• Impact Physiotherapy

The Myths and Facts of Low Back Pain

Updated: Feb 26

Over 80% of the population suffer with lower back pain at some point in their lives and treatment for this condition is often costly, ineffective and occasionally harmful (1). Unhelpful beliefs are proven to be causing greater levels of disability / work absence / and increasing the use of medication and healthcare (2). This is sometimes fueled by the medical profession, using damaging language like, “spondylosis” or “lordosis”, which are perfectly normal observations, but left without explanation, this can create worry and anxiety within the general population. Using unhelpful examples like, “my spine is out of place” or “the doctor told me my spine in crumbling” is also generally accepted to be more damaging than the physical problem the patient is experiencing.


Peter O’Sullivan and colleagues in 2019 set out to highlight some low back pain myths and facts to help the general public understand their symptoms to help them continue to function.


Myths

Myth 1 – Low back pain is usually a serious medical condition

Myth 2 – Low back pain with become more persistent and deteriorate in later life

Myth 3 – Persistent low back pain is always related to tissue damage

Myth 4 – Scans are always needed to diagnose the cause of low back pain

Myth 5 – Pain is related to exercise

Myth 6 – Low back pain is caused by poor posture

Myth 7 – Low back pain is caused by a weak core

Myth 8 – Repeated spinal loading results in “wear and tear” and tissue damage

Myth 9 – Pain flare ups are a sign of tissue damage and require rest

Myth 10 – Treatments such as strong medications, injections and surgery are effective and necessary to treat low back pain


These unhelpful beliefs might lead to negative behaviours – such as avoiding movement or bending and adopting different movements to avoid “flare ups” or guard against painful positions. This in turn may lead to the patient opting for unnecessary invasive and often damaging measures in an attempt to improve their symptoms, such as surgery, injections and passive treatments like – manipulations (clicking the joints in your back). In truth, if someone tells you your spine is out of place and a manipulation/audible click is needed “to put it back in place” or “you have one leg longer than the other and need it manipulated to “realign your body”. This is nothing but a misleading marketing technique to get you to continue treatment with them. There has never been any evidence to suggest a spine is out of place and a click of the lower back is no different to clicking your knuckles. It might give some assistance in the short term (if explained correctly) but it is often short lived and unhelpful in the long term.


Sullivan and colleagues suggest a positive mindset when dealing with low back pain is necessary to assist with levels of pain, disability and healthcare seeking.


The 10 facts to be aware of with low back pain are:

Fact 1 – Low back pain is not a serious life-threatening condition

Fact 2 – Most episodes of low back pain improve and does not get worse as we age

Fact 3 – A negative mindset, fear avoidance, negative recovery expectations, poor pain coping strategies are more strongly associated with persistent pain than tissue damage

Fact 4 – Scans do not determine the outcome or the likelihood of further lower back pain flare ups and do not improve outcomes

Fact 5 – Graduated exercise and movement in all directions and safe for the spine

Fact 6 – Spine posture during sitting, standing and lifting does not predict low back pain or its persistence

Fact 7 – A weak core does not cause low back pain

Fact 8 – Spine loading and movement is safe and builds structural resilience

Fact 9 – Pain flare ups are more closely related to changes in activity, stress and mood rather than structural damage

Fact 10 – Effective care for low back pain is relatively cheap and safe. This includes appropriate education, encourage positive mindset, coaching to help improve positive and mental health, encouraging graded exercises, improving sleep habits, weight loss and remaining in employment

It is vital to rule out any red flags that might be associated with low back pain and although very rare, they need medical attention right away and a visit to an emergency department is suggested:

1. Loss of bladder or bowel control.

2. Bladder or bowel retention.

3. Saddle anaesthesia (numbness around the groin/bottom/testicles/vagina).

4. Pins and needles / numbness / tingling / pain into both legs.

5. Weakness into the leg / foot – feeling like you are dragging your leg, catching it on carpets or when going upstairs – often described as not feeling like your own.



For more information, please visit: www.spinalinjuries.ie


References.

Foster NE, Anema JR et al (2018). Prevention and treatment of low back pain. The Lancet. 391, 2368-2383 2. Bushbinder R, et al (2018). Low back pain: a call for action. The Lancet. 391 2384-2388 3. Sullivan PB et al (2019). Back to basics: 10 facts every person should know about back pain. Journal of Sports Medicine.

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