By Dr. Matt Graham
About 80% of the population will experience low back pain at some point in their life, and recent studies show that a large portion of the general population lacks awareness around what is causing their pain and what can be done to help. Let’s debunk some myths, shall we?
MYTH: Back pain is caused by damage or weakness of the spine
FACT: Hurt does not equal harm
Pain is often a warning signal your brain sends when you’re at risk of an injury, or if you’ve already sustained an injury. Even after an injury has healed your brain can still remember what caused that pain the first time. Any experience that is similar may cause a (very real) pain signal, even if no tissue damage has taken place. When you experience pain in the absence of a physical injury it’s likely that you’re experiencing hurt, not harm. Oftentimes we see this occur during mundane tasks like tying a shoe. In general, we call this “sensitization”, which can make dealing with chronic back pain very challenging. This is one reason it’s important to seek help from a trained professional who can help guide you on your journey.
MYTH: I just need to rest until my back pain is better.
FACT: Movement is medicine
While taking it easy for the first 1-2 days after an injury can be helpful and necessary in some cases, prolonged bed rest has been shown to have a negative impact on the cardiovascular, muscular, and skeletal systems in as little as two weeks. Muscle wasting and weakness can occur after only 5 days of bed rest. Instead of full bed rest after a flare-up of back pain, find tolerable ways to move, and move frequently.
MYTH: Avoid bending and twisting because it’s bad for your back.
FACT: Your spine was built to move.
Spinal joints are able to achieve many degrees of motion, including rotation, side bending, back bending, and forward bending. If your spine wasn’t meant to move in multiple directions, it would be shaped like a leg bone. Sure, bending and twisting to pick up a heavy object can cause pain if your body lacks the strength and mobility to perform the task. But doesn’t mean that bending and twisting are inherently dangerous - in fact, the only dangerous movements are those that you are not prepared for. Instead of avoiding these movements, shouldn’t we instead find ways to tolerate these movements under less demand, then work toward increasing our overall capacity to perform more difficult tasks?
MYTH: Lifting weights is dangerous and damages your spine.
FACT: Weight training can alleviate back pain and improve your ability to perform daily activities.
Done properly, weight lifting can not only improve your pain, but also make your life more fulfilling. Getting rid of back pain is only one piece of the puzzle; getting back on the court, being able to hike Mount Doug, or being able to chase your kids around is just as important. To be able to do that you need to be strong, confident, and have TRUST in your back's ability to get you where you want to be. Before starting a new exercise program, get assessed by a trained professional to ensure that you’re lifting weights in a safe way, and in a way that lets you best reach your goals. All in all, the most “dangerous” thing we can do to our spine is not exercise at all.
MYTH: Back pain can only be fixed with surgery.
FACT: Surgery is only required in very rare cases of back pain, and is almost always a last resort option.
While there are times when surgery is necessary, these instances are very rare and generally involve symptoms much more significant that back pain alone. Some sources estimate that 10-40% of patients who undergo spinal surgery continue to have persistent back pain and must undergo further surgeries to improve their outcome. Unless you have had a serious spinal cord injury, surgery is generally only considered after trying a course of conservative care. This can include many different approaches including hands-on therapy, exercise rehabilitation, modifying your daily activities, improving sleep and nutrition, and many more. Regardless of whether you have surgery or not, a well designed exercise program should be the foundation of your recovery plan. Before you opt for spinal surgery, make sure you have a good understanding of the risks, rates of complication, and your pre and post operative physical rehab program.
MYTH: l need an x-ray or MRI to find out what’s wrong with my back
FACT: There is no correlation between back pain and imaging findings.
Imaging can be helpful in cases of back pain where there are red flags present, or a lack of improvement after several weeks of conservative care. However, abnormalities will show up on imaging in a large portion of the population, and they certainly do not correlate with the presence of pain. Disc degeneration is often seen on x-ray in individuals without back pain, in as much as 30% of people in their 20’s and 95% of those in the 80’s. These findings are normal, and can be thought of as “wrinkles” - yes they are there, but they don’t cause pain. For this reason, imaging is not needed in most cases of back pain. Rather, overreliance on imaging often causes more harm than good, and creates a huge burden on our medical system.
MYTH: Back pain with daily activities is normal.
FACT: Ignoring your back pain is unlikely to make it go away!
While back pain is common, it should not be interfering with your regular daily activities like sitting, walking, bending, and lifting. If you’ve tried seeking help for your recurring back pain in the past and you haven’t seen improvement, don’t be discouraged. Stretches, heat, ice, medications, and passive manual therapy approaches can only get you so far. Instead of relying on the same approaches you’ve already tried, and the same basic core exercises you’ve already done, find a provider who can create a treatment plan that will become progressively more challenging over time. This is the key to a long lasting solution to recurring back pain.
References:
American Society of Anaesthesiologists. (n.d.). Back surgery - Types & recovery | Made for this moment. Made For This Moment | Anesthesia, Pain Management & Surgery. https://www.asahq.org/madeforthismoment/preparing-for-surgery/procedures/back-surgery/ Accessed January 23, 2024.
Brinjikji, W., Diehn, F. E., Jarvik, J. G., Carr, C. M., Kallmes, D. F., Murad, M. H., & Luetmer, P. H. (2015). MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis. AJNR. American journal of neuroradiology, 36(12), 2394–2399. https://doi.org/10.3174/ajnr.A4498
Hall, A., Coombs, D., Richmond, H. et al. What do the general public believe about the causes, prognosis and best management strategies for low back pain? A cross-sectional study. BMC Public Health 21, 682 (2021). https://doi.org/10.1186/s12889-021-10664-5
Marusic U, Narici M, Simunic B, Pisot R, Ritzmann R. Nonuniform loss of muscle strength and atrophy during bed rest: a systematic review. J Appl Physiol (1985). 2021 Jul 1;131(1):194-206. doi: 10.1152/japplphysiol.00363.2020. Epub 2021 Mar 11. PMID: 33703945; PMCID: PMC8325614.
Welch, N., Moran, K., Antony, J., Richter, C., Marshall, B., Coyle, J., Falvey, E., & Franklyn-Miller, A. (2015). The effects of a free-weight-based resistance training intervention on pain, squat biomechanics and MRI-defined lumbar fat infiltration and functional cross-sectional area in those with chronic low back. BMJ open sport & exercise medicine, 1(1), e000050. https://doi.org/10.1136/bmjsem-2015-000050