Did you know that 80-90% of us experience low back pain at some point in our lives?

Did you also know that even with more access to diagnostic scans, core stability exercises, injections and low back surgeries, the rate of low back pain continues to rise?

So what’s really going on here?

We know that low back pain can be an extremely complex condition that can be influenced by many factors. What we thought was true and factual for low back pain has not been backed up with the latest evidence we have available to us. Previously held inaccurate beliefs have a way of impacting how we approach low back pain and can negatively influence our recovery process. Here are some of the most common myths and misconceptions about low back pain, which need to be debunked.

Myth: Low back pain is usually something to be concerned about.

In most cases, low back pain is painful but not dangerous. Very often it’s “bark” is bigger than it’s “bite”. Between 1-4% of all cases are due to something serious such as a fracture, inflammatory disorder, infection or a malignancy. When these are present, there are other factors involved such as persistent night pain, pain not relieved by rest, fever, weight loss and fatigue.

We also know that low back is pain very closely related to poor sleep, being run down and stress (1) and that 90% of low back pain incidents will resolve in 2-6 weeks by keeping a relatively normal lifestyle, performing some simple movement based exercises and limiting prolonged periods of rest.

Myth: Having a scan on your back will let you know what the problem is.

In recent times, scans such as MRI have become much more available to people presenting with pain. These scans can see everything and anything that’s inside us. We would think this is a great thing, however, detailed images from scans can show things which we have previously assumed to be abnormal and dangerous, but are in fact normal changes in our bodies. Disc bulges, disc degeneration and facet joint degeneration are more common than we think and can be seen frequently in people without back pain (2).

Brinjki et al 2015

The problem is that we have now created a situation whereby in the search for the 1-4% of individuals who may have a serious problem, we have a tendency to scan anyone who presents with back pain. This has resulted in people being told that disc bulges, disc degeneration and facet joint degeneration are dangerous and need fixing.  This in turn can result in fear avoidance behaviours, and unhelpful beliefs about the state of one’s spine, which has been shown to negatively influence pain (3).

Scans are only recommended when there is progressive neurological deficits such as weakness of the lower limbs, a change in bladder and bowel function, or a history which suggests that there is something more serious going on.

Myth: If you have low back pain then you need to do specific exercises to strengthen your “core”.

Just because you have back pain does not mean that you need to specifically strengthen your “core”. The hype of “core stability” has enveloped the physiotherapy and fitness industry with the promise that if you can selectively isolate a few key muscles in your trunk, you will be able to stiffen and stabilise your back. This really insinuates that a few small muscles are the crux of a very complex condition. Our backs need a complex interaction of many muscles to act together to produce both movement and strength.

Attempting to pre-stabilise or “switch on your core” before movement has not shown to improve the outcome of low back pain and in fact can reinforce negative behaviours and fear which can lead to even more pain. The research has demonstrated that selectively activating core muscles was no better than other forms of exercise for rehabilitating low back pain (4,5). Another study looking at “core stability” demonstrated that an improvement in low back pain and function was not associated with improvements in abdominal muscle functioning suggesting that other factors were involved (6).

People suffering from low back pain can rehabilitate successfully with a variety of exercises such as gym based strengthening, pilates, yoga and swimming to name a few. It is clear that there is no magic bullet for low back pain and that a combination of movement, exercise and addressing other lifestyle factors are recommended.

Myth: If you sit incorrectly then you will develop low back pain.

This is a widely held belief in our society that is not well backed up with the latest evidence. A perfect sitting posture has not yet been found and the relationship to developing low back pain is questionable (7,8).

Evidence suggests that varying your position on a daily basis is probably better than keeping yourself in one position, be it upright or slouched. I have previously seen people with high levels of muscle activity and discomfort in their lower back because they have attempted to sit in an upright position for extended periods of time. It is also ok to slouch, however, changing your position is important and taking regular breaks from your desk at work is recommended.

Unfortunately, low back pain has been given some bad press in the past, which has created more fear around this condition. Scans and medical procedures have become more prevalent, as well as advice to stiffen and stabilise the spine to prevent injury. All of these interventions have not been able to curb the incidence and disability of low back pain. Back pain is a multidimensional problem, which needs a multidimensional approach. This includes movement based exercises, general conditioning and addressing lifestyle factors and negative beliefs surrounding pain in order to produce effective outcomes.

Chris has a special interest in low back pain, especially for individuals whose pain has persisted for longer than expected. He is available on Tuesdays and Thursdays.

References:

1. Kundermann B, Krieg J, Schreiber W, Lautenbacher S (2004). The effect of sleep deprivation on pain. Pain resource management. 9(1) 25-32

2. Brinjiki W et al (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology. 36(4) 811-6

3. Chou R et al (2007). Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American pain Society. Annals of internal medicine. 147(7) 478-91

4. Smith B, Littlewood C, May S (2014). An update of stabilisation exercises for low back pain: a systematic review with meta analysis. BMC Musculoskeletal disorders. 4:515

5. May S, Johnson R (2008). Stabilisation exercises for low back pain: a systematic review. Journal of Physiotherapy. 94(2008) 179-189

6. Mannion A, Caporaso F, Pulkovski N, Sprott H (2012). Spine stabilisation exercises in the treatment of chronic low back pain: a good clinical outcome is not associated with improved abdominal muscle function. European Spine Journal. 21(7) 1301-10

7. Hartvigsen J, Leboeuf Y, Lings S, Corder E (2000) Is sitting-while-at-work associated with low back pain? A systematic, critical literature review. Scandinavian Journal of Public Health. 28(3) 230-239

8. Roffey D et al (2010). Causal assessment of occupational sitting and low back pain: results of a systematic review. The spine Journal. 10(3) 252-61