FEATURE: The Myths of Back Pain
Feature by Angus Gould (M.Ost, BSc) Registered Osteopathy
Back pain, especially low back pain is extremely common amongst the general population with the National Institute of Clinical Excellence estimating up to 60% of us can expect to experience it at some point in our lives. This is perhaps why it is the highest lived with disability in the world and has such a dramatic effect on work absence, productivity as well as the economy. With one study estimating low back pain cost the UK in excess of £20 billion in the year 2000.
Over the last 20 years the theories of why back pain occurs, what aggravates it, and what the best course of action for treatment is, have all changed. Gone are the years of having to worry about lifting everything with a straight back and bent knees, and gone are the days where surgery is common practice for those suffering from persistent low back pain!
You may have heard a variety of conflicting opinions of what to do when you have back pain, so this article sets out to debunk some of the most common myths surrounding the subject.
“Bed rest will help ease my back pain”
It is a common misconception amongst patients, that when suffering from back pain, all physical activity must be reduced or stopped, and ‘taking it easy’ is the best move. More often than not, this isn’t the case. When patients present to me in clinic, often the best piece of advice I can give them is to try and carry out their day to as near, normal as possible. Don’t let it stop you walking to work, don’t let it stop you going cycling or doing that yoga class.
I understand for some people this may not be possible and back pain can be hugely debilitating.
But the research shows that movement and higher activity rates produce significant improvements in pain, quality of life and functional limitations, in those suffering from both acute and chronic back pain.
Now this doesn’t mean you should go and start powerlifting immediately after injuring yourself. It’s all about moderation! Small things like walking, swimming, cycling or specific exercises to help improve spinal mobility, connective tissue health and stability in the area may significantly reduce your recovery time.
On the other hand bed rest is not advised in those suffering from low back pain and studies have identified that it can lead to your pain becoming persistent as well as having a taxing effect on your mental health and quality of life.
“I can’t do exercise whilst I have back pain, especially weight training!”
This is kind of a follow on from myth 1, but it is so important so why not talk about it twice!
Whether you are suffering from acute or chronic low back pain, exercise is generally accepted amongst healthcare professionals as the best method of self management. Multiple studies have shown that exercise including high load resistance and weight training provides great benefits for those suffering from low back pain.
A study published in 2014, found there is strong evidence that stability exercises significantly improve long term outcomes in pain and disability. Searle et al. (2015) supported this finding, concluding that there are considerable beneficial effects for strength/resistance and coordination/stabilisation exercise programs for those suffering from chronic low back pain.
Articles have even shown that no, one type of exercises is better than another. So if you find a exercise class you love or you enjoy doing a specific sport, stick at it, and gradually increase the intensity as your ability improves. Chances are it’ll pay off in the long run and not just in relation to back pain.
Exercises combined with therapies such a osteopathy have also shown to have even greater benefits than these forms of treatment alone. Osteopaths have great knowledge of the stressors on the body and can incorporate specific stability and mobility exercises into your treatment protocol so you can start taking control of your pain, get on the road to self management and enjoy a life pain free.
“I must get a scan to find the cause of my back pain!”
There is a wealth of evidence which has been sourced in recent years showing that findings on scans such as MRI’s and X-Rays for back pain are not very good at identifying structures which may be the cause of pain. Not only do scan results correlate poorly with symptoms being experienced, but also most people without back pain may have similar scan results and have no pain whatsoever.
An article in 2015 concluded that imaging findings of spinal degeneration are present in high proportions of asymptomatic individuals (people suffering with no symptoms), with these findings increasing with age. ‘Spinal degeneration’ seen on scans is therefore considered a normal process of ageing and unlikely to be associated with pain.
Similarly, a study which was published this year showed that 23.4% of healthy individuals without any history of back pain had positive MRI results for Sacroiliac irritation/inflammation, and only 6.4% of patients suffering from chronic low back pain had this finding. In short, these results showed that those individuals with symptoms actually had LESS abnormalities on MRI scans than those without symptoms!
For these reasons and many more, scans and imaging alone are not capable of telling us exactly why someone is experiencing pain. Now, don’t get me wrong MRI scans can be extremely helpful if the clinician thinks your low back pain might be caused by something like a fracture or an infection etc. but majority of the time this isn’t the case. There is also new evidence suggesting that having a scan can actually make situations worse for patients. Especially when the scan report uses phrases like stenosis of the intervertebral foramina, indentation of the thecal sac and degeneration of the vertebral end plates. By the way these big long words don’t really mean much in terms of pain; they are normal consequences of ageing, and when I say ageing these were all written on my report and I’m 23.... and yes you guessed it, have no pain at all.
“If I have pain, that means I’ve damaged my back!”
Believe it or not the amount of pain you experience is very rarely linked to the amount of damage that has occurred. Like our health, pain is very complex, it is a result of many different factors including but not limited to; physical damage, stress, mental health, beliefs, past experiences of back pain, and the environment around you.
Take two people with low back pain, one a self-employed labourer, the other a 9 to 5 desk worker for example. Unfortunately those who are self-employed are usually affected by pain and illness the most. If they can’t work, they don’t earn. This adds a whole lot of stress to the situation which can actually amplify symptoms and result in longer recovery times. On the other hand someone who is being paid sick pay doesn’t have to worry about the financial consequences of missing work for a few days, may experience a quicker recovery.
Basically, the same physical injury can affect every person differently depending on their circumstances and a good clinician will take a multifactorial approach, addressing your anxieties of pain, your beliefs as well as addressing the symptoms you may be experiencing.
Everyone is different. There is no normal recovery! So don’t compare yourself to others it may have an even greater effect on your mental health.
If you are concerned there is some damage to your back following an injury, seek professional assessment by a healthcare professional or doctor, and they will recommend the best course of action for you.
So there we have it. How many of these myths did you believe in? You may be a bit sceptical to believe me especially as you’ve probably lived by these for a while. So if your interested have a look at the studies bellow. Be warned they can be a bit wordy!
Bevan, S. (2015). Economic impact of musculoskeletal disorders (MSDs) on work in Europe. Best Practice & Research Clinical Rheumatology, 29(3), 356-373.
de Winter, J., de Hooge, M., van de Sande, M., de Jong, H., van Hoeven, L., de Koning, A., ... & Weel, A. (2018). Magnetic resonance imaging of the sacroiliac joints indicating sacroiliitis according to the assessment of Spondyloarthritis International Society definition in healthy individuals, runners, and women with postpartum back pain. Arthritis & rheumatology (Hoboken, NJ), 70(7), 1042.
Videman et al, (2003) Associations Between Back Pain History and Lumbar MRI Findings
Webster et al, (2010) Relationship of early magnetic resonance imaging for work-related acute low back pain with disability and medical utilization outcomes.
Baker, A. D. (2014). Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. In Classic papers in orthopaedics (pp. 245-247). Springer, London.
Arnbak, B., Grethe Jurik, A., Hørslev‐Petersen, K., Hendricks, O., Hermansen, L. T., Loft, A. G., ... & Holst, R. (2016). Associations between spondyloarthritis features and magnetic resonance imaging findings: a cross‐sectional analysis of 1,020 patients with persistent low back pain. Arthritis & Rheumatology, 68(4), 892-900.
Schmidt, C. (2017). Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. manuelletherapie, 21(02), 54-55.
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., ... & Wald, J. T. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816.
Berg, L., Hellum, C., Gjertsen, Ø., Neckelmann, G., Johnsen, L. G., Storheim, K., ... & Norwegian Spine Study Group. (2013). Do more MRI findings imply worse disability or more intense low back pain? A cross-sectional study of candidates for lumbar disc prosthesis. Skeletal radiology, 42(11), 1593-1602.