Back pain myths

While back pain can be really painful and worrying, it is very common and rarely dangerous.  About 75% of people worldwide will experience back pain in their lifetime.  About 90% of these injuries are what are referred to as mechanical injuries.  These include joint sprains, muscle strains, age related changes and trauma.  The vast majority of these will recover.  In fact, 40% of cases of acute low back pain will recover within a week.  80% will recover within 3 weeks and 90% will recover within 6 weeks.  Only about 7-10% of cases will experience symptoms for more than 6 months.  And only 1% require surgical intervention.

When you attend a physio appointment, a thorough history of your injury will be taken and a physical examination will be performed.  Based on the answers you give us and the results of the tests performed, your physio will be able to advise as to whether an MRI is indicated.  For the vast majority of people, an MRI will not be necessary.  This is because scans only truly reveal something important in a very small number of cases.  Any results of scans must be interpreted correctly and correlated with the clinical presentation as often changes seen on a scan can be completely normal and unrelated to a patient’s back pain.  In a study that looked at the MRIs of people without any back pain, it was found that 90% had degenerative discs, 52% had bulging discs, 38% had arthritic changes and 28% had herniated discs.  Remember, these people had NO back pain.  These findings are the equivalent of finding wrinkles in your skin- a very normal part of the aging process.  We also know that these findings are a poor predictor of future pain or disability.

Bed rest has been shown to be counterproductive in acute and chronic back pain.  The number one piece of advice we give to patients with back pain is to try to remain as active as possible.  This might mean modifying your activity levels in the short term until you are more comfortable eg going for a walk instead of running or doing body weight exercises instead of lifting heavy weights in the gym.  If your back pain is particularly bad, this might mean doing short walks regularly through the day or gentle stretches to keep you as mobile as possible.  Our backs love to move.  Sometimes your back is very sore so it is hard to find a way to move that feels good for you but your physio will be able to help you find the best way to keep yourself moving.

There is strong evidence to suggest that exercises for your “core” are no more effective than any other exercises that keep you active.  For some people, trying to engage their core by bracing their abdominal muscles can actually make them worse.  An easy way to demonstrate this would be to clench your fist and try moving it up and down.  Now relax your hand and move it.  Which way do you think your back would rather move?

Sometimes we see patients who have been told that things like they have a disc out of place or their pelvis is out of alignment and that whatever is out of place needs to be realigned for their pain to settle.  There is no evidence that there is a difference in pelvic movement or bony alignment between painful and non-painful sides in people with chronic low back pain or pelvic pain.  Many patients will feel better after manual therapy techniques but this is not because they have been realigned, it is because the manual therapy has helped to reduce pain and muscle tone.

Despite many trials and reviews of the literature, there has been no consistent evidence that poor posture causes back pain.  Part of the reason for this is that there is no consistent definition of what good or bad posture is.  In fact, there is much stronger evidence that links back pain to factors such as gender, family income, and mental health.

If you are concerned about back pain or a niggling injury contact one of our physios at PMC Physiotherapy Dunboyne and get it checked out.

• Handa R (2019) Low Back Pain- Myths and Facts. Journal of Clinical Orthopaedics and Trauma (10) 828-830.

• Smith B et al,. (2014) An update of stabilisation exercises for low back pain: a systematic review with meta-analysis.  BMC Musculoskeletal Disorders 9(15):416.

• Mirtz T et al, (2009) An epidemiological examination of the subluxation construct using Hill’s criteria of causation. Chiropr Osteopat.  2(17):13.

• Swain et al (2020). No consensus on causality of spine postures or physical exposure and low back pain: a systematic review of systematic reviews. J Biomech. 26;102.