Let's imagine two people. Call them what you want. Let's use "R" and "J" for now.

R is someone who exercises regularly.
J is someone who never finds time for it.

R watches what they eat. Not perfect, but they make an effort.
J relies on fast food and takeaways.

R does a job they wanted to do because they wanted to work outdoors.
J works all hours, under constant pressure, with little activity.

R has a couple of drinks at the weekend.
J drinks every day.

R hasn't smoked since a few cigarettes as a student.
J smokes 10 cigarettes a day.

R pays attention to their sleep routine and gets 7 hours each night.
J stays up late, on the internet, and regularly feels like they've not slept well.

R drinks plenty of water and a few coffees per day.
J is always picking up energy drinks, perhaps since they didn't sleep well.

Would you say you now have a picture of how R and J?

Some questions

Who, out of R and J, might you expect to develop diabetes?

Who might you expect to suffer a heart attack or stroke later in life?

Who is more likely to develop cancer?

The mystery

The chaos of human biology and medicine makes it impossible to understand exactly how our bodies manage to exist within their environments, and whether they thrive or not.

From the top-down, we can identify certain traits amongst groups of people that might predispose to certain outcomes.

But from the bottom up, we just can't tell individuals what they will each go on to develop with any degree of certainty.

What to do?

The first thing to note is that not everything can be changed. Patients can't just give up pressured jobs. People with responsibilities to care for others can't just disappear to the gym every day. Sadly, better quality food often costs more than the less healthy options.

The best thing we can do is load the dice in our favour.

What we eat and drink, how we exercise and sleep, are powerful tactics. But even sticking to the "best evidence" won't stop every individual from getting ill or developing a disease. 

If you're trying to influence a population, however, you can see the motivation for promoting healthy diets and regular exercise, smoking cessation, less alcohol. We can perceive how these tactics might dissolve into the population, leading to better overall health. 

What's this got to do with Back Pain?

Think about R and J again.

Might one of them be more likely to develop back pain?

I would suggest that one of them is more resilient to certain initial causes of injury. One of them is seemingly in a better physical condition and therefore should have a better chance of brushing off an innocuous incident that might cause injury to the other.

Alternatively, let's consider that they both have the same injury; the same damaged muscles and ligaments, and the same amount of joint inflammation. Which of them might you expect to heal more swiftly? I think the answer is fairly clear.

Living in your environment

The best we can do is to strive to live well in our own environment.

That means eating well, watching our consumption of the treats in life. Our bodies need to be used, so exercise is good. If we are in good condition, then we should profit from it.

We should all try.