The legal framework that governs our practice is not always reflective of the real world issues we navigate, and, as I’ve recently come to learn, such is the case with back injuries. 

Back pain is one of the most common types of pain that human beings suffer, so it’s no surprise that it is one of the most typical injuries that we assist clients with. It’s easy for the groupthink de jour to dictate the framework that we, our opponents, judges, and jurors understand back injuries. Such groupthink concepts include the fact that a true back injury is caused by a certain pathology, and that can be seen on a diagnostic study (such as a disc herniation shown by an MRI), or that there is a therapeutic framework for recovery from back injuries and one need to little more that follow that roadmap to recovery.

Suffice it to say that my mind was a bit blown recently to learn that accepted framework for understanding back injuries is not nearly as settled as it may seem. Dr. Stefi Cohen, in an interview on the Tim Ferriss Show Podcast, explained just how much we still have to learn about back injuries.

Dr. Cohen, who also happens to be a world record holding power lifter, explains that despite the fact that back pain is one of leading cause of disability in the world, there is no discernable cause for pain in 95 to 99 percent of cases. The validity of a back injury is therefore not dictated by the existence of a diagnostic finding, such as a bulging disc. Back injuries also likely require a much more personalized approach to healing than the therapyàinjectionsàsurgery framework often used in the medical community to and then accepted as fact by the legal community. As advocates, we must also venture to build cases recognizing that a binary picture of medical causation not always going to be apparent for back injuries.

Of course, the challenge for us, operating in a world of a ‘reasonable degree of medical certainty’ and burdens of proof, an established framework of understanding gets you places in terms of doing what you need to do to prove your case. The challenge becomes demonstrating the legitimacy and severity of back injuries where the pathology causing the pain and injury is not obvious – which is more often the case that is widely appreciated.

I would urge anyone practicing in this area to give the episode a full listen.

Dr. Stefi Cohen — 25 World Records, Power Training, Deadlifting 4.4x Bodyweight, Sports Psychology, Overcoming Pain, and More (#491)