Both misunderstood and mismanaged, low back pain is a huge source of suffering for many people worldwide. Despite being one of the most common sources of pain, disability and time off work, low back pain is often poorly managed. Here are a few of the myths (and what research actually shows) we commonly hear at Physiotas.
Myth #1: ‘My back hurts so much; I’m never going to get better’.
An episode of low back pain can be severe and frightening, and understandably make people worry they have done serious damage. While the pain can be terrible, the majority of low back pain should be considered a part of normal, everyday life. Like the common cold, almost everybody will experience low back pain at some point. Most episodes will run their own course and clear up quickly (usually within 6-8 weeks), often without a need for treatment. It should be a relief to hear that up to 99% of back pain is not serious
There is a poor link between the amount of pain someone is in and actual tissue damage. Pain is, simply put, an unpleasant sensation as the result of actual or perceived threat of tissue damage. Like any other sensation (taste/touch/sight/hearing etc) pain is processed in the brain. The brain also processes our feelings, our hopes and fears, and our memories. These all combine with the threat of tissue damage to produce the experience we call pain. Pain is real, whether or not there is actual tissue damage. But pain does not equal tissue damage!
Similar to conditions like migraine, asthma and depression, low back pain can have a recurrent pattern of coming and going. Simply put, if a person has experienced an episode of low back pain in the past, they will probably experience low back pain again. However, these episodes are rarely serious.
This recurrent nature of low back pain should not be a cause for despair, as getting pain from time to time does not mean a person will suffer any major disability. Since almost everyone gets low back pain at some point, it should not be seen as rare or serious. Figuring out and understanding the triggers, and what a person should and should not do, is more useful than trying to prevent low back pain. Trying to prevent low back pain from ever happening is like trying to prevent ever getting tired, a headache or low mood – things we all experience at some stage.
Remember, low back pain is common and often recurrent, but rarely serious.
Myth #2: ‘The back is a delicate/weak structure’ or ‘My back is out’.
The spine and the muscles, tendons and ligaments surrounding it, make up a well-designed structure that’s incredibly strong, flexible and supportive. Research also clearly shows that discs, bones and joints in your back do not go ‘out of place’ or ‘slip’.
The term ‘slipped disc’ is not only inaccurate but harmful; as it suggests the spine is so vulnerable things can be easily displaced. This makes people with back pain less likely to do things that will help, such as exercise and gradually increasing their normal work and life activities. The discs are firmly attached between the back bones (vertebrae) and cannot ‘slip’ out of place.
Some health professionals do tell people they are putting their bones and discs back into place through treatments like manipulation. This just adds to the confusion and is again inaccurate. While the ‘crack’ you experience can feel nice and reduce your pain, any benefit is short-term. It is due to changes in the nervous system and muscle relaxation, not to adjusting the positions of discs and joints. Remember that your back is a strong stable structure, capable of lots of movement. If a person experiences a severe episode of low back pain lifting, nothing has fallen out of place even if it might feel like it!
To help maintain the back and spine, proper conditioning is needed including strengthening, flexibility and aerobic conditioning. While there are some exceptions to the rule (such as an unstable spinal fracture), the back does not need to be overprotected after recovering from a typical episode of back pain.
Remember, the back is a strong structure that does not ‘go out of place’ but is actually able to deal with a lot of load
Myth #3: ‘I need a scan to see what is wrong with my back’.
In general, this is definitely not the case. Most trained health professionals should be able to develop a successful diagnosis and treatment approach, based on a thorough medical history and physical examination. Only a few specific symptom patterns in a minority of cases (less than 10%) indicate the need for an MRI scan or other investigations.
The issue is that, when people have scans for low back pain, the report will always show ‘stuff’, but much of it is poorly linked with pain. Scans will pick up the ‘kisses of time’. These are the adaptations of your vertebrae and joints to withstand forces on them, just like grey hair and wrinkles. They pick up old minor injuries (perhaps you never knew you had) that have healed but left their trace, just like a scar on your skin. And they pick up your own normal anatomical characteristics, just like a photo of your face clearly shows you’re not the same as anyone else. Unfortunately, when it comes to MRIs, these usual things are given scary names such as ‘broad-based disc bulge’, ‘degenerative changes’ and spondylolysis. But research shows that people who don’t have low back pain have disc bulges, disc degeneration, disc protrusions and facet joint degeneration just as often as people with low back pain. So, the issue isn’t just these changes on investigations.
The problem isn’t getting the scan, but rather what people are told about it and what happens next. Unfortunately, people with low back pain are often told these non-serious things need more tests, injections and surgery. As well as being unnecessary and expensive, these procedures can create a lot of worry that distract people from helpful activities like exercise. While leaving no stone unturned can be good for other things in life, too many tests can lead to the ineffective over treatment of low back pain.
Remember, scans are not the be all and end all in the diagnosis and management of back pain. Speak to your physio (or other health care professional) about whether you actually need scans and, if you have had them, what they mean.
Myth #4: ‘Moving will make my pain worse’.
Bed rest and prolonged rest were previously popular treatments for low back pain. However, we now know that people with low back pain who remain active (even when in pain) do better long-term. In fact it appears the longer a person stays in bed because of low back pain, the worse their pain, disability and ability to work becomes.
For recent onset low back pain, finding the balance between letting the pain settle while still moving is important. It’s similar to a football player who has twisted their ankle: avoiding aggravating movements and reducing training for a few days/weeks helps, but they need to ensure the ankle isn’t rested excessively as it would get stiff and weak. They would then gradually resume training and matches over days and weeks.
A similar approach should be taken with low back pain. During the first few days of pain, it is common that back movement or posture can be significantly altered. This is a normal part of the back pain experience and is like limping after an ankle sprain. Like the footballer, it might be helpful to do less of certain movements for a while but, most importantly, moving when you can, and even doing your activities in a modified or altered way, can be good. As the pain settles, movement patterns get better. However, it is important that people do not wait for the pain to be gone before they get moving.
Exercise is good for low back pain. It has been shown to be the best treatment to reduce pain and disability. Exercise is the only current approach that has been shown to prevent recurrence of low back pain by almost 50%. The best exercise is one you enjoy and will stick with. Clinical Pilates (LINK TO OUR CLINICAL PILATES INFO HERE and Lisel’s blog) can be excellent for low back pain (and I personally highly recommend it), but walking, running, cycling, swimming, and yoga all have similar effects and are equally safe.
Remember, remain active, exercise and avoid bed rest. #motionislotion.
Myth #5: ‘Now I’ve hurt my back, I’ll never get back to work/sport/hobbies’.
It is common for people with low back pain to be cautious about returning to their usual activities such as work, sports and hobbies/leisure activities. However, there is strong evidence that keeping active and returning to normal activities and hobbies is important in aiding recovery.
People are generally worried about activities that involve impact, bending, lifting and twisting. People in pain often avoid these for fear of doing damage to their body. However, these things are safe (even if sore initially) and people should feel confident to return to them.
Take the example of a new runner. People who are new to running have an increased risk of pain or injury if they start by running three or more times a week. This increased risk does not mean they should give up running forever, or that it is bad for them. They might just need to change some things: the amount they do, the way they do it, and give their body more time to get accustomed to this new activity.
It is helpful to think of back pain and lifting/moving in a similar way. People should try to use their back sensibly and build up tolerance to certain activities, like bending and lifting, through practice with different loads and weights. But people shouldn’t wrap their back in cotton wool and avoid activities. The back, like all body parts, is designed for movement and will adapt to different activities and loads with practice.
Remember, the back is strong and, even after an episode of low back pain, able to lift/twist/bend.
Myth #6: ‘My pain is really bad, therefore I must need surgery to get better’ or ‘My X-Ray/CT/MRI scan shows damage, so surgery is needed to correct this’.
Only a small proportion of people with back pain require surgery. Most people with back pain can manage it by staying active, developing a better understanding about what pain means, and identifying the factors involved in their pain. As discussed above, pain does not equal tissue damage.
While there are some causes of back pain that may require surgery (spinal tumours, fractures etc), these are exceptionally rare. For the majority of back pain ‘diagnoses’(such as disc bulges, sciatica, facet joint arthritis etc) the results of spinal surgery are no better in the medium and long term than non-surgical managements, such as exercise and physiotherapy.
Remember, surgery is rarely needed for low back pain
Hopefully this article has helped clear up some of the common myths and misunderstandings we frequently hear at Physiotas. Like any article, this is general information and you should speak with your healthcare professional about your individual situation should you have any questions or concerns.
About the Author:
Dan has been working at Physiotas since graduating from Monash University with Honours in 2011. He has undertaken further professional development in the acute management and rehabilitation of sporting and spinal injuries, as well as dry needling and Clinical Pilates. Dan is involved in the Clinical Pilates and Workplace Health programs at Physiotas.
Dan has worked with a variety of local and interstate sporting clubs including Devonport FC, Tassie Mariners and Soccer TAS. His professional interests include Clinical Pilates, sports and spinal injuries, post-operative rehabilitation, dry needling.
In his spare time Dan enjoys working with sporting teams, running, hiking, and playing tennis and hockey.