Myth-busting Back Pain

Almost everyone will experience an episode of lower back pain at some point in their lives. For most, these episodes are brief and resolve quickly. For some, however, back pain becomes persistent. Persistent low back pain is a leading cause of disability and is something physiotherapists see frequently in their practice. There are a wide variety of inaccurate beliefs about low back pain that can result in a slower recovery and even contribute to back pain continuing. Below we highlight 10 of these inaccurate and unhelpful beliefs associated with back pain, and provide more accurate, up-to-date facts.

Myth #1 – Lower back pain is a serious medical condition.

Fact – While lower back pain can be debilitating and very distressing, it is very rarely a serious or life-threatening condition. Consulting a physiotherapist for a thorough assessment will help to rule out any serious pathology or “red flags”. Even better, a physiotherapist can give you an accurate understanding of your situation and what steps to take to help the back pain resolve.

Myth #2 – Lower back pain is likely to become persistent and tends to worsen as you age.

Fact – The typical lower back pain episode will resolve within a few days to a few weeks. It can return again from time to time. However, low back pain does NOT worsen or happen more frequently as we age. Evidence based treatments guided by a physiotherapist, including education and appropriate graded exercise will help ease pain, increase mobility and return to meaningful activities.

Myth #3 – Back pain that persists (greater than 3 months) is always related to serious tissue damage.

Fact – Very rarely is persistent back pain related to serious damage to tissues in your back. Backs are very strong structures and are meant to move and be loaded. Generally speaking, after an injury, tissue healing occurs within the first three months. If pain persists there are usually other factors contributing to your back pain. Your physiotherapist can help you to determine what those factors might be and develop a plan with you to work towards managing your pain and disability.

Myth #4 – Scans are needed to determine the cause of lower back pain.

Fact – For lower back pain occurring as a result of trauma, imaging will rule out serious injuries such as fractures. X-rays show good images of bone, and MRIs and CT Scans show us what is happening in the soft tissues of the body. Disc bulges and degenerative joint or disc changes are common findings on scans even in people without back pain. Scan results do not correlate well with symptoms in many people with ongoing back pain. Having a thorough evaluation with a physiotherapist can help you determine if a scan is necessary or would contribute any useful information about your back pain. Often the severity of degenerative changes or disc bugles does not accurately predict the amount of pain or disability you are experiencing.

Myth #5 – Pain with movement is always a sign that you are damaging your spine and need to rest or stop activity.

Fact – Progressive exercise and movement in all directions is safe and beneficial for the spine. If you have persistent back pain, experiencing pain with movement and activity is usually a sign of how sensitive the structures in your back have become, not that you are causing damage. Especially when beginning a new exercise program, or starting a new activity, it is normal to feel some pain. This will reduce as you become accustomed to the movement, and you will be less sore over time. Working with a physiotherapist, you can develop an appropriate exercise program and increase your activity level safely.

Myth #6 – Poor posture causes lower back pain.

Fact – You can experience low back pain in any posture. How you sit or stand routinely does not cause low back pain. Slouching and rounding your back is often a comfortable way to sit initially, but it can become uncomfortable if prolonged. Increasing back pain is often more associated with the length of time in a certain position, whether it is sitting, standing, bending or lying. At Best Health Physiotherapy, we can help you to determine how your back pain relates to posture, provide guidance about appropriate movement strategies and self-management techniques to help ease your pain. Your best posture is your next posture.

Myth #7 – Back pain is caused by “weak core” muscles.

Fact – Research has not shown that “weak core” muscles lead to lower back pain. Having strong muscle support in your core is never a bad thing and can increase your activity tolerance, but won’t necessarily change your risk of back pain. Often people with lower back pain tend to over-tense the muscles in their back as a protective mechanism. This can be an unconscious response to back pain, but if muscles are constantly overactive it can actually increase the pain. A thorough assessment by a physiotherapist can help determine whether relaxing these muscles or strengthening them may be beneficial to easing your back pain.

Myth #8 – Repeated bending and lifting will cause “wear and tear” damage to your back.

Fact – Backs are meant to bend and move in a variety of different directions and with different loads. Loading the spine increases muscle strength and endurance. It also helps to strengthen the bones, and increase resilience of the ligaments and soft tissues supporting the spine. If, and when appropriate, a physiotherapist can work with you to create a graded exercise program to increase strength and mobility that will help get you back to the activities you enjoy.

Myth #9 – Pain flare-ups mean you are damaging your back and need bed rest.

Fact – Flare ups of back pain can be very scary and sometimes debilitating, but they are not often related to tissue damage. The spine can become very sensitive and sore with changes in activity, such as lifting after long periods of inactivity. Other common triggers for pain flare ups are poor sleep, worry, low mood and stress. A physiotherapist can perform a thorough examination to help you determine what factors may be contributing to your pain or recent flare up, and then develop an evidence-based treatment plan to reduce your pain and keep you moving.

Myth #10 – Spinal injections, strong drugs like opioids and spinal surgery are needed to cure back pain.

Fact – Evidence suggests that injections, strong drugs and spinal surgery are not that effective in the long term for persistent lower back pain. These treatments often come with a high level of risk and should not be the first line of treatment. Effective care for lower back pain includes patient-centered education and encouragement to return to, or to begin to engage in physical activity that is appropriate for you. Working with a physiotherapist will support you through this process. They will be able to provide effective treatments and strategies to control your pain and help you return to usual activities.

If you are experiencing acute, recurrent or persistent low back pain, make sure that you are armed with accurate information. The knowledgeable physiotherapists at Best Health Physio can support you in understanding your condition as well as providing helpful treatments and strategies to help you minimize your pain and disability.


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