Dr. José Sion Cantos

Back pain: inheritance of evolution

Studies show that around 25% of the Brazilian population suffers from chronic low back pain, the famous “back pain”, when low back pain lasts for more than three months is considered “chronic”.

The development of chronic low back pain as well as most chronic diseases will depend on the presence of risk factors, among them we can mention overweight and obesity, working daily in a sitting position (drivers, seamstresses, work in offices), smoking, advanced age , depression, working lifting heavy loads, housework and a sedentary lifestyle.

In Latin America, the incidence of chronic low back pain is around 16% in populations with few risk factors for low back pain and 65% for groups that have many of the aforementioned risk factors.

It is considered that over 80% of the adult population may experience low back pain at some point in their lives. Around 40% of these will turn into cases of chronic low back pain.

In addition to the suffering it causes in millions of people around the world, low back pain is the biggest cause of absence from work (absenteeism) both in Brazil and in the rest of the world.

In Brazil, 270 workers get sick assistance every day because of back pain, which means a leave every 5 minutes.

Evidently, in addition to the individual medical situation of each patient with back pain, there is a problem for the health system as a whole, a problem for social security and a high financial cost for companies.

Although chronic low back pain can have many causes, the most frequent cause is related to degenerative processes and wear of the spine as a whole and in particular the lumbosacral spine. Bone wear of vertebral bodies, vertebral joints, degeneration and rupture of intervertebral discs, ligament overload and paravertebral muscle overload are related to the presence of back pain.

There is no doubt that the spine is the “Achilles heel” of the human species.

In recent decades, the anthropological hypothesis has emerged to explain this fragility of humans.

The biped and upright posture of humans is an adaptation that arises from the separation of the hominid lineage from the chimpanzee lineage approximately 6 million years ago.

It takes about 4 million years for humans to spread from Africa to Eurasia and the subsequent evolution of different human species. It is worth remembering here that it is difficult for us humans, who generally live less than a century, to imagine what can happen to a given species after a million years or several million years.

All the anatomical changes (bone, muscular, neurological) that took place in primitive men and that led to upright walking, gait and running took place in an environment of savannas and woods that no longer exists. This means that our bodies were shaped by natural selection for an environment different from the one we inhabit.

In general terms, we can say that humans adapted a musculoskeletal system from a quadruped to the bipedal posture, and the main problem derived from this was precisely the change in the center of gravity precisely to the region of the lumbosacral spine.

Due to this, the lumbar spine was subjected to a regime of increased load, stress and wear. Disc hernias are caused precisely by a series of compressions and wear of the vertebrae and intervertebral discs.

The study of the diseases of our ancestors and the adaptive changes over millions of years has given rise to a new specialty of medicine called Evolutionary Medicine.

Thanks to this, today we can understand, for example, that there are genetic variations in human groups less adapted to the bipedal posture, which have a greater facility for developing vertebral disc hernias.

Although each case has its particularities, the best way to reduce the symptoms of your chronic low back pain is to combat risk factors, reduce overweight, start physical activities under professional guidance, stop smoking, adopt changes in posture, which often requires adequate ergonomics of chairs and tables, avoid carrying weights, correct posture when sleeping with an adequate mattress and leaving the use of analgesics and anti-inflammatory drugs only for acute crises.

#pain #inheritance #evolution

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