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.

Factory worker deep-breathes with a sore back
Your doctor or physio can rule out serious damage.
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.

Physio helps patient use an exercise strap
Some programs combine education with gradual increases in movement.
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.The Conversation

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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  • The Pains That Good Posture Now Can Help You Avoid Later

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    Dr. Murat Dalkilinç explains:

    As a rule…

    Posture is the foundation for all body movements and good posture helps the body adapt to stress.

    Problems arise when poor posture causes muscles to overwork in ways that are not good for them, becoming tight or inhibited over time. Bad posture can lead to wear and tear on joints, increase accident risk, and make some organs (like the lungs, which feed everything else with the oxygen necessary for normal functioning) less efficient. It’s also of course linked to issues like scoliosis, tension headaches, and back pain, and can even affect emotions and pain sensitivity.

    Good posture includes straight alignment of vertebrae when viewed from the front/back, and three natural curves in a (very!) gentle S-shape when viewed from the side. Proper posture allows for efficient movement, reduces fatigue, and minimizes muscle strain. For sitting posture, the neck should be vertical, shoulders relaxed, arms close to the body, and knees at a right angle with feet flat.

    But really, one should avoid sitting, to whatever extent is reasonably possible. Standing is better than sitting; walking is better than standing. Movement is crucial, as being stationary for extended periods, even with good posture, is not good for our body.

    Advices given include: adjust your environment, use ergonomic aids, wear supportive shoes, and keep moving. Regular movement and exercise keep muscles strong to support the body.

    For more on all this, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Beyond Just Good Posture: 6 Ways To Look After Your Back

    Take care!

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  • Experience life lessons with the powerful message of "Make Your Bed" beyond the comfort of a picture.

    Beyond “Make Your Bed”—life lessons from experience

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    Beyond “Make Your Bed”—life lessons from experience

    This is Admiral William H. McRaven, a former United States Navy four-star admiral who served as the ninth commander of the United States Special Operations Command.

    So, for those of us whose day-to-day lives don’t involve coordinating military operations, what does he have to offer?

    Quick note: 10almonds’ mission statement is “to make health and productivity crazy simple”.

    We tend to focus on the health side of this, and in the category of productivity, it’s often what most benefits our mental health.

    We’re writing less for career-driven technopreneurs in the 25–35 age bracket and more for people with a more holistic view of productivity and “a good life well-lived”.

    So today’s main feature is more in that vein!

    Start each day with an accomplishment

    McRaven famously gave a speech (and wrote a book) that began with the advice, “make your bed”. The idea here doesn’t have to be literal (if you’ll pardon the pun). Indeed, if you’re partnered, then depending on schedules and habits, it could be you can’t (sensibly) make your bed first thing because your partner is still in it. But! What you can do is start the day with an accomplishment—however small. A short exercise routine is a great example!

    Success in life requires teamwork

    We’re none of us an island (except in the bathtub). The point is… Nobody can do everything alone. Self-sufficiency is an illusion. You can make your own coffee, but could you have made the coffee machine, or even the cup? How about, grown the coffee? Transported it? So don’t be afraid to reach out for (and acknowledge!) help from others. Teamwork really does make the dream work.

    It’s what’s inside that counts

    It’s a common trap to fall into, getting caught up the outside appearance of success, rather than what actually matters the most. We need to remember this when it comes to our own choices, as well as assessing what others might bring to the table!

    A setback is only permanent if you let it be

    No, a positive attitude won’t reverse a lifelong degenerative illness, for example. But what we can do, is take life as comes, and press on with the reality, rather than getting caught up in the “should be”.

    Use failure to your advantage

    Learn. That’s all. Learn, and improve.

    Be daring in life

    To borrow from another military force, the SAS has the motto “Who dares, wins”. Caution has it place, but if we’ve made reasonable preparations*, sometimes being bold is the best (or only!) way forward.

    *Meanwhile the Parachute Regiment, from which come 80% of all SAS soldiers, has the motto “Utrinque paratus”, “prepared on all sides”.

    Keep courage close

    This is about not backing down when we know what’s right and we know what we need to do. Life can be scary! But if we don’t overcome our fears, they can become self-realizing.

    Writer’s note: a good example of this is an advice I sometimes gave during my much more exciting (military) life of some decades ago, and it pertains to getting into a knife-fight (top advice for civilians: don’t).

    But, if you’re in one, you need to not be afraid of getting cut.

    Because if you’re not afraid of getting cut, you will probably get cut.

    But if you are afraid of getting cut, you will definitely get cut.

    Hopefully your life doesn’t involve knives outside of the kitchen (mine doesn’t, these days, and I like it), but the lesson applies to other things too.

    Sometimes the only way out is through.

    Be your best at your worst

    Sometimes life is really, really hard. But if we allow those moments to drive us forwards, they’re also a place we can find more strength than we ever knew we had.

    Keep on swimming

    It’s said that the majority in life is about showing up—and often it is. But you have to keep showing up, day after day. So make what you’re doing sustainable for you, and keep on keeping on.

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  • Broccoli Sprouts & Sulforaphane

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    It’s Q&A Day at 10almonds!

    Have a question or a request? We love to hear from you!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small 😎

    ❝How much science is there behind sulforaphane / broccoli spirits and its health claims??❞

    So, first of all, what it is: sulforaphane is a compound found in Brassica oleracea, of which species broccoli is a cultivar. It’s found in the other Brassica oleracea cultivars too (e.g. cauliflower, various cabbages, Brussels sprouts, kale, etc), but for whatever reason*, most research has been on broccoli and broccoli sprouts.

    *Likely the reason is: research begets research—it’s easier to get funding to expand upon previous research, than it is to break ground on researching a different plant, where for the first third of your paper you have almost no existing scientific literature to cite. So once they got started on broccoli sprouts, everything else has been broccoli sprouts too.

    And for clarity on what broccoli sprouts are: this means that when broccoli seeds have been germinated and just begun to sprout, they are harvested and eaten. That’s the one-line explanation, anyway; there’s a little more to it than that, so anyone interested should check out our previous main feature:

    Good Things Come In Small Packages: Sprout Your Seeds, Grains, Beans, Etc

    …and for more depth than we have room for in a one-page article, check out this book we reviewed:

    The Sprout Book: Tap Into The Power Of The Planet’s Most Nutritious Food – by Doug Evans

    One thing that the science is clear on: sprouts of a given plant indeed have much higher general nutritional density than their “adult” siblings. And in the case of sulforaphane specifically, it’s about 100x higher in broccoli sprouts than in adult broccoli:

    Broccoli or Sulforaphane: Is It the Source or Dose That Matters? ← we suggest skipping down to the section “broccoli-based clinical trials”

    So, that prompts the next question: do we care?

    In other words: is sulforaphane really particularly important?

    Sulforaphane vs cancer

    The most well-evidenced health-giving property of sulforaphane is its anticancer activity:

    Brassicaceae-Derived Anticancer Agents: Towards a Green Approach to Beat Cancer

    A lot of the research there is epidemiological rather than RCTs, and where there are RCTs, they are mostly small ones, like this 10-person broccoli soup study about bioavailability (rather than the effects themselves):

    Bioavailability of Glucoraphanin and Sulforaphane from High-Glucoraphanin Broccoli

    To get into sulforaphane’s anticancer potential in seriousness, we have to look at a lot of in-vitro studies trialling it to limit carcinogenesis, or to shrink tumors with it, or specifically targetting cancer stem cells with it, which make for quite compelling reading:

    Dietary Sulforaphane in Cancer Chemoprevention: The Role of Epigenetic Regulation and HDAC Inhibition

    A quick aside: if you’re reading that and thinking “Why is sonic the hedgehog in here?” it’s because after the observation of the influence of certain genes that influence cuticular denticles (the growth of spikes) on fruit fly larvae (bearing in mind the fruit fly Drosophila melanogaster is used for so much first- or second-line genetic research, being either the go-to or the go-to after the nematode C. elegans) caused the whole group of genes to get called “hedgehog genes” and then it became scientific convention to name each newly researched gene in that set after a different kind of hedgehog. One of them, instead of being named after a real-world hedgehog species like the others, got named after the videogame character.

    Unfortunately, this now means that because the gene is associated with a certain congenital brain disorder, sometimes a doctor has to explain to a family that the reason their baby has a brain defect is because of a mutated sonic hedgehog.

    Ok, back to talking about cancer. Let’s just quickly drop a few more papers so it’s clear that this is well-established:

    However, that’s not the only established benefit:

    ❝SFN has other beneficial effects in addition to cancer protection. SFN exhibits neuroprotective effects and is implemented in treating conditions such as traumatic brain injury, Alzheimer’s disease and Parkinson’s disease.❞

    Source: Sulforaphane in broccoli: The green chemoprevention!! Role in cancer prevention and therapy

    Now, after the extract we quoted above, the rest of the section “other health benefits of sulforaphane” includes a lot of speculation, weak science, and/or things attributable to other phytochemicals in broccoli, including various polyphenols, vitamins, and minerals.

    About those broccoli spirits

    Ok, we know it was a typo, but… Actually, there is something worth mentioning here, and that’s that sulforaphane is only activated when glucoraphanin (its inactive form) comes into contact with myrosinase (an enzyme that’s only released when the plant is damaged).

    In other words, it’s necessary to injure the broccoli before consuming it, in order to release the spirits myrosinase. Now, while very few people are out there swallowing adult broccoli plants whole, it could well happen that people might wolf down uncut broccoli sprouts, since they are only small, after all.

    For this reason, it’s best that broccoli, even if it’s broccoli sprouts, be cut while raw before consumption.

    In terms of cooking, heat in excess of 140℃ / 284℉ will destroy the glucoraphanin, and less/no glucoraphanin means less/no sulforaphane.

    So, enjoying them raw or lightly steaming them seems to be best for this purpose:

    Impact of thermal processing on sulforaphane yield from broccoli (Brassica oleracea L. ssp. italica)

    Just want a supplement?

    Many studies (including some cited by the research reviews we cited above) deal with sulforaphane in extract form, rather than whole plants, so there’s no shame in taking it that way if you’re not a fan of broccoli.

    We don’t sell it, but here for your convenience is an example product on Amazon 😎

    Enjoy!

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  • 100 Things Productive People Do – by Nigel Cumberland

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    This is a book of a hundred small chapters (the book is 396 pages, so 2–3 pages per chapter) which makes for a feeling of quick reading, and definitely gives an option of “light bites”, dipping into the book here and there.

    Cumberland offers a wide range of practical wisdom here, and while the book is (per the title) focused on productivity, it also includes all due weight to not burning out and/or breaking down. Because things productive people do does not, it turns out, include working themselves directly into an early grave.

    But—despite the author’s considerable and obvious starting point of social privilege—nor is this a tome of “offer your genius leadership and otherwise just coast while everyone does your work for you”, either. This is a “brass tacks” book and highly relatable whether your to-do list most prominently features “personally manage the merger of these Fortune 500 companies” or “sort out that junk in the spare room”

    Bottom line: we’d be surprised if this book with 100 pieces of advice failed to bring you enough value to more than pay for itself!

    Pick up your copy of 100 Things Productive People Do from Amazon today!

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  • How to Vary Breakfast for Digestion?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝Would appreciate your thoughts on how best to promote good digestion. For years, my breakfast has consisted of flaxseeds, sunflower seeds, and almonds – all well ground up – eaten with a generous amount of kefir. This works a treat as far as my digestion is concerned. But I sometimes wonder whether it would be better for my health if I varied or supplemented this breakfast. How might I do this without jeopardising my good digestion?❞

    Sounds like you’re already doing great! Those ingredients are all very nutrient-dense, and grinding them up improves digestion greatly, to the point that you’re getting nutrients your body couldn’t get at otherwise. And the kefir, of course, is a top-tier probiotic.

    Also, you’re getting plenty of protein and healthy fats in with your carbs, which results in the smoothest blood sugar curve.

    As for variety…

    Variety is good in diet, but variety within a theme. Our gut microbiota change according to what we eat, so sudden changes in diet are often met with heavy resistance from our gut.

    • For example, people who take up a 100% plant-based diet overnight often spend the next day in the bathroom, and wonder what happened.
    • Conversely, a long-time vegan who (whether by accident or design) consumes meat or dairy will likely find themself quickly feeling very unwell, because their gut microbiota have no idea what to do with this.

    So, variety yes, but within a theme, and make any changes gradual for the easiest transition.

    All in all, the only obvious suggestion for improvement is to consider adding some berries. These can be fresh, dried, or frozen, and will confer many health benefits (most notably a lot of antioxidant activity).

    Enjoy!

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  • Unlock Your Air-Fryer’s Potential!

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    Unlock Your Air-Fryer’s Potential!

    You know what they say:

    “you get out of it what you put in”

    …and in the case of an air-fryer, that’s very true!

    More seriously:

    A lot of people buy an air fryer for its health benefits and convenience, make fries a couple of times, and then mostly let it gather dust. But for those who want to unlock its potential, there’s plenty more it can do!

    Let’s go over the basics first…

    Isn’t it just a tiny convection oven?

    Mechanically, yes. But the reason that it can be used to “air-fry” food rather than merely bake or roast the food is because of its tiny size allowing for much more rapid cooking at high temperatures.

    On which note… If you’re shopping for an air-fryer:

    • First of all, congratulations! You’re going to love it.
    • Secondly: bigger is not better. If you go over more than about 4 liters capacity, then you don’t have an air-fryer; you have a convection oven. Which is great and all, but probably not what you wanted.

    Are there health benefits beyond using less oil?

    It also creates much less acrylamide than deep-frying starchy foods does. The jury is out on the health risks of acrylamide, but we can say with confidence: it’s not exactly a health food.

    I tried it, but the food doesn’t cook or just burns!

    The usual reason for this is either over-packing the fryer compartment (air needs to be able to circulate!), or not coating the contents in oil. The oil only needs to be a super-thin layer, but it does need to be there, or else again, you’re just baking things.

    Two ways to get a super thin layer of oil on your food:

    • (works for anything you can air-fry) spray the food with oil. You can buy spray-on oils at the grocery store (Fry-light and similar brands are great), or put oil in little spray bottle (of the kind that you might buy for haircare) yourself.
    • (works with anything that can be shaken vigorously without harming it, e.g. root vegetables) chop the food, and put it in a tub (or a pan with a lid) with about a tablespoon of olive oil. Don’t worry if that looks like it’s not nearly enough—it will be! Now’s a great time to add your seasonings* too, by the way. Put the lid on, and holding the lid firmly in place, shake the tub/pan/whatever vigorously. Open it, and you’ll find the oil has now distributed itself into a very thin layer all over the food.

    *About those seasonings…

    Obviously not everything will go with everything, but some very healthful seasonings to consider adding are:

    Garlic and black pepper can go with almost anything (and in this writer’s house, they usually do!)

    Turmeric has a sweet nutty taste, and will add its color anything it touches. So if you want beautiful golden fries, perfect! If you don’t want yellow eggplant, maybe skip it.

    Cinnamon is, of course, great as part of breakfast and dessert dishes

    On which note, things most people don’t think of air-frying:

    • Breakfast frittata—the healthy way!
    • Omelets—no more accidental scrambled egg and you don’t have to babysit it! Just take out the tray that things normally sit on, and build it directly onto the (spray-oiled) bottom of the air-fryer pan. If you’re worried it’ll burn: a) it won’t, because the heat is coming from above, not below b) you can always use greaseproof paper or even a small heatproof plate
    • French toast—again with no cooking skills required
    • Fish cakes—make the patties as normal, spray-oil and lightly bread them
    • Cauliflower bites—spray oil or do the pan-jiggle we described; for seasonings, we recommend adding smoked paprika and, if you like heat, your preferred kind of hot pepper! These are delicious, and an amazing healthy snack that feels like junk food.
    • Falafel—make the balls as usual, spray-oil (do not jiggle violently; they won’t have the structural integrity for that) and air-fry!
    • Calamari (vegan option: onion rings!)—cut the squid (or onions) into rings, and lightly coat in batter and refrigerate for about an hour before air-frying at the highest heat your fryer does. This is critical, because air-fryers don’t like wet things, and if you don’t refrigerate it and then use a high heat, the batter will just drip, and you don’t want that. But with those two tips, it’ll work just great.

    Want more ideas?

    Check out EatingWell’s 65+ Healthy Air-Fryer Recipes ← the recipes are right there, no need to fight one’s way to them in any fashion!

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