My goodness, is there really only one cause of back pain? Many things combined can and do cause back pain, and the end result is one feeds off the other and they do that very, very quickly.

Let's see for me.

1. original pain came on suddenly overnight, and increased day by day to an impossible ability to function.
the end result would have been emergency surgery due to cauda equina syndrome if I had not been scheduled for spinal decompression surgery the next day.

2. original MRI showed severe nerve compression in the lateral recess area of the L4/L5 causing severe pain.

3. conservative treatments all failed and surgery was done to widen the lateral recess area and thereby relieving the compression on the nerves and ending the cauda equina syndrome involving my bladder.

4. during that 4 month period of time, weight gain from inability to walk more than 20 steps without all but collapsing in pain added to the problem.

5. post op and recovery, I lost the extra 20 pound, plus an additional 20 by just being able to return to a functioning life.

6. prior to the surgery and initially post op, muscles where weakened and begun to atrophy from lack of use, that put my entire body off balance.

7. 10 week round of physical therapy to strengthen core muscles, quads, hamstrings etc. solved all of that problem and had me functioning at 99% level prior to the sudden onset of spine issues.
The 1% not returned has to do with other issues totally unrelated to any spine issues.

8. second spine issue the result of sudden breaking while a passenger in a car, cut off by a car going through a red light. caused a disc bulge in the L3/L4, that was causing compression of the nerves.

9. MRI showed the disc bulge and of course some narrowing of of the central foramen and some arthritis. The result of normal age degeneration and the fact that I am not very tall, under 5 feet. That causes problems in itself.
The shorter you are, the smaller the vertebrae in your spine. The smaller the vertebrae, the less room for the spinal nerves to pass through.
Because of the size of the vertebrae, injury and narrowing that may not cause a problem in a taller person, is a serious problem in someone that is short.

10. a second decompresion, microdisectomy and widening of the central foramen solved that problem.

11. another round of physical therapy for 10 weeks solved any weakness that developed from lack of use for a few months before surgery.

Most times, Awaq, when one develops spine issues, there are no simple, this caused it, that caused it, but it is a multitude of unknown issues that all combine to then create a problem.

Some people require surgery to correct the spine issues, others can heal with physical therapy and other conservative treatments.

Some people are born with congenital deformities that create a problem, and it is now found that many spine issues can be genetic in nature as well.

And there are many, many young people that suffer from serious spine issues as well.

There is some belief that the increase in children involved in sports at a very young age, that play only one type of sport all the time year round, put a serious strain on their spine and other muscles, joints, tendons and ligaments, have caused and increase in spine issues, especially in teens and young adults.

There are far too many things that combine into one that can create spine issues, that attempting to single out any one thing is a real waste of time.

As we age, the body does degenerate and the spine is one of the first thing to go.

Evolution has done wonders in the world, but it forgot one simple thing. Man's spine has not evolved as it should have.

We walk upright on 2 feet, but the design of our spine is not for walking upright on 2 feet.
Therefore, the problem with spines in human beings. Not much we can do about the design of our spines, but to try and take care of it.

Prolonged sitting should be avoided, one should get up and walk around for at least 5 minutes every hour or so.

Prolonged standing is not good either.

Good posture is important as well.

Good diet, not smoking, drinking an adequate amount of fluid that is not a diuretic is important in overall health, trying to maintain proper weight as well.

BUT, and this is important, AWAQ, one can do all of those things and it still won't make a difference in what happens to one's spine.

Some people are just prone to spine issues and no matter what they do or attempt to do, it will not make a difference.

Case in point would be myself and many people that I know personally.

Fran

Fran, thank you for the insightful post. I agree spine issues can be congenital. Yours sounds like that, at least on the surface. Basically you had pain, MRI showed a problem area, surgery fixed the problem, and the problem never returned - except because of something unusual like a car accident.
I agree some people are born with a tendency for back issues. They could have inherited a weak back or maybe the problem is they inherited their father's poor posture. This is no different than people born with allergy issues. While some people can eat anything they want, other are born with an intestinal weakness where eating nuts will give them diverticulitis and they could die.
For congenital birth defects in the spine I can see how chiropractic, acupuncture, massage, etc. could reverse these problems. But, if the problems return I would say the problem is a matter of lifestyle, and not simply a "birth defect".
My friend has never had any success with P/T except when he broke his shoulder. They key here is that his shoulder was functional before the accident and P/T simply returned him to a functional state. If someone has a chronic issue, the solution becomes much, much more difficult to resolve.
While some say we weren't born to walk on 2 legs, I'm going to take a more positive approach and say while some may have a tendency for pain, with proper attention, they do not have to lead painful lives anymore than someone with asthma can never exercise. Sure they can. But they will have to work harder at managing their condition.
Read Esther Gokhale's "8 Steps to a Pain-Free Back" for examples of how primitive cultures show no back degeneration. Even at age 55.
So if we weren't designed to walk upright, how come so many people don't have any back pain? How do you come to the conclusion that our spine was not designed for walking upright? I am going to take the positive approach that God designed the human body correctly, and if we use it correctly - as God intended, we will not have pain. At least not to the extent that society suffers from it today.

You make excellent observations here:
"Prolonged sitting should be avoided, one should get up and walk around for at least 5 minutes every hour or so.

Prolonged standing is not good either.

Good posture is important as well.

Good diet, not smoking, drinking an adequate amount of fluid that is not a diuretic is important in overall health, trying to maintain proper weight as well.

BUT, and this is important, AWAQ, one can do all of those things and it still won't make a difference in what happens to one's spine. "

And this is exactly why P/T has such a poor success rate. Part of the problem is we live in such a dysfunctional society. Even if P/T works, after our 30 minutes of P/T, getting all straightened out, we have to go right back to our dysfunctional lifestyle of sitting at a desk for the next 8 hours. Then sitting on the couch watching T.V. until bedtime. We used to walk as a part of living. Now we have to make a conscious decision to get off the couch and take a walk. We now have the opportunity to make more decisions on how we live and usually make the wrong choice. Our society forces us into dysfunction. We are forced to sit or stand in one place as part of our job. That's no problem with someone born with a strong back. But it is a problem for someone born with a weak back.
I love going into the doctor's office where every inch of wall space has a chair. The only space is behind the door so you can open the door. Believe me, I know this because sitting kills my back and I would be grateful for a few inches of open wall so I could stand or lean against the wall. But doctor's are so clueless they promote further injury. Instead of teaching people the dangers of sitting, they literally force you into dysfunctional positions. Sometimes I lie right down on the floor because I REFUSE to hurt my back more.
If we live motion filled lives our bodies will naturally acclimate to health motion patterns. If we don't, our bodies will quickly let us know. If we are sedate, there is no feedback so the problem goes on for years or decades before it gets so bad that we finally notice. Then one day we wake up with pain and wonder "Where did that come from?". By then the dysfunctions are so ingrained, and they are different for each person, it takes a genius to figure out what is going on. The problem is insanely complex. And backs are not like a hip. It's no so easy to just pop in a new one.

So why do no therapies help most people? Because they are akin to saying "Food is good for you". But we know better, right? Shellfish can kill someone who has an allergy. Likewise therapies that provide generic, cookie cutter, one-size-fits-all treatments are pretty worthless. Some do the shotgun approach and prescribe everything in the book hoping something will hit the spot.
Fran, would you be willing to follow me through some examples? We all know that ab work is necessary to treat back pain because strong core muscles support the spine. So everyone should do ab work, right? First let me ask, how do you know weak abs are the cause of the problem? Do you lift heavy weights? Play sports? So how strong do your abs need to be? Let's go ahead and assume weak abs are the problem even if you are not super athletic.
How do you know abs work will hit your dysfunction in the correct way? Say your problem is a tight psoas muscle and you choose to do full situps with feet hooked under the couch. You come up with an arched back because it feels good and your psoas are already super strong and tight so you naturally work the abs in a way in which you are already strong. But this furthers your dysfunction. Gee, ab work didn't help, I wonder why.
Or say you've been told decompression is good. But what happens if your right psoas is strong while the left is weak / inhibited. Now go ahead and pull on your back. What do you think happens? The right pulls back and gets stronger while the weak, left side gets ripped apart even more. That's the direction you body is aimed in. Do you really think decompression will change that trend?
Or say you have no motion at L4/L5 while L3 is hypermobile. Now pull on the spine. What happens? Chance are the body continues just like it have been. Hypermobile L3 gets yanked apart even more while L4/L5 stay locked up and those tight muscles tighten down even more. So decompression hurts the person with these dysfunctions even more.

In your case, like most people here, they go by what they see on an MRI and never stop to think that discs don't just spontaneously herniate. Something caused it.

So I think back pain is caused by:
1) Muscle tension. For example:
To remain viable and functional cartilage (fiber cartilage like discs or hyaline cartilage like what covers joint's surfaces) must not only be squeezed but especially released. There is no blood flow at the surface of a joint as blood vessels are too delicate to withstand the pressure at the surface of a joint. Instead hyaline cartilage (like fact joints) joints receive their nourishment from a thick liquid called synovial fluid.
Discs are 88% water and act like a sponge. They receive their nutrition by imbibing nutritive fluid. When squeezed, unwanted waste fluid seeps out. When the pressure is released, nutritive fluid is absorbed back into the disc.
In the chronically tense person (and this goes for static postures as well) the muscles of the back never relax, the discs never imbibe their nutritive fluid, and disc degeneration results.
2) Imbalanced muscle tension. These may be visually observed by postural deviations. Note that imbalanced muscles create areas of high tension and opposing areas of low tension. This sets the person up for injury when experiencing a high impact from a car accident, football tackle, or slip on ice.
3) Lack of motion.

The ultimate cause of your back pain is also the ultimate solution. Everything else is just a band-aid. It is so frustrating that people come on this site and all they talk about is what has shown up on an MRI (Meaningless - Resonant - Imaging) film. Did you know:

***** There is virtually NO correlation with what shows up on an MRI and people's pain. *****

There are just as many people walking around with herniated, bulging discs, who have no pain. Films are useful so a surgeon knows where to cut. Do you want to know the cause of most people's pain? It's staring you right in the face. Look at the person with the rounded shoulders or a twist to the spine. There's your diagnosis. There's your cause of pain.

Yes, your back can be so far gone that only surgery can remove those bone spurs that are compressing the nerve. Or you have such a dysfunctional lifestyle, sitting all day, that there is no hope of returning to a healthy lifestyle where the body can heal itself.