Almost a million people in the UK are now too sick to work because of back or neck pain, according to a recent Guardian article. This number has apparently increased by 28% in the last four years.

Over the last few weeks, The Guardian newspaper has devoted several articles to the topic, but there has been a fair degree of ‘missing the point’. The elephant in the room – barely acknowledged by these articles – is what modern pain science tells us.

I’ll come to that at the end. But first, let’s see what The Guardian reports have been saying.

Four main reasons for the increase in back and neck pain (according to The Guardian)

The main reasons given were:

  • change in work patterns. Since the pandemic, more people are working from home. The result is more sedentary behaviour combined often with the wrong home ‘set-up’ (chair, desk, computer etc).
  • unhealthy lifestyles. There is evidence linking lower back pain and obesity.
  • people working longer into old age. Older working people are more likely to be living with multiple chronic conditions. In addition, there is now a large number of ‘baby boomers’ who are approaching retirement.
  • lack of access to treatment. Long NHS waiting lists mean that people are unable to access the help they need. The problem gets worse over time, and more people than ever are going to A&E with neck and back pain.

Five ways to avoid neck and back pain (according to The Guardian)

At the same time as the above, The Guardian published a feature article listing five ways to avoid back pain. These were:

  1. get active. Regular aerobic exercise is ‘probably the best prevention’.
  2. quit smoking. Smoking could itself lead to back and neck pain because it decreases blood flow to the intervertebral discs.
  3. ditch the chair. There is ‘a lot of evidence’ that swapping chairs for a height-adjustable standing desk can reduce back pain among workers.
  4. take care while lifting. Apparently, 300,000 people in the UK experience back pain each year as a result of ‘manual-handling accidents’.
  5. if pain strikes, do not stay in bed. Resuming activity is important because otherwise postural muscles weaken, and this can extend the overall period of disability.

20 ways to treat back pain (according to The Guardian)

And then, a couple of weeks later, The Guardian published another article, listing osteopaths’ views on 20 ways to treat back pain. I won’t list the 20 ways here, but a lot of the emphasis was on aspects such as movement, exercise, working on ‘the core’ and using heat or ice packs.

Missing the point?

As I mentioned at the start, the ‘elephant in the room’ is that little in these articles seems to have been informed by modern pain science.

In recent years, there has been a shift in scientists’ understanding of pain. There is now a recognition that pain is caused by the interplay of biological, psychological and social factors, and that there is not a direct link between physical damage and the experience of pain. This is especially the case in a condition such as low back pain, where pain can persist even when there is no (longer) evidence of tissue damage. This means that to focus solely on the physical – for example with simple stretching or strength-based approaches – is missing the point.

Due to overwhelming evidence, the previous mainstream approach – known as the biomedical model – has been superseded by the biopsychosocial model. The difference between the two is chalk and cheese, and the implications for modern approaches to treatment are huge.

Although The Guardian articles make occasional references to areas such as stress, sleep or mental health, the underlying assumption is that back and neck pain are a ‘physical’ problem and require a ‘physical’ solution.

In contrast, if you want to get up to speed on the implications of modern pain science for back and neck pain – how psychological and social factors are equally as important – you can read my summary of the topic here.