Our ancestors had low back pain too

You have to go much, much further back than industrialisation to avoid it.

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Stand up from your desk, stretch and regret the sedentary career that condemns you to a lifelong backache.

Picture with a rose-tinted imagination a pre-industrial bucolic lifestyle full of fresh air and honest, physically tiring labour.

Nup. According to this paper in Proceedings of the Royal Society B, traditional forager-farmer lifestyles were absolutely as rife with pain as ours, despite our supposedly novel and unnatural daily practices.

“Compared to rural subsistence settings,” the authors write, “in high-income urban settings the relatively high levels of physical inactivity and atypical mechanical loading patterns (e.g. from prolonged sitting in chairs at school or work; sleeping on soft mattresses; and walking on shoes with cushioned heels) are hypothesized to increase risk of pain.”

Obesity and the use of analgesics and anti-inflammatory drugs are also novelties associated with chronic pain, thanks to a proposed “mismatch” between modern life and our evolutionary past.

To test this, the researchers talked to the Tsimane people, who live a semi-sedentary hunter-farmer life in villages in lowland Bolivia. They hunt and fish with an array of modern and traditional tech, from guns to bows and arrows and machetes, and farm rice, plantain and other crops on a small scale. Women have an average of nine childbirths and carry their children around in slings, and both sexes do a lot of hauling around of crops and game products on foot.

Musculoskeletal and connective tissue problems are their most prevalent health issues, according to a long-running health study.

The present research team interviewed about 400 villagers over the age of 10 about their experiences of pain, and the women also about their reproductive history, which has been proposed to increase women’s susceptibility to pain.

They found 87% of villagers had at least one source of current pain, and 35% had chronic pain of more than three months’ duration.

Back pain was the most prevalent type of both chronic and acute pain.

Age brought increasing pain, but sex differences were non-significant and pain was not associated with reproductive history.

The Tsimane attributed their own pain to physically intensive subsistence work in more than 70% of cases, with horticulture the biggest single cause (30%) followed by load carrying, then food finding.

Horticulture as baddie reminds the Back Page of an idea we encountered in Yuval Noah Harari’s mind-altering book Sapiens: A Brief History of Humankind, though we don’t know whether he originated it:

Rather than humans domesticating wheat, what if wheat domesticated us? The grain got a better deal in terms of massively increased genetic propagation, thanks to slavish labour and attention from humans. Those humans, who were used to running around after animals for a bit and taking the rest of the week off, became bound to one place and now spent their days hunched over in a field, their diets narrowing from a mix of meat and vegetation to one depending mainly on porridge.

This is a romantic simplification and we know that the transition from hunter-gatherer to farmer wasn’t either/or, but this was still the biggest break between what our bodies had evolved to do and what they hadn’t.

The authors surmise that chronic nonspecific low back pain “may not be a ‘mismatch disease’ limited to post-industrialized populations”. Instead, pain “is reliably associated with overuse, underuse and misuse of the musculoskeletal system across human populations”.

It seems you have to go back well past the industrial revolution, past even the agricultural revolution, to find the true origin of our perpetually sore backs.

Spinal disease is rare in quadruped primates, the authors write, suggesting that the transition to walking upright is where it all went wrong: “Hominin musculoskeletal changes supporting bipedalism likely imposed at least some health costs, which, after millions of years of evolution, remain a significant epidemiological burden that can be exacerbated by modern conditions.”

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