Table 2 Discourses identified from the answers to the question “What causes your persistent or recurrent LBP”

LBP as biomedical problem.

N = 101

(66.4%)

LBP is explained by incorrect postures, damage, degeneration or weakness of neuromusculoskeletal structures. Pain is produced or provoked because something is biomedically wrong in the body.

Participant 20: “Pelvic tilt anteriorly, lacking strength in abdominal muscles with hypertonic erector spinae muscles, thorax vertebrae kyphosis, slight scoliosis, flat foot problem and gait problem”

LBP as unbalanced lifestyle.

N = 74

(48.7%)

LBP as a warning sign, or consequence, of an unbalanced lifestyle. A metaphorical individualised “balance scale” about the amount of exercise, sitting, standing, walking time or load.

Participant 21: “… Doing too much or too little exercise? ...”

Participant 58: “Unregular daily routine …”

LBP is about menstruation and ‘kidney’ status.

N = 14

(9.2%)

In Chinese culture, menstruation is important to women’s overall health while ‘kidney function’ is vital to men’s. Women during menstruation are generally believed vulnerable and emotionally unstable while men who have poor kidney function, are believed to have low sexual performance.

Participant 21: “ShenKui (kidney deficiency) ...”

Participant 37: “Because of menstruation”

LBP is about the ‘Five Elements’ imbalance.

N = 12

(7.9%)

There are ‘Five Elements’ in Chinese medicine: Water, Fire, Wood, Metal and Earth. It is considered important to keep the balance between these elements to maintain good health. Climate conditions such as wind, heat, dampness, dryness and cold are represented separately by wood, fire, earth, metal and water. It is thought that climate conditions can ‘invade’ the body and cause an imbalance in the Five Elements.

Participant 38: “… after staying in cold water for several hours, my back pain suddenly occurred”

Participant 61: “Accumulation of Wind, Damp”

Participant 114: “… and drinking too little water will cause my recurrent low back pain”

LBP is about energy status.

N = 9

(5.9%)

Thinking low or disturbed energy status is a cause of LBP. In traditional Chinese medicine a low (disturbed) mental energy status can be caused by, or causes a possible ‘Qi’ stagnation, resulting in muscle pain. ‘Qi’ understood as a ‘matter-energy’ or ‘vital force’, connects physical and mental energies in individuals.

Participant 10: “JingShen status is not optimal”

‘Jing’ means essence while ‘Shen’ means ‘Mind’. ‘JingShen’ status can be understood as mental energy status.

Participant 70: “… also because of life stress and fatigue caused by work”