. Statins can also cause lower back pain. So, even though it is an uncommon side effect of these medications, you should rule them out by not taking the medication for a while if your doctor okays it.

" Some other medications that may cause lower back pain as a side effect include: - Corticosteroids like prednisone - These can sometimes cause back pain due to osteoporosis or compression fractures over time. - Aromatase inhibitors used in breast cancer like Arimidex - Musculoskeletal pain including back pain can occur with these medications. The exact mechanism is unknown. - Osteoporosis medications like alendronate (Fosamax) - Back pain can sometimes occur when starting these medications. They may also cause worsening of existing back pain. - Statins like atorvastatin (Lipitor) - Back pain is an uncommon side effect thought to be related to muscle inflammation. - Methotrexate - Back pain has been reported with methotrexate, likely due to inflammation. Those with pre-existing back issues may be more susceptible. - Antidepressants like fluoxetine (Prozac) - Back pain is a rare side effect, possibly due to changes in pain perception."

In that the body cannot be separated from the psyche (unless you’re finally dead) everything could be termed psychosomatic. It’s just the choice of word, which has a bad rap as something that’s not ‘real’. And further to your context, isn’t everything allowed by the person experiencing it until they change their response and framework boundaries?
Just a thought.


Also - intestinal issues are directly linked to back ache in many individuals, myself and several family members included.

How many times a week did you do the exercises?
Did you have an x-ray or MRI?
Did you have any injections? If not, why not?
Were you roughhousing with the kid?

Based on several interviews I have done with people in the pain resolving business, I think of pain as like an emotion, which is a set of signals the unconscious brain sends to influence behavior. Pain can be from damage (although damage doesn’t always cause pain), it can be from a past injury that the brain wants to avoid happening again, or it can be from a stressful life circumstance that triggers pain in a part of the body the person fears being damaged the most. Or a 1000 other things.

Pain is real just as fear or happiness is real.

In addition: rest is rarely the right solution…do what you can. And, be careful about getting imagery of joints…old joints do not look like young joints, but that doesn’t mean it should hurt. Once the ugly image is in your head how will you get it out?

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Typically exercise 3 or 4 times a week, but during this period I had to cut way back due to my back/shoulder pain.
No X-ray or MRI
No injections (had not heard of those helping - it was a weird pain, not like a torn rotator cuff or something, more diffuse.)
Yes - typical childhood - lots of roughhousing, lots of sports (gymnastics for 4 hours a day for years from 14 to 18).


Same principles as CBT, I believe.