Has your back really “gone out”?

Do you think you’ve “put your back out”, or “thrown your back out”?  If it went out, where did it go?  Which part went out?  These phrases are so much part of our culture, but what do they really mean?

I guess the phrase may have originated from someone in pain looking in the mirror and saying “my back is out” i.e. out of alignment/not straight.  But whatever its origins, the phrase leads to all sorts of misunderstandings and many clinicians (including me) have been guilty of allowing the myth to continue (some even actively promote the myth) – NO MORE!!

Sudden movements, or even slow movements often precipitate an onset of back pain.  This may give the impression that you’ve “thrown your back out” or “put your back out”.  It’s a descriptive phrase that seems to match what you feel.  But when you say “there’s a red hot poker jabbing into my back”, there isn’t really, is there?  So, just because it feels like you’ve “thrown/put your back out”, doesn’t mean you have literally thrown/put something out.

What do people think they’re putting out?  I’ve had patients think that a vertebra or a disc moves out of line and gets stuck.  This is a very attractive concept, because it’s easy to understand and a lot easier therefore for any clinician to explain.  But X-Rays and MRIs confirm that putting a vertebra out of place only happens in extreme trauma, and would likely result in paralysis below that level due to pressure on a number of nerves (in the lower back).  Any significant misalignment would put a pretty disastrous amount of pressure on these nerves.  Bits of the discs can bulge or prolapse out (and push on one or more nerves), and if you’d like to know more about discs read this.  But this isn’t really what people mean by “put my back out”.

So what does happen when you get that sensation of “putting your back out”?  There are lots of possibilities – muscles, ligaments, tendons, and joints all have a rich sensory nerve supply, and any one of them may give you a sensation that something has gone amiss (often including pain).  That DOES NOT MEAN THAT SOMETHING IS NOW OUT OF PLACE / MISALIGNED / SLIPPED or any other description you may choose to use.  Perhaps “gone wrong” would be more accurate, while I’ll admit it seems annoyingly vague…  There are lots of things that could cause you to feel that something’s gone wrong in your back, but don\’t confuse that with something “going out” – it doesn’t happen!

Diagnosis is an art-form when it comes to back pain.  There are clear dangers in over-simplifying it.  So, if you believe your back has “gone out”, next time you’re in seeing me, just ask me what’s really gone wrong with your back, and I’ll give you the slightly more complicated answer 😉





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