In Australia, at any one time, 1 in 4 people will be experiencing lower back pain. 80% of Australians will experience lower back pain in their lifetime, and 35% of those will still be experiencing symptoms after 5 years. I myself, a physiotherapist, have fallen prey to the sting of lower back pain. When you experience it, it is painful, frustrating and downright debilitating and disabling. Lower back pain affects our work, our participation in sport and fitness, our home lives and our social lives. As a country, Australians spend billions of dollars every year trying to find the golden cure for back pain, most likely seeing a myriad of health professionals whilst attempting to navigate a confusing and overwhelming health care system. It is therefore not hard to see how our experiences, beliefs and fears of lower back pain can shape our views of what is happening to our bodies, giving rise to misconceptions that may actually be more unhealthy, and detrimental to our recovery.
For the ‘Lower back pain: myth busters edition’, I have highlighted 10 of the most common misconceptions about lower back pain, that may change the way you think about your back injury, and change the way you recover.
Myth # 1. My disc has slipped!
Vertebral discs lie between individual vertebrae in our spine, providing shock absorption and allowing movement. I liken them to a jelly doughnut: with an outer, fibrous ring, and a softer gel like centre. They act like the perfect little cushion for our spine to balance on. Unfortunatley, they don’t always go very well with combined torsion and compressive forces, such as a good bend and twist while simultaneously lifting up a heavy box. None of us would ever do this right? When this happens, you can bulge, herniate, or rupture a disc. Following on our very basic analogy, the outer ring of the doughnut is compromised or damaged, and the jelly is leaking, bulging or ‘herniating’ out of the doughnut. In the spine, this can lead to inflammation and compression to the nerves, which is quite often the source of the pain.
While a herniated disc can be most horrible and painful, the disc has not ‘slipped’, or come ‘out of alignment’ or even ‘blown out’. It is still aligned with our spine and held in place by very strong collagenous tissues. It then goes without saying…
“If the disc has not “slipped” out of alignment, then it can’t actually be “re-adjusted”, “re-aligned” or “cracked” back into place. It can be treated though, with movement, strengthening and support.”
Myth # 2. Because my pain is persisting beyond the normal healing time, my doctor thinks the pain must be ‘all in my head’.
When pain persists beyond the normal expected healing time for that injury, we call it ‘persistent’, or ‘chronic pain’. Chronic pain can occur because the bodies ‘danger messenger system’, or ‘pain system’ has become more sensitive, and things that were previously non-painful, are deemed by the brain to be ‘high danger’ and therefore processed as pain. This process is called ‘central sensitisation’. Central sensitisation is a complex condition that involves changes within the brain and nervous system (so I suppose in a way, part of it is ‘all in our head’). This means that it may take a range of therapies and health professionals to help treat it, such as physiotherapy, psychology, mindfulness, medical intervention and exercise.
Myth # 3. My lower back pain is caused by weak core muscles.
Lower back pain is a complex condition that can be attributed to a range of causes. Often, the origin of the pain is very difficult to identify, and we call this ‘non specific lower back pain’- (sounds like a cop out, but I promise, it’s not!). Pain in the lower back can be caused by damage or irritation to bones, joints, connective tissue, muscles, nerves, discs, or any combination of the above. What we do know is that poor core stability is often associated with lower back pain, and lower back pain is associated with poor core stability. It is a bit of a ‘chicken and the egg’ kind of scenario.
“When we talk about core stability, it is not only the raw strength of the muscle that we must consider, but also the nerves that innervate the muscle, and our bodies ability to recruit the right muscle fibres in the right pattern of movement.”
Some of the best evidence we have for treating lower back pain is to train and activate the deep core stabilisers, but that doesn’t necessarily mean the pain has occurred due to weakness in the area, and it certainly doesn’t call for a new sit-up regime. In fact, the best way to stabilise the lower back and provide support for a painful area, is to speak with a physiotherapist about starting a safe, and gradual deep core stability program.
Myth # 4. If my disc has been affected, I will need surgery.
While some disc herniations benefit from surgical intervention, it is rarely necessary. Lower back pain usually resolves within 2-3 months, and with the right treatment even a disc herniation can be treated conservatively. In fact, 30% of 20 year old and 60% of 50 year old people with no back pain at all have been shown on MRI or CT to have ‘disc bulging’, meaning a disc injury does not always lead to pain and disability.
Myth # 5. Lower back pain is normal during pregnancy.
While lower back pain is common during pregnancy, it is not normal. Back pain in pregnancy is due to the rapid changes in posture, weight, ligament structure and hormone levels. With a balanced exercise program, strengthening and postural correction, it is possible to reduce the effects of lower back pain during pregnancy, and in many cases, prevent it. There are these really cool belts that can help too, but we prefer strong muscles!
Myth # 6. I should rest in bed to heal my lower back pain.
While continuing to smash yourself at cross fit and lift 50 kg concrete bags above your head is generally not advised after an episode of lower back pain, completely resting in bed is often the worst thing you can do for it. To ensure a speedy recovery, some level of movement and exercise is beneficial. While it is tempting to hang out in bed and feel sorry for ourselves, a gentle level of walking, leg and hip movements, exercising in the water and specific movement therapies prescribed by a physiotherapist are the best way to a quick and full recovery.
Myth # 7. I need to see someone to put my spine back into alignment.
Bones and joints do not move themselves, they need our muscular system to move them. Unfortunately, when we have an unbalanced or over-stressed muscular system, it can lead to unhealthy levels of torsion or stress on our bones and spine, leading to pain and injury. When this happens, it is tempting to have our spine ‘cracked’ back into alignment. While this may feel good in the short term, it often does not address the cause of the problem.
“Remember, the spine is a complex network of joints, muscles, ligaments and nerves; the bones are only 1 piece of the puzzle, and can often be coaxed into good behaviour with more gentle therapies such as exercise and muscle energy techniques.”
Myth # 8. Exercise will make my pain worse.
Exercise is one of the best things you can do for lower back pain and chronic pain. When done in the right way, specific exercises can help build strength and support the painful area, create good posture to relieve pressure and improve the control of movement at the site. By exercising in a gentle, progressive and safe way, you can help refresh the nervous system and the way the body processes pain, helping reduce the impact and risk of developing chronic pain. If in doubt, ‘start low, go slow’.
Myth # 9. I will need an X-ray or MRI to get an effective assessment and treatment.
Unless your health care team suspect something more malicious, X-rays or MRI’s are rarely required to provide insight into or treat lower back pain. In fact, they often only serve to scare the daylights out of us. Rarely will the result of a scan make a difference to the type of treatment you should be receiving. This is because your health care professional will base your treatment on your signs and symptoms, rather than a scan. Furthermore, MRI’s and X-rays tend to have high amount of ‘false positives’ and ‘false negatives’, meaning a scan may show something that is not actually the cause of the problem, or fail to show something that is. In some cases, X-rays or MRI’s are warranted, and you should be guided on the expertise of your health care team to determine if a scan is the right thing for you.
Myth # 10. I should avoid taking medication in case I become addicted.
Short term use of pain relief medication is rarely associated with developing a ‘drug tolerance’ or ‘drug dependence’. These terms are different from ‘drug addiction’, as ‘drug addiction’ refers to compulsive and dangerous drug seeking and use. In the short term, the use of pain medication can be important to help you normalise your movement and perform your prescribed exercises, leading to better outcomes in the long term. Your medical team will generally be aware of the dose and duration of pain medication that you have been taking, and can discuss the risk of a ‘drug tolerance’ or ‘drug dependence’ with you, to ensure you maintain a healthy and long life. Just remember, pain medication is not a free ticket to continue ‘high risk of back pain type activities’ …of course that is the technical term 😛
Lower back pain is very complex, and we are working hard on finding the answers. Until the time comes when we have a cure for lower back pain, remember to try to keep an open mind, avoid fabrications, illusions or catastrophizations of your injury, and seek treatment early.
I am off to the 25th National Conference on Incontinence in Adelaide! Next time I will let you in on all the secrets, updates, latest research and goss from the world of pelvic floor therapies! Until then…
Be kind to yourself,