By Dr. Peter Yu, PT, DPT, CSCS, USAW
Low back pain is extremely common as it is one of the leading prevalent injuries in the United States and worldwide. There is an estimated 2.06 million episodes of low back pain per year and over $200 billion spent on interventions and treatments per year. Often times, treatments end up being costly and even ineffective as well due to false beliefs and the spread of misinformation.
These false beliefs can lead to a negative mindset, catastrophizing, unnecessary worries about the future, fear avoidance behaviors, and a decrease in meaningful activities. Pain is shown to be extremely complex and is not only influenced from a biomedical and anatomical standpoint but can be affected by a multitude of other factors as well including psychological, emotional, cognitive, and social aspects. Here are 10 myths and 10 facts about low back pain!
Myth 1: Low back pain is usually a serious medical condition
Fact: Persistent back pain can be scary, but it’s rarely dangerous.
It can certainly be distressing and disabling, but it’s rarely life-threatening and you are very unlikely to end up in a wheelchair.
Myth 2: Low back pain will become persistent and deteriorate in later life
Fact: Getting older is not a cause of back pain.
Although it is a widespread belief and concern that getting older causes or worsens back pain, research doesn’t support this and evidence-based treatments can help at any age. There are plenty of studies showing ASYMPTOMATIC older adults with no pain while having normal age related changes at the spine.
Myth 3: Persistent low back pain is always related to tissue damage
Fact: Persistent back pain is rarely associated with serious tissue damage.
Backs are strong. If you have had an injury, tissue healing occurs within 3 months so if pain persists past this time, it usually means there are other potential contributing factors such as life stressors, beliefs, nutrition, or sleep. A lot of insidious back pain begins with no injury or with simple everyday movement. These occasions may relate to stress, tension, fatigue, inactivity, or unaccustomed activity which make the back sensitive to movement and loading.
Myth 4: Scans are ALWAYS needed to detect the cause of low back pain
Fact: Scans rarely show the cause of back pain.
Scans are only helpful in a minority of people. Lots of scary sounding things can be reported on scans such as disc bulges, degeneration, protrusions, arthritis, etc. Unfortunately, the reports don’t say that these findings are very COMMON in people without back pain and that they don’t predict how much pain you feel or how disabled you are.
Myth 5: Pain related to exercise and movement is always a warning that harm is being done to the spine and a signal to stop or modify activity
Fact: Pain with exercise and movement doesn’t mean you are doing harm.
Whenever pain persists, it is common that your spine and surrounding muscles become really sensitive to touch and movement. The pain you feel during movement and activities reflects how sensitive your structures are – not how damaged you are. So it is safe and normal to feel some pain when you start to move and exercise. This usually settles down with time as you get more active. In fact, exercise and movement are one of the most effective ways to help treat back pain!
Myth 6: Low back pain is caused by poor posture when sitting, standing, and lifting
Fact: How we sit, stand, and bend does not cause back pain even though these activities may be painful.
A variety of postures and different movements are healthy for the back. Our backs LOVE movement and different motions. It is safe to relax during everyday tasks such as sitting, bending, and lifting with a round back. – In fact, sometimes, it’s more efficient as we want to promote as much movement variability as possible.
Myth 7: Low back pain is caused by weak “core” muscles and having a strong core protects against future low back pain.
Fact: Back pain is not caused by a “weak core”
Weak “core” muscles don’t cause back pain. In fact, people with back pain often tense their “core” muscles as a protective mechanism and response. People are often very guarded and tight after an acute onset of low back pain. Therefore, we want to promote different movement options that feel safe so that we can be efficient at completing whatever said task at hand. Being strong is important when you need the muscles to switch on, but being tense and guarded all the time isn’t helpful.
Injuries occur when the load > the capacity of our tissues and muscles. So one way to decrease risk of future injuries is to increase the strength and resiliency of our low backs through meaningful and progressive loading!
Myth 8: Repeated spinal loading results in “wear and tear” and tissue damage
Fact: Backs don’t wear out with everyday loading and bending
The same way lifting weights makes muscles stronger, moving, and loading make the back stronger and healthier. So activities, like running, twisting, bending, and lifting, are safe if you start gradually and practice regularly! Our backs are extremely resilient, robust, and adaptable to the environment and loads it is placed in!
Myth 9: Pain flare-ups are a sign of tissue damage and require rest
Fact: Pain flare-ups don’t mean you are damaging yourself
While pain flare-ups can be very painful and scary, they are not usually related to tissue damage. The common triggers are things like poor sleep, stress, tension, worries, low mood, inactivity or unaccustomed activity. Controlling these factors can help prevent exacerbation, and if you have a pain flare-up, instead of treating it like an injury, try to stay calm, relax, and keep moving!
Myth 10: Treatments such as strong medications, injections, and surgery are effective, and necessary, to treat low back pain
Fact: Injections, surgery, and strong drugs usually aren’t a cure
Spine injections, surgery, and strong drugs like opioids aren’t very effective for persistent back pain in the long term. They come with risks and can have unhelpful side effects. Finding low-risk ways to put you in control of your pain is the key. Management of stressors, load management, and gradual exposure to threatening positions and movements will be key components for getting you back to the activities you love!
Hopefully this helps paint a clearer picture of a lot of the confusing myths and beliefs about back pain. If you’ve been dealing with low back pain for a while, contact us today so that we can help create a roadmap to success and a detailed plan to get you back to your valued life goals!
About the Author: Dr. Peter Yu is the owner of MOTION RX Health & Performance - a performance physical therapy clinic in Jacksonville, FL that is dedicated to helping athletes and active adults get back to the activities they love pain free!
He can be reached at 904-414-3796 or at dr.peter@motionrxhealth.com.
To learn more about MOTION RX Health & Performance, check out their website at www.motionrxhealth.com or their IR @motionrxhealth where they post daily educational videos on all things rehab and performance!
Reference: O’Sullivan PB, Caneiro JP, O’Sullivan K, et al. Back to Basics: 10 facts every person should know about back pain British Journal of Sports Medicine 2019