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Ever wonder why some people seem to suffer from back pain while others do not? Why are some people able to “cure” their back pain just by changing their lifestyle? What makes one person healthy in a certain situation, yet another person becomes unwell in a similar situation?

Scientists have been searching for answers to this question for centuries. And we may just have the answer…The latest evidence has divided the causes of health into so-called determinants. These determinants of health include a range of factors which can ultimately influence our health either positively or negatively.

The social ecological model (Bronfenbrenner, 1977) provides a complex yet intuitive way to understand how multiple factors influence human development, starting with the individual, moving outwards—interpersonal, organizational, community, and public policy. Each of these inter-connected layers shape an individual as well as the collective, and they in turn shape their environments. This complex interplay is exemplified in the context of health by what are called the social determinants of health.

Social determinants of health (Dahlgren & Whitehead, 1993), as the name implies, are a collection of factors whose interplay determine how healthy an individual (or a population) is. It is generally well researched and accepted that good health stems from the correct balance and interaction of these determinants, which are a person’s biology (age, sex, genetics), individual lifestyle factors (whether someone smokes or drinks, eats healthy or exercises or not), social and community networks (close ties with kin, social bond in a neighbourhood, etc.), and general socio-economic, cultural, and environmental conditions (i.e., everything else). The last category would include things like education, work environment, health care services or housing.

It may surprise you – but most of these determinants are modifiable to some degree! Can you change your genetics? Well, not really; however, the expression of our genes responds to changes in our environment. Certain genes are switched on or off depending on these environmental cues. For example, depending on the food we eat we can switch on different genes! This is called nutrigenomics. And it’s not just food which our genes can react to! Medications, hormones, light and temperature all affect the switching on and off our genes (Lobo, 2020). This entire field is termed “epigenetics”.

The determinants of health model is extremely useful because it shows us how to prevent most illnesses! Let’s apply it to back pain:

A. Genetics

1. Back pain can run in families.

2. The most common types of studies which examine genetic links to back pain are twin studies. These have shown that “wear and tear” to the spine can have a substantial genetic component (Battié et al., 2009).

3. Other studies have also shown that the genes which code for pain in our bodies are also inherited. These twin studies show that in some cases 50% of the differences in chronic pain may be attributed to genes (Fillingim, Wallace, Herbstman, Ribeiro-Dasilva & Staud, 2008).

4. But there is also ongoing research into the epigenetics of chronic pain which should help us identify which genes can have modified expression to decrease pain (Descalzi et al., 2015). The early research shows that genes may switch on after an injury and remain switched on long-term thus causing chronic pain.

B. Nutrition

1. The foods we eat can contribute to the health of our muscles and bones. Certain deficiencies or imbalances can lead to back pain (Elma et al., 2020).

2. We will explore in a future article the best diet to tackle and prevent back pain.

C. Lifestyle

1. This encompasses many factors from sleep to our daily routine. It also includes our mental health and stress levels. All these lifestyle factors can affect the strength of our muscles and bones and affect how we react to pain. Certain lifestyle factors like smoking and lack of exercise can contribute to causing back pain (Dijken, Fjellman-Wiklund & Hildingsson, 2008).

D. Environment

1. The work environment is a very common cause of back pain (Xu, Bach & Orhede, 1997). This includes the activities we may be asked to do at work and the effects of sitting in the office or standing on our feet for long periods of time, depending on our jobs.

Here at Doti Health we are passionate about preventing back pain by optimising these determinants of health. Through our future blog articles, we will be exploring these determinants and how we can optimise our habits and modify them to help deal with and even cure back pain. Although our blog posts will be specific to back pain, these tips will help improve your health in general, too!


Battié, M., Videman, T., Kaprio, J., Gibbons, L., Gill, K., & Manninen, H. et al. (2009). The Twin Spine Study: Contributions to a changing view of disc degeneration†. The Spine Journal, 9(1), 47-59. doi: 10.1016/j.spinee.2008.11.011

Bronfenbrenner, Urie. “Toward an experimental ecology of human development.” American psychologist 32.7 (1977): 513. doi: 10.1037/0003-066X.32.7.513

Dahlgren, Göran, and Margaret Whitehead. “Tackling inequalities in health: what can we learn from what has been tried.” Working paper prepared for the king’s fund international seminar on tackling inequalities in health, 1993. Retrieved 25 July 2020, from

Descalzi, G., Ikegami, D., Ushijima, T., Nestler, E., Zachariou, V., & Narita, M. (2015). Epigenetic mechanisms of chronic pain. Trends In Neurosciences, 38(4), 237-246. doi: 10.1016/j.tins.2015.02.001

Dijken, C., Fjellman-Wiklund, A., & Hildingsson, C. (2008). Low back pain, lifestyle factors and physical activity: A population based-study. Journal Of Rehabilitation Medicine, 40(10), 864-869. doi: 10.2340/16501977-0273

Elma, Ö., Yilmaz, S., Deliens, T., Coppieters, I., Clarys, P., Nijs, J., & Malfliet, A. (2020). Do Nutritional Factors Interact with Chronic Musculoskeletal Pain? A Systematic Review. Journal Of Clinical Medicine, 9(3), 702. doi: 10.3390/jcm9030702

Fillingim, R., Wallace, M., Herbstman, D., Ribeiro-Dasilva, M., & Staud, R. (2008). Genetic contributions to pain: a review of findings in humans. Oral Diseases, 14(8), 673-682. doi: 10.1111/j.1601-0825.2008.01458.x

Lakhotia, S. (2015). Book Review- Integrative Approaches for Health: Biomedical Research, Ayurveda and Yoga. Proceedings Of The Indian National Science Academy, 81(3). doi: 10.16943/ptinsa/2015/v81i3/48227

Lobo, I. (2020). Environmental Influences on Gene Expression | Learn Science at Scitable. Retrieved 22 July 2020, from Xu, Y., Bach, E., & Orhede, E. (1997). Work environment and low back pain: the influence of occupational activities. Occupational And Environmental Medicine, 54(10), 741-745. doi: 10.1136/oem.54.10.741