Toby was treating a patient recently who he has known on and off for a few years. The patient works in construction, nowadays supervising projects, no longer on the tools.

He was on-site that morning and told Toby that he had seen a younger chippy struggling with his back. He asked him if everything was ok, and his answer confirmed that he was in pain - perhaps we won't publish his actual words.

Toby's patient told the younger chippy to go see someone about it - to get some help and advice before his problem got worse. But apparently, the chippy didn't seem too keen on the idea.

Toby said to his patient:
"I bet I know what his answer was. I bet he told you that he was too young to have a bad back"

"That's EXACTLY what he said! How did you know?" replied the patient.

The Other BBC

It's fairly typical for younger people not to want to label themselves as having a bad back. It seems the territory of the elderly, or at least the middle-aged.

But why the label, and why does the Bad Back Club have so many members?

Back pain causes a strange reaction in patients. 

• If you had back pain 20 years ago, you probably tell people that you have a "bad back", despite the fact that you nowadays rarely have any pain.
• In contrast, if you twisted your ankle 20 years ago, you probably don't tell everyone that you have a "bad ankle".

It's also not uncommon for patients to blame new episodes of pain on historic injuries. A patient who has had back pain for the last fortnight might declare that a disc that slipped 10 years ago is causing the pain.

For start, discs do not slip. But more importantly, discs heal! They get better. They can be slow, but the body sorts them out. So you can not simply blame back pain on a disc injury that occurred 10 years ago. To be clear, there may be a link, but until it is investigated properly, it is only an assumption!

Painful or Damaged?

Here's a thought that Toby tells patients regularly:
"You do not have a bad back. It's a perfectly good back. But it hurts right now."

We must try to educate patients away from the notion that all pain indicates damage. Backs are particularly sensitive areas of our body - they have to be - they're important!

How common is it for people to have back pain for a few days, and for it to then settle and fully resolve? It's pretty common.

So can it be damaged? There isn't much bodily damage that heals in only a few days... There must be something else going on.

Alarm systems

Our nervous system looks after us. It protects us and warns us about potential hazards. And it does that when it suspects something might hurt.

Sometimes we can mildly irritate something, let's say in our low backs, but our alarm system will go crazy, setting off all the alarm bells, and lighting up your dashboard with warning lights.

But all too often it's a false alarm.

So should you ignore it? Absolutely not. You should be sensible, acknowledge the warning lights are on and test some movements carefully. Some TLC can help soothe things, and moderate activity and exercise can start to fill us back up again with confidence.

Of course, if those warning lights don't go off after a few days, then it might be time to seek advice.

But you're back might be perfectly fine. It's just hurting.