How long does back pain last? And how can learning about pain increase the chance of recovery?
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Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will have it this year.
Chronic pain, of which back pain is the most common, is the world’s most disabling health problem. Its economic impact dwarfs other health conditions.
If you get back pain, how long will it take to go away? We scoured the scientific literature to find out. We found data on almost 20,000 people, from 95 different studies and split them into three groups:
- acute – those with back pain that started less than six weeks ago
- subacute – where it started between six and 12 weeks ago
- chronic – where it started between three months and one year ago.
We found 70%–95% of people with acute back pain were likely to recover within six months. This dropped to 40%–70% for subacute back pain and to 12%–16% for chronic back pain.
Clinical guidelines point to graded return to activity and pain education under the guidance of a health professional as the best ways to promote recovery. Yet these effective interventions are underfunded and hard to access.
More pain doesn’t mean a more serious injury
Most acute back pain episodes are not caused by serious injury or disease.
There are rare exceptions, which is why it’s wise to see your doctor or physio, who can check for signs and symptoms that warrant further investigation. But unless you have been in a significant accident or sustained a large blow, you are unlikely to have caused much damage to your spine.
DG fotostock/Shutterstock
Even very minor back injuries can be brutally painful. This is, in part, because of how we are made. If you think of your spinal cord as a very precious asset (which it is), worthy of great protection (which it is), a bit like the crown jewels, then what would be the best way to keep it safe? Lots of protection and a highly sensitive alarm system.
The spinal cord is protected by strong bones, thick ligaments, powerful muscles and a highly effective alarm system (your nervous system). This alarm system can trigger pain that is so unpleasant that you cannot possibly think of, let alone do, anything other than seek care or avoid movement.
The messy truth is that when pain persists, the pain system becomes more sensitive, so a widening array of things contribute to pain. This pain system hypersensitivity is a result of neuroplasticity – your nervous system is becoming better at making pain.
Reduce your chance of lasting pain
Whether or not your pain resolves is not determined by the extent of injury to your back. We don’t know all the factors involved, but we do know there are things that you can do to reduce chronic back pain:
- understand how pain really works. This will involve intentionally learning about modern pain science and care. It will be difficult but rewarding. It will help you work out what you can do to change your pain
- reduce your pain system sensitivity. With guidance, patience and persistence, you can learn how to gradually retrain your pain system back towards normal.
How to reduce your pain sensitivity and learn about pain
Learning about “how pain works” provides the most sustainable improvements in chronic back pain. Programs that combine pain education with graded brain and body exercises (gradual increases in movement) can reduce pain system sensitivity and help you return to the life you want.
Halfpoint/Shutterstock
These programs have been in development for years, but high-quality clinical trials are now emerging and it’s good news: they show most people with chronic back pain improve and many completely recover.
But most clinicians aren’t equipped to deliver these effective programs – good pain education is not taught in most medical and health training degrees. Many patients still receive ineffective and often risky and expensive treatments, or keep seeking temporary pain relief, hoping for a cure.
When health professionals don’t have adequate pain education training, they can deliver bad pain education, which leaves patients feeling like they’ve just been told it’s all in their head.
Community-driven not-for-profit organisations such as Pain Revolution are training health professionals to be good pain educators and raising awareness among the general public about the modern science of pain and the best treatments. Pain Revolution has partnered with dozens of health services and community agencies to train more than 80 local pain educators and supported them to bring greater understanding and improved care to their colleagues and community.
But a broader system-wide approach, with government, industry and philanthropic support, is needed to expand these programs and fund good pain education. To solve the massive problem of chronic back pain, effective interventions need to be part of standard care, not as a last resort after years of increasing pain, suffering and disability.
Sarah Wallwork, Post-doctoral Researcher, University of South Australia and Lorimer Moseley, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Debunking the vitamin D fad
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Throughout the pandemic, many unproven miracle COVID-19 “cures” emerged, and vitamin D claims have been one of the most persistent. This is not new for the vitamin. It’s been touted in recent decades as a way to “boost” the immune system, improve overall health, prevent a host of diseases, and allegedly even substitute for vaccines.
But as with many internet-popular health “remedies,” the reality is far less flashy and far more nuanced.
What is vitamin D, and why is it important?
Vitamin D is a nutrient that helps the body absorb calcium, which is essential for bone health. In the sunlight, your skin naturally produces vitamin D that is then stored in fat cells until it is used.
The skin pigment melanin absorbs the UV rays necessary for vitamin D production, meaning that more highly pigmented or darker skin produces less vitamin D than lighter skin with the same amount of sun exposure. Thus, people with darker skin are at higher risk of vitamin D deficiency.
Most of our vitamin D comes from the sun. An additional 10 percent to 20 percent of our vitamin D comes from foods like fatty fish (such as salmon), eggs, and mushrooms. Vitamin D supplements are another source of the nutrient for people who are unable to get enough from sun exposure and diet.
Vitamin D deficiency is real, but there’s no epidemic
Some people who promote vitamin D supplements claim that vitamin D deficiency is an epidemic causing widespread health issues. There is little evidence to support this claim. A 2022 analysis of 2001-2018 data found that 2.6 percent of people in the U.S. had severe vitamin D deficiency.
Severe vitamin D deficiency can cause serious health issues, such as muscle weakness, bone loss in adults, and rickets (weak bones) in children. Some people are at higher risk for the deficiency, including individuals with certain disorders that prevent the body from absorbing or processing vitamin D or those with a family history of vitamin D deficiency.
Black Americans have the highest rates of severe vitamin D deficiency at nearly 12 percent. Severe vitamin D deficiency is also slightly higher in the U.S. during the winter when people get less sun exposure. Rates of moderate vitamin D deficiency are higher at 22 percent overall and are highest among Black Americans (49 percent) and Mexican Americans (35 percent).
Although severe vitamin D deficiency exists in the U.S., it is far from common. Most tellingly, conditions that are directly linked to vitamin D deficiency are not widespread. There is no epidemic of rickets, for example, or bone loss in adults.
There’s little evidence that vitamin D supplements improve overall health
Vitamin D supplements have clear, proven positive effects for people with vitamin D deficiency. Other health benefits of vitamin D supplements are less certain.
There is some evidence that the supplement may reduce the risk of fracture in adults with osteoporosis, a condition that causes weak, fragile bones. However, the benefit appears to be limited to people who have low vitamin D levels. In adults with normal vitamin D levels, supplements have no effect on fracture risk.
The largest randomized controlled trial of vitamin D, called VITAL, investigated the effects of vitamin D supplementation in people without an existing deficiency. The study found that vitamin D supplements had no effects on the risk of cancer, diabetes, or cardiovascular disease, including heart attack and stroke. The study concluded that more research is necessary to determine who may benefit from vitamin D supplements.
Independent analyses found that vitamin D supplementation may be associated with a long-term decrease in cancer mortality, but results are mixed and also require more investigation.
A 2021 analysis of past vitamin D trials found no overall health benefits from vitamin D supplements in people with normal vitamin D levels. Most large-scale studies have found no link between vitamin D supplements and lower all-cause mortality (deaths from any cause), except in older adults and those with vitamin D deficiency.
Vitamin D provides modest protection against respiratory infections
Vitamin D is important for immune function, but this is often misconstrued as vitamin D “boosting” the immune system.
Some people falsely believe that taking vitamin D supplements will keep them healthy and prevent infections like the flu or COVID-19. In reality, clinical trials and large-scale studies of vitamin D have found only minimal protective effects against respiratory infections.
A 2021 analysis of 46 trials found that 61.3 percent of participants who took daily vitamin D supplements got respiratory infections during the study periods—compared to 62.3 percent of people who did not take the supplements. A 2024 meta-analysis of 43 trials found no overall protective effect against respiratory infections, but it detected a slight decrease in risk among people who took specific doses daily.
In young children, there is some evidence that vitamin D supplementation may reduce the length of respiratory infections. However, it does not affect the number or severity of infections that children have.
Despite claims that taking vitamin D can protect against COVID-19, two clinical trials found that taking daily vitamin D supplements did not reduce the risk or severity of COVID-19 infections, even at high doses.
Context is key when considering vitamin D’s benefits
None of these studies contradict the well-established evidence that people with vitamin D deficiency benefit from vitamin D supplements. But it’s important to remember that many of the most popular health claims about vitamin D’s benefits are based on research in people with vitamin D deficiency.
Research in vitamin D-deficient populations is important, but it tells us little about how vitamin D will affect people with normal or close to normal vitamin D levels. A closer look at vitamin D research in people without low levels reveals little evidence to support the idea that the general population benefits from taking vitamin D supplements.
For more information, or to learn about your vitamin D levels, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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10 Ways To Delay Aging
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This is Dr. Colin Rose; he is a Senior Associate of the Royal Society of Medicine. He’s also a main contributor to EduScience, a programme funded by the E.U. which is designed to enhance the teaching and learning of science in schools in Europe.
His most recent work has been about aging—and how to delay it. We also reviewed his latest book, here:
Delay Ageing – by Dr. Colin Rose
So, what does he want us to know? The key lies in his compilation of ten ways in which we age on a cellular level, and what we can to do slow each one of those:
Damage to DNA accumulates
While DNA can get damaged without any external stimulus to cause that, there are a lot of modifiable factors that we can do to reduce DNA damage. The list is easy: if it causes cancer, it causes aging.
Thus, check out: Stop Cancer 20 Years Ago
Cells become senescent
Our cells are replaced all the time; some sooner than others, but all of them at some point. The problem occurs when cells are outliving their usefulness. If a cell becomes completely immortal, that is cancer, but happily most don’t. Nevertheless, having senescent (aging) cells in the body means that those senescent cells are what get copied forwards by mitosis, and our DNA becomes like a photocopy of a tattered old photocopy of a tattered old photocopy. Which, needless to say, is not good for our health. So, the best thing to do is to kill them earlier:
Yes, really: Fisetin: The Anti-Aging Assassin
Mitochondria become dysfunctional
Without properly functional mitochondria, no living human cell can do its job properly.
Options: 7 Ways To Boost Mitochondrial Health To Fight Disease
Beneficial genes are switched off, harmful genes are on
It’s easy to think of our genes as being immutable, but epigenetics means that our environment (amongst other factors) can mean that our gene expression changes.
Imagine it this way: your genes are a set of instructions for your body. However, your body will act or not on those instructions, depending on other factors. Hormones often play a big part in this; for example sex hormones tell the body which set of genetic instructions to read (and thus what kind of body to build/rebuild), and cortisol or oxytocin can tell the body which set of contingency plans to activate or suppress (respectively). A milder example is gray hair; genes have the program for it, but many other factors inform the body when, if, and how to do it.
Of more concern when it comes to aging is what goes on with more critical systems, such as the brain, in which the aforementioned DNA damage can cause unhelpful instructions to get interpreted, resulting in epigenetic changes that in turn facilitate age-related degeneration.
As to what can be done, see : Klotho: Unzipping The Genes Of Aging?
Stem cells become exhausted
Stem cells can become different kinds of cells, and thus they’re very useful for maintaining a healthy body. However, they get depleted with age. We can slow down the rate of loss, though; for example, intermittent fasting can help:
Per Dr. Li’s 5 Ways To Beat Cancer (And Other Diseases)
And for more detail, see:
Doctor’s Tip: Regeneration (stem cells) — one of your body’s five defense systems
(complete with lists of foods to eat or avoid for stem cell health)
Cells fail to communicate properly
Cells need to talk to each other constantly, to continue doing their jobs. We are one big organism, after all, and not a haphazard colony of the countless cells that constitute such. However, cell signalling gets worse with age, which in turn precipitates others age-related problems. Fortunately, there are nutrients that can improve cellular communication.
For example: PS, We Love You ← this is about phosphatidylserine, also called “PS”
Telomeres become shorter
These protective caps on our DNA suffer the wear-and-tear so that our DNA doesn’t have to. However, as they get shorter, the DNA can start suffering damage. For this reason, telomere length is considered one of the most “Gold Standard” markers of cellular aging.
Here’s what can be done for that: The Stress Prescription (Against Aging!)
The body fails to sense nutritional intake properly
This is mostly about insulin signalling (though problems can occur in other systems too, but we only have so much room here), so it’s important to take care of that.
See: Turn Back The Clock On Insulin Resistance
Proteins accumulate errors
This is due to DNA damage, of course, but there are specific things that can reduce protein error accumulation; see for example:
A quick fix – preventing protein errors extends lifespan
See also: Rapamycin Can Slow Aging By 20% (But Watch Out)
The microbiome becomes unbalanced
We at 10almonds often mention that gut health affects pretty much every other kind of health, and it’s true for aging as well. So, take care of that microbiome!
Here’s a primer: Gut Health 101
Want to know more about delaying aging beyond the cellular level?
Check out: Age & Aging: What Can (And Can’t) We Do About It?
Take care!
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Yoga Teacher: “If I wanted to get flexible in 2025, here’s what I’d do”
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Progress in flexibility isn’t about doing more but doing it smarter:
Step by step
First, we need a good foundation. Create three routines focusing on different areas of the body, namely:
- Hips & hamstrings
- Shoulders & spine
- Wrists, ankles, & neck
Alternate these on a daily basis (e.g. Mon = 1, Tue = 2, Wed = 3, Thu = 1, Fri = 2, Sat = 3, Sun = 1, Mon = 2, Tue = 3, and so on), doing just 10 minutes per day and focusing on consistency.
Next, we will want to identify problem areas (likely they will identify themselves, i.e. a particular stretch will be harder than others). Use “focus sessions” twice a week (20–30 minutes) to address these spots. While you’re at it, incorporate techniques like active stretches, weighted stretches, and resistance bands to improve strength and range of motion.
Because commitment is important, schedule flexibility sessions like important meetings and set calendar alerts. Focus on consistency rather than perfection.
To help keep you going, remember that flexibility improvements are less obvious than other fitness goals. Take photos every couple of weeks (e.g. forward fold, low lunge, shoulder stretch). Visual proof of progress can motivate you to keep going.
For more on all of this, plus suggested specific stretches for those routines, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
Getting Flexible, Starting As An Adult: How Long Does It Really Take?
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100 Ways to Change Your Life – by Liz Moody
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Sometimes we crave changing things up, just to feel something new. This can result in anything from bad haircut decisions or impulsive purchases, to crashing and burning-out of a job, project, or relationship. It doesn’t have to be that way, though!
This book brings us (as the title suggest) 100 evidence-based ways of changing things up in a good way—small things that can make a big difference in many areas of life.
In terms of format, these are presented in 100 tiny chapters, each approximately 2 pages long (obviously it depends on the edition, but you get the idea). Great to read in any of at least three ways:
- Cover-to-cover
- One per day for 100 days
- Look up what you need on an ad hoc basis
Bottom line: even if you already do half of these things, the other half will each compound your health happiness one-by-one as you add them. This is a very enjoyable and practical book!
Click here to check out 100 Ways to Change Your Life, and level-up yours!
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How Much Does A Vegan Diet Affect Biological Aging?
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Slow Your Aging, One Meal At A Time
This one’s a straightforward one today, and the ““life hack” can be summed up:
Enjoy a vegan diet to enjoy younger biological age.
First, what is biological age?
Biological age is not one number, but a collection of numbers, as per different biomarkers of aging, including:
- Visual markers of aging (e.g. wrinkles, graying hair)
- Performative markers of aging (e.g. mobility tests)
- Internal functional markers of aging (e.g. tests for cognitive decline, eyesight, hearing, etc)
- Cellular markers of aging (e.g. telomere length)
We wrote more about this here:
Age & Aging: What Can (And Can’t) We Do About It?
A vegan diet may well impact multiple of those categories of aging, but today we’re highlighting a study (hot off the press; published only a few days ago!) that looks at its effect on that last category: cellular markers of aging.
There’s an interesting paradox here, because this category is:
- the most easily ignorable; because we all feel it if our knees are giving out or our skin is losing elasticity, but who notices if telomeres’ T/S ratio changed by 0.0407? ← the researchers, that’s who, as this difference is very significant
- the most far-reaching in its impact, because cellular aging in turn has an effect on all the other markers of aging
Second, how much difference does it make, and how do we know?
The study was an eight-week interventional identical twin study. This means several things, to start with:
- Eight weeks is a rather short period of time to accumulate cellular aging, let alone for an intervention to accumulate a significant difference in cellular aging—but it did. So, just imagine what difference it might make in a year or ten!
- Doing an interventional study with identical twin pairs already controlled for a lot of factors, that are usually confounding variables in population / cohort / longitudinal / observational studies.
Factors that weren’t controlled for by default by using identical twins, were controlled for in the experiment design. For example, twin pairs were rejected if one or more twin in a given pair already had medical conditions that could affect the outcome:
❝Inclusion criteria involved participants aged ≥18, part of a willing twin pair, with BMI <40, and LDL-C <190 mg/dL. Exclusions included uncontrolled hypertension, metabolic disease, diabetes, cancer, heart/renal/liver disease, pregnancy, lactation, and medication use affecting body weight or energy.
Eligibility was determined via online screening, followed by an orientation meeting and in-person clinic visit. Randomization occurred only after completing baseline visits, dietary recalls, and questionnaires for both twins❞
~ Dr. Varun Dwaraka et al. ← there’s a lot of “et al.” to this one; the paper had 16 collaborating authors!
As to the difference it made over the course of the 8 weeks…
❝Various measures of epigenetic age acceleration (PC GrimAge, PC PhenoAge, DunedinPACE) were assessed, along with system-specific effects (Inflammation, Heart, Hormone, Liver, and Metabolic).
Distinct responses were observed, with the vegan cohort exhibiting significant decreases in overall epigenetic age acceleration, aligning with anti-aging effects of plant-based diets. Diet-specific shifts were noted in the analysis of methylation surrogates, demonstrating the influence of diet on complex trait prediction through DNA methylation markers.❞
~ Ibid.
You can read the whole paper here (it goes into a lot more detail than we have room to here, and also gives infographics, charts, numbers, the works):
Were they just eating more healthily, though?
Well, arguably yes, as the results show, but to be clear:
The omnivorous diet compared to the vegan diet in this study was also controlled; both groups were given a healthy meal plan for their respective diet. So this wasn’t a case of “any omnivorous diet vs healthy vegan diet”, but rather “healthy omnivorous diet vs healthy vegan diet”.
Again, the paper itself has the full details—a short version is that it involved a healthy meal kit delivery service, followed by ongoing dietician involvement in an equal and carefully-controlled fashion.
So, aside from that one group had an omnivorous meal plan and the other vegan, both groups received the same level of “healthy eating” support, guidance, and oversight.
But isn’t [insert your preferred animal product here] healthy?
Quite possibly! For general health, general scientific consensus is that eating at least mostly plants is best, red meat is bad, poultry is neutral in moderation, fish is good in moderation, dairy is good in moderation if fermented, eggs are good in moderation if not fried.
This study looked at the various biomarkers of aging that we listed, and not every possible aspect of health—there’s more science yet to be done, and the researchers themselves are calling for it.
It also bears mentioning that for some (relatively few, but not insignificantly few) people, extant health conditions may make a vegan diet unhealthy or otherwise untenable. Do speak with your own doctor and/or dietician if unsure.
See also: Do We Need Animal Products To Be Healthy?
We would hypothesize, by the way, that the anti-aging benefits of a vegan diet are probably proportional to abstention from animal products—meaning that even if you simply have some “vegan days”, while still consuming animal products other days, you’ll still get benefit for the days you abstained. That’s just our hypothesis though.
Take care!
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Non-Alcohol Mouthwash vs Alcohol Mouthwash – Which is Healthier?
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Our Verdict
When comparing non-alcohol mouthwash to alcohol mouthwash, we picked the alcohol.
Why?
Note: this is a contingent choice and is applicable to most, but not all, people.
In short, there has been some concern about alcohol mouthwashes increasing cancer risk, but research has shown this is only the case if you already have an increased risk of oral cancer (for example if you smoke, and/or have had an oral cancer before).
For those for whom this is not the case (for example, if you don’t smoke, and/or have no such cancer history), then best science currently shows that alcohol mouthwash does not cause any increased risk.
What about non-alcohol mouthwashes? Well, they have a different problem; they usually use chlorine-based chemicals like chlorhexidine or cetylpyridinium chloride, which are (exactly as the label promises) exceptionally good at killing oral bacteria.
(They’d kill us too, at higher doses, hence: swill and spit)
Unfortunately, much like the rest of our body, our mouth is supposed to have bacteria there and bad things happen when it doesn’t. In the case of our oral microbiome, cleaning it with such powerful antibacterial agents can kill our “good” bacteria along with the bad, which lowers the pH of our saliva (that’s bad; it means it is more acidic), and thus indirectly erodes tooth enamel.
You can read more about the science of all of the above (with references), here:
Toothpastes & Mouthwashes: Which Help And Which Harm?
Summary:
For most people, alcohol mouthwashes are a good way to avoid the damage that can be done by chlorhexidine in non-alcohol mouthwashes.
Here are some examples, but there will be plenty in your local supermarket:
Non-Alcohol, by Colgate | Alcohol, by Listerine
If you have had oral cancer, or if you smoke, then you may want to seek a third alternative (and also, please, stop smoking if you can).
Or, really, most people could probably skip mouthwashes, if you’ve good oral care already by other means. See also:
Toothpastes & Mouthwashes: Which Help And Which Harm?
(yes, it’s the same link as before, but we’re now drawing your attention to the fact it has information about toothpastes too)
If you do want other options though, might want to check out:
Less Common Oral Hygiene Options ← miswak sticks are especially effective
Take care!
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