Back Facts: Myths About Low Back Pain

Low back pain is the number one cause of disability in the world! It often leads people to seek costly, ineffective and occasionally harmful care. But what is it that drives disability and poor care?

Unhelpful beliefs are common in people with and without low back pain and can be reinforced by the media, the health industry and some well-meaning practitioners. Unfortunately, unhelpful beliefs about low back pain are associated with higher levels of pain, disability, work absenteeism, medication use and invasive healthcare seeking.

Unhelpful beliefs may lead to unhelpful behaviours such as avoiding normal postures (ex: slouching, sitting), movement (ex: bending forward, lifting) and meaningful activities (ex: physical activity, social activities, work and activities of daily living). These are all important things to our lives and if we are avoiding activities that we enjoy, it can take a toll on our physical and mental health.

Unhelpful beliefs may also lead to unhelpful protective behaviours such as muscle guarding (tensing), bracing the “core” muscles and slow movement. We may think these actions are helping us, instead they may be causing the pain to stick around. This persistent pain may also lead people to opt for more invasive treatments in order to ease symptoms. This may include medications, injections and surgery.

With all of this downside to low back pain, it is important to outline these unhelpful beliefs and get the facts straight, so you don’t fall into the same trap!

Myth #1: Low back pain is usually a serious medical condition.

Fact: Low back pain is not a serious and life-threatening medical condition. Although it can be annoying, distressing and disabling, it is rarely life-threatening and you are unlikely to end up in a wheelchair.

Myth #2: Low back pain will become persistent and deteriorate as we age.

Fact: Most episodes of low back pain improve and low back pain does not get worse as we get older. It is a widespread belief and concern that getting older causes or worsens back pain, however, research does not support this. Most low back pain can be managed with treatment and staying active.

Myth #3: Persistent low back pain is always related to tissue damage.

Fact: A negative mindset, fear-avoidance behaviour, negative recovery expectations and poor pain coping behaviours are more strongly associated with persistent pain than tissue damage. Backs are strong! If you have had another injury, tissue healing generally occurs within three months, so if pain persists past this time, it usually means there are other contributing factors. It is common for back pain to begin with no injury or with simple, everyday movements such as bending, lifting or twisting. These occasions may actually be related to stress, tension, fatigue, inactivity or unaccustomed activity which makes the back more sensitive to movement and loading.

Myth #4: Diagnostic imaging is always needed to detect the cause of low back pain.

Fact: Imaging does not determine prognosis of low back pain, the likelihood of future low back pain disability and does not improve low back pain outcomes. Imaging is only helpful in the minority of patients. Lots of scary sounding things can be reported on in images such as disc bulges, degeneration, protrusions and arthritis etc... However, the reports do not say that these findings are very common in people without back pain. They also do not predict how much pain you feel or how disabled you are. Imaging changes over time and can show that most disc prolapses shrink and heal.

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: Graduated exercise and movement in all directions is safe and healthy for the spine. When pain is persistent, it is common for the spine and surrounding muscles to become really sensitive to touch and movement. The pain you feel during movement and activities reflects how sensitive your structures are – not how damaged they are. So, it is safe and normal to feel some pain when you start to move and exercise. This usually settles down with time and as you get more active. In fact, exercise and movement are 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: Spine posture during sitting, standing and lifting does not predict low back pain or its persistence. How we sit, stand and bend does not cause back pain even though these activities may be painful. A variety of postures are healthy for the back. It is safe to relax during everyday tasks such as sitting, bending and lifting with a rounded back – in fact, it is more efficient! Change your positions and postures often in order to avoid discomfort.

Myth #7: Low back pain is caused by weak “core” muscles and having a strong core protects against future low back pain.

Fact: A weak core does not cause low back pain and some people with low back pain tend to over-tense their “core” muscles. This is like clenching your fist after you’ve sprained your wrist. While it is good to keep the trunk muscles strong, it is also helpful to relax them when they aren’t needed.

Myth #8: Repeated spinal loading (such as repetitive bending and lifting) results in “wear and tear” and tissue damage.

Fact: Spine movement and loading is safe and builds resilience when it is graded. The same way lifting weights makes muscles stronger, moving and loading make the back stronger and healthier. Activities like running, twisting, bending and lifting are safe if you start them gradually and practice regularly.

Myth #9: Pain flare-ups are a sign of tissue damage and require rest.

Fact: Pain flare-ups are more related to changes in activity, stress and mood rather than structural damage. While pain flair-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 exacerbations and if you have a pain flair-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: Effective care for low back pain is relatively cheap and safe. This includes; education that is patient-centred and fosters a positive mindset and coaching people to optimise their physical and mental health (such as engaging in physical activity and exercise, social activities, healthy sleep and body weight, and remaining in employment). Spine injections, surgery and strong medications like opioids are not 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.

As a health care provider, I am committed to providing people with evidence informed education and care for low back pain. Exploring patients’ concerns, fears and beliefs about low back pain provides me with an opportunity for constructive discussions. Coaching patients to confidently engage with variable postures, movements, graded loading, physical activity, healthy living, social and work engagement can build a positive mindset about low back pain and is one of my goals of treatment. You have control over you back pain, let me show you!

Sources:

O’Sullivan PB, Caneiro JP, O’Sullivan K, et al. Br J Sports Med Epub ahead of print: [7 June 2020]. doi:10.1136/bjsports-2019-101611