It happens. One moment you're fine, the next you're not.

As well as dealing with your symptoms, you start to wonder how you got into this state.

No single thing

Let's take back pain. Patients often ask their clinicians why they have been given the gift of back pain.

• Was it bad posture?
• Was it from lifting and twisting?
• Was it because of a weak core?

If you're looking to identify a single cause of an injury, you are going to struggle. Researchers will tell you that they find it hard to demonstrate in a rigorous manner that any of these factors directly cause back pain. 

And this leaves people confused.

Correlation is not causation

A common trap we fall into is correlating events that happen close to each other, labelling one as being the cause of the other.

Some examples:

• More ice cream sales lead to more shark attacks
• Vitamin D makes you live longer
• Breakfast is the most important meal of the day

These are all examples of correlation, not causation.

• When the weather is hot, ice cream sales soar. More people also swim in the sea. You figure the rest.
• It's a good thing for us all to take vitamin D, but researchers have often mistaken low vitamin D in hospital patients as a cause of their illness, when in fact, it's a response to having spent time in a hospital, with no sunlight exposure (and questionable nutrition).
• Similarly, when researchers tried to back up Mr Kellogg's claim about breakfast, they identified that patients in a hospital who finished their breakfast did better. But think about it. Many people in hospital are in a bad, bad way. And breakfast might not be top of their priorities.

A better way of thinking?

Let's not get too deep, but a better way of looking at things is to consider dispositions.

A back pain patient will have certain dispositions. For example, their weight might or might not be an issue, and their career and sporting activities will likely have an impact on their physical health.

How they think about back pain, and how they react to it will be individual to them, and shaped by their life experiences and surroundings. 

Whether they have supportive friends and family will matter, and any caring duties must be considered, such as for children or relatives.

Already, we see a much richer view of the world and especially the world around our patient.

Does this help?

It might seem complicated to construct such a fragmented view of a person, and you may think that we're missing the bullseye of what to do, what to blame.

But in fact, we're making a plan. Each of the factors that we can identify in others, or even in ourselves, can be targets for change.

If we can help a patient identify a handful of realistic targets, they can take action and be part of their recovery. So can you.

Let's not waste time dwelling on should haves and could haves, but instead be constructive and start working the problem together.