Dispelling myths around 
lower back pain

Part Two

Adapted from: O'Sullivan, P. B., Caneiro, J. P., O'Sullivan, K., Lin, I., Bunzli, S., Wernli, K., & O'Keeffe, M. (2020). Back to basics: 10 facts every person should know about back pain. British journal of sports medicine, 54(12), 698-699.

Low back pain is one of the most common musculoskeletal (MSK) conditions seen within physiotherapy clinics, with data suggesting over any given one-month period, close to one-third of people aged over 25 are living with low back pain in the UK [1]. Given its prevalence, many theories exist around the causes of low back pain and how best to manage it. It’s an area of significant research, given the impact it can have on an individual, but also the wider social and economic effects of low back pain. Appointments and consultations relating to low back pain cost the NHS almost £5 billion pounds a year [2]. Consequently, there is a significant amount of misinformation relating to low back pain. In this blog, we will look at some commonly reported beliefs in low back pain and how many may not be entirely accurate. 

Below we look at part two of our blog series - if you missed part one you can read that here.

Myth 6 - "Back pain is NOT caused by poor posture"

One of the most commonly held beliefs in people experiencing ongoing low back pain symptoms is that this is directly caused by poor posture. It is commonly reiterated in media with specialist chairs and desks aiming to create the perfect posture. It remains a commonly held belief that we most adopt a perfect posture when lifting, bending at our knees, bracing our core, and keeping our spine as straight as possible to minimise our risk of injury. But if you had a painful wrist, would you clench your fist as hard as possible to keep it secure if you had recently sprained it?

Whilst postures may influence the pain we feel, there is no evidence that they cause back pain. Spines are strong, resilient, and adaptable even when we are feeling pain. The only posture I discourage with my clients, is the one that we spend too much time in. A variety of postures is best for the spine. It is also completely safe to relax during everyday tasks such as sitting, bending, slouching …and even lifting with a rounded back. There is no evidence that these more relaxed postures put us at greater risk of developing spinal pain. Much like the stiff wrist that I’ve described above, in long standing back pain it can be as important and beneficial for pain to move in a more relaxed manner.

Myth 7 – “Back pain is NOT caused by a weak core”

Another commonly discussed and held belief in regard to long term low back pain, is that it is caused by having a weak core. There is no scientific evidence that weakness of the superficial (close to surface of skin) or deep abdominal muscles makes people more prone to having back pain. In fact, people with back pain often tense their ‘core’ muscles as a protective response. Being strong is important when you need the muscles to switch on for a particular task, but being tense all the time is not helpful. Learning to relax the core muscles can contribute to achieving more comfortable spinal movements. 

Myth 8 – “Backs do NOT wear out with everyday loading and bending”

A person walks into a gym and picks up a dumbbell. They perform repeated ‘bicep curls’ (holding dumbbell in hand, bending the elbow, and slowly extending it back down) until their upper arm felt tired. They repeated this every other day for 6 weeks. Did this wear out the muscle? No. In fact, we know through years of evidence-based science that muscles adapt to this stimulus and become stronger. People who commit to regular strength exercises often find with time and regularity; they can lift heavier weights.

The same can be said for movements and activities involving your low back. The same way lifting weights makes muscles stronger, moving and loading the back regularly makes it stronger and healthier. Movements such as bending, twisting, running and lifting do not contribute to “wear and tear” in the spine and are safe. Starting gradually, practicing movements regularly and listen to your symptoms during this process create the best environment for your muscles, ligaments, tendons, and joints to adapt to these demands. 

Myth 9 – “Pain flare ups do NOT mean you are damaging yourself”

While pain flare ups can be very scary and painful, they are very rarely related to actual tissue damage. They are instead most affected too how sensitive these structures are. We know from longstanding research; a number of factors can influence the sensitivity of structures that are painful. These can include poor sleep, increased stress, being more tense, having a low mood, being less active or completing an activity that the tissues are not used to completing. We also know that having more co-morbidities (other health conditions you may take medication for) puts you at an increased risk of developing longer standing pain. Your overall health has far more to do with pain and the sensitivity of structures. Controlling or improving these above factors can reduce the likelihood of a flare, but if you are experiencing a flare the most important thing to do is not panic and remain as active as possible, using pain relief if required. 

During the process of rehabilitation, some people may expect that with the more time that passes and with the more positive things we do to help, the pain gradually and continuously improves (orange line). We know that in reality, it is normal that we experience setbacks along a usual rehabilitation journey as we gradually introduce exercise, activity and movement. The green line better represents an expected journey for the typical person experiencing a new onset of low back pain. Both lines reach the same destination, but the experience to that point can be very individual to you and there is no right or wrong.

Myth 10 – “Injections and surgery are usually not a cure”

We know from years of research into surgical interventions for persistent back pain, that they are not very effective in improving pain or function for a large majority of people. We know in roughly 90% of cases, persistent back pain symptoms cannot be attributed to a specific spinal structure that can be targeted with an invasive procedure. In 2016, the NHS through their NICE guidance recommended against the use of fusion surgery or disc replacement surgery for persistent low back pain, as it did not lead to better outcomes than not having surgery.  Surgical interventions including injections or fusions also come with risks and can have unhelpful and undesired side effects.

In persistent low back pain, I see my role as a physiotherapist to be more of coach. Helping someone find low risk ways to put them back in control of their pain is the key, and I’m attempting to fill up their own tool-box with tools they can use. We know from research that this style of approach is superior to surgery in supporting people with persistent low back pain to return to valued activities and move forwards.

Thank you for joining me within this blog to unpick some common misleading beliefs about chronic back pain. At Injury Armour, we are extremely experienced in delivering an evidence-based approach to put you back in control of your symptoms. Book with us now to begin your journey.

References

[1] GBD 2021 Low Back Pain Collaborators. (2023). Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: A systematic analysis of the Global Burden of Disease Study 2021. The Lancet. Rheumatology, 5(6), e316.

[2] Macfarlane, G.J., Beasley, M., Jones, E.A., et al. (2012) The prevalence and management of low back pain across adulthood: results from a population-based cross-sectional study (the MUSICIAN study). Pain 153(1), 27-32.

[3] Bardin, L.D., King, P. and Maher, C.G. (2017) Diagnostic triage for low back pain: a practical approach for primary care. Medical Journal of Australia 206(6), 268-273.

[4] webpage: Low back pain (who.int) – World Health Organization – link checked on 22nd May 2024.

[5] O'Keeffe, M., O'Sullivan, P., Purtill, H., Bargary, N., & O'Sullivan, K. (2020). Cognitive functional therapy compared with a group-based exercise and education intervention for chronic low back pain: a multicentre randomised controlled trial (RCT). British journal of sports medicine, 54(13), 782-789.

[6] Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., ... & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American journal of neuroradiology, 36(4), 811-816.

[7] Yu, Pengfei, Feng Mao, Jingyun Chen, Xiaoying Ma, Yuxiang Dai, Guanhong Liu, Feng Dai, and Jingtao Liu. "Characteristics and mechanisms of resorption in lumbar disc herniation." Arthritis Research & Therapy 24, no. 1 (2022): 205.