10 Persistent Low Back Pain Myths
Swipe through the images or read below to have some of the most commonly held unhelpful myths about low back pain debunked! Based on the influential paper published in the British Journal of Sports Medicine.
Myth 1: Low back pain is usually a serious medical condition
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Persistent back pain can be very disabling and distressing, but it’s rarely dangerous! Less than 1% of low back cases are due to serious conditions that require medical intervention. Back pain is rarely life-threatening and you are very unlikely to end up in a wheel chair.
Myth 2: Low back pain will become persistent and worsen with age
Although a widespread belief and concern that getting older causes or worsens back pain, research does not support this. Current data indicates back pain is worst around the 3rd or 4th decade of life, after which there is a gradual decline with age. Evidence-based treatments can help at any age!
Myth 3: Persistent low back pain is always related to tissue damage
Hurt often does not equal harm in persistent low back pain. If you have had an injury, adequate tissue healing often occurs within 3 months – for reference, bone fractures heal in 6 to 8 weeks on average. If pain persists past this time, it usually means there are other contributing factors. Many cases of back pain begin with no apparent injury or everyday movement/activity. These occasions may relate to stress, fatigue, tension, inactivity or unaccustomed activity which can make the back sensitive to movement and loading.
Myth 4: Scans are always needed to detect the cause of back pain
Scans rarely show the cause of back pain and are only helpful in a minority of people; approximately 95% of low back pain cases have no diagnosis based on scan. Scary sounding findings reported on scans such as arthritis, disc bulges, protrusions and degeneration are very common in people without back pain and poorly predict severity of pain or level of disability. Scans also change, and most disc prolapses shrink over time.
Myth 5: Pain is always a sign of damage in chronic low back pain
Movement can be sore but safe! When pain persists, the spine and surrounding muscles can become really sensitive to movement and touch. The pain experienced during movement and activities is more so a representation of how sensitive your structures are – not how damaged they are.
Myth 6: Low back pain is caused by poor posture during sitting, standing and lifting
Spine posture does not predict low back pain or its persistence. There is currently no convincing evidence to suggest that how you sit, stand and lift will cause back pain even though these activities may be painful. A variety of postures are safe and healthy for the back and it is safe to relax during sitting, standing and everyday/low load lifting.
Myth 7: Bracing during everyday tasks prevents future low back pain
Keeping a tensed core during everyday low-load activities is likely unnecessary and unhelpful. People with low back pain often tense their core as a protective response – while this may be a useful strategy during the very early healing phase in acute injuries, its value after healing has occurred is very questionable. In chronic low back pain, constantly bracing likely exacerbates the problem by placing continued stress on sensitised structures and by further contributing to muscle tension. Learning to relax the core muscles during everyday tasks can be helpful.
Myth 8: Repeated spinal loading results in ‘wear & tear’ and tissue damage
Backs do not wear out with everyday loading and bending. The same way lifting weights makes muscles stronger; moving and loading makes the back and intervertebral discs stronger and healthier. Activities like running, twisting, bending and lifting are safe if you start gradually and practice regularly.
Myth 9: Pain flare-ups are a sign of damage and require rest
Flare-ups often do not mean damage. While they can be very painful and scary, they are usually not related to tissue damage. Flares often occur well before damage when the back is sensitised – instead of treating it like an injury, try to stay calm and keep moving. Common triggers include poor sleep, stress, tension, low mood, inactivity or unaccustomed activity – controlling these factors can help prevent exacerbations.
Myth 10: Opioids, injections and surgery are necessary to treat persistent low back pain
Injections, surgery and strong drugs usually aren’t a cure. These treatments are not very effective in the long term for managing persistent low back pain and may have significant costs, risks and side-effects. When compared with conservative treatments, there are often no long-term significant differences in outcomes with the exception of increased complications and side-effects from strong drugs and surgery. Finding low-risk ways to put you in control of your pain is key!
Written by: David Resic (Osteopath)
O’Sullivan, P., Caneiro, J., O’Sullivan, K., Lin, I., Bunzli, S., Wernli, K., & O’Keeffe, M. (2021). Back to basics: 10 facts every person should know about back pain. British Journal of Sports Medicine, Vol 54, Issue 12