man touching lower back in pain

Understanding Pain: Why do we “pick the scab?”

Abbie SawyerThe Research

man touching lower back in pain

Photo from Google Images

Back pain is the #1 cause of disability globally, with 50-80 percent of the adult population experiencing back pain at some point in their life (1). This means there is a high likelihood you will, at some point in your life, experience an episode of back pain. To many, back pain can seem mysterious. It can be difficult to comprehend why you went from pain free to unable to bend over or move without pain. As physicians, our goal is to improve your understanding of your condition and build confidence that you will overcome it.

The following information is an excerpt from a great book meant for the non-physician to help resolve their own back problems. The book is by Stuart McGill, PhD and is called “Back Mechanic: The secrets to a healthy spine your doctor isn’t telling you.” The aim of the book is to remove the stressors and improve your spine health with proper movement and strengthening exercises. 

Excerpt from “Back Mechanic”

“Many back pain sufferers would experience a huge breakthrough in their recovery if they only realized that it was their flawed movement patterns that kept them pain-sensitive. Much like a scab forming on our skin, our backs are constantly trying to patch and health themselves. We, however, by continuing to repeat harmful movement patterns in our daily lives cause re-injury. We are essentially “picking the scab.” It is unreasonable to expect the body to heal if we continue to provoke it in the same way that led to the original injury. Continued provocation of pain sensitizes the nerves so that the pain is triggered with even less stimulation. Remove the provocative motions and we can find the solution. 

Here’s how pain sensitivity works: people increase their sensitivity through repeated stressful and painful loading. These muscles and joints are loaded with sensors: pain sensors, pressure sensors, force sensors, chemical sensors. Some detect carbon dioxide; some detect pain, some sense histamine for inflammation. Human joints are packed with sensors that relay position and movement information to the brain. These signals travel along the sensory nerves. Along the highway of nerves, there are checkpoints or “gates,” at junctions. According to the Gate Theory of Pain, the idea is to flood the checkpoint with “good information,” in other words, signals associated with pain-free movement. In this way, there is no more room for the pain signals as they are crowded out. 

Try this: close your eyes and find the tip of your nose with your finger like in a roadside sobriety test. You are using kinesthetic sensory organs that run throughout your arm to navigate. These sensors alert the brain as to the position of your forefinger in relation to your nose. The sensation of this simple pain-free motion dominates the information traffic on your sensory nerves with feel-good kinesthetic sensory information that identifies position, length, and force. Finding and repeating pain-free motions in your back will cause the remaining painful activities to hurt less. Read the previous sentence again – it really is that important.

By discovering and ingraining positive movements for your back, you will find that the pain often dissipates and then disappears entirely. This is because when we remove pain triggers and stop “picking the scab” we give our tissues a chance to rest, heal and regenerate. Simultaneously our sensors for pain are actually being desensitized. Master this, and you have mastered your back pain.”

Avoiding pain by avoiding aggravation

Another analogy to think about is a paper cut on the back of your finger. Every time you go to bend your finger, it reopens the cut and delays healing. If you avoid bending the finger too much, it gives the finger a chance to heal so that you can regain pain free movement.

“For those of you that have a known type of injury, a name to attach to your condition, your personal recovery strategy should always begin with avoiding the aggravating posture for your unique spine. This is key to getting yourself back on track. 

Various symptoms of back pain have a distinct and known cause (although this information is not widely known). Injuries can be avoided if we avoid the injury mechanism itself. Here’s a recap of some pain avoidance strategies, as well as an introduction of some that will be discussed later. This information will provide the foundation that can help you: 

  1. Locate and eliminate the cause of your pain–get an appropriate assessment that provides a specific diagnosis. 
  2. Increase your consciousness around what movements and postures cause you pain. 
  3. Develop replacement postures and movement patterns that enable you to function pain-free. 
  4. Stabilize your torso, core, and spine to remove painful spine joint micro-movements.
  5. Develop a daily exercise plan that includes walking. 
  6. Mobilize your hips.
  7. Learn to create power at the ball and socket joints (hips and shoulders). 
  8. Learn exercises that are based on patterns of movement: push, pull, lift, carry, lunge, squat, etc. 
  9. Make healthy spine choices when sleeping, sitting, or engaging in more demanding activities.” 

If you are experiencing pain or an injury, let us guide you through the treatment process to get you feeling good again.


  1. Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., Hoy, D., Karppinen, J., Pransky, G., Sieper, J., Smeets, R. J., Underwood, M., Buchbinder, R., Hartvigsen, J., Cherkin, D., Foster, N. E., Maher, C. G., Underwood, M., van Tulder, M., … Woolf, A. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356–2367.

Adapted from the Chiropractic Success Academy.

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