We all know the stat: about 80% of people will experience low back pain at some point. It’s the leading cause of disability worldwide, and Americans spend more than $50 billion a year on it. Back pain is a real nemesis for many, a struggle that feels endless.
With so much attention and so many resources, why does low back pain still bother so many people? There isn’t a single answer. As my friend David Dellanave says, “different stuff is different.” It’s impossible to point to one or two culprits and say, “That’s why everyone’s back hurts.” We end up guessing based on a mix of anecdotes, experience, expertise, and research, but it’s still mostly an educated guess.
A while back, my friend and physical therapist Zak Gabor shared a thorough paper on managing low back pain. He summarizes it well: movement helps, but educating people about false beliefs about the body may be the most important part of the puzzle.
I recently watched a VICE News segment on opioid addiction, which included a former drug representative whose chronic back pain led him through a long list of treatments—massage, acupuncture, ultrasound, physical therapy, traction—and ultimately surgery, yet he still depended on pain meds. The piece showed him interacting with his family and, in a moment of bending to pick up a golf ball, reminded me how small daily movements can aggravate the back. The point isn’t to judge his experience, but to highlight how easy it is to miss simple, everyday “hammers” that can contribute to pain.
What I mean by hammers are not literal tools, but repetitive movements—endless spinal flexion and even extension—that start harmless and become harmful once tissue tolerance is exceeded. As my strength coach friend Joy Victoria emphasizes, habitual daily postures and movement patterns have more influence than the workouts we intentionally perform. Massage, ultrasound, and similar treatments can help briefly, but they’re only band-aids.
Strength and movement have a meaningful place in the bigger picture, but we must stay vigilant. Deadlifts aren’t a cure-all. Recognizing and correcting small, wonky movements can make a huge difference for those dealing with low back pain.
I sometimes wonder how the statistics would look if more people moved regularly or adopted different daily habits—like sitting in a deep squat versus relying on ergonomic chairs, which some cultures naturally favor. I’m not saying posture or chairs alone determine back pain, but culture and daily behavior likely shape the numbers in meaningful ways.
And yes, I even slip in a light pop-culture aside now and then—just to illustrate how easily we can connect back pain to everyday life and stories.
To be clear: I’m not anti-spinal flexion. The spine is meant to flex. I’m against spinal flexion when it worsens symptoms, and I’m against loaded spinal flexion as well.
