Common misconceptions about low back pain

Low back pain (LBP) is extremely common in the general population, but unfortunately seems to be fraught with misconceptions on its management. One of the challenges we are presented as clinicians is to address people’s beliefs that sometimes contrasts with the best evidence there is on managing the condition.

Living through episodes of acute low back pain can generate distress and anxiety regarding one’s health. There is growing evidence that people’s beliefs and behaviours regarding their LBP influence their level of disability far greater than the intensity of their pain. Today’s column will focus on addressing five most commonly reported myths on LBP.

‘I hurt my back, I will have to deal with this

all my life’

Although people who injure their backs can experience high levels of pain initially, most will be able to return to work and hobbies within a few weeks with continuing progress into the next couple of months. Simple basic advice can help manage pain and avoid recurrences. Only a minority of people will develop longstanding pain that can cause more serious disability. People who suffer from high levels of distress, anxiety, and fear of movement are more at risk of developing persistent pain. However, when these risk factors are addressed early on, the potential for recovery improves significantly.

‘I hurt my back, I better stay in bed’

Just like any new injury, it is important in the first few days to avoid any aggravating activities. However, there is surmounting evidence that complete bed rest is much more harmful for recovery of LBP. It can actually increase your levels of pain. A gradual return to hobbies, work and general activity, even when it is a little sensitive, seems to be sound advice for optimal recovery. You spine is made to move!

‘The worse my pain is, the more damage I must be

causing to my spine’ Although this one might feel less intuitive, we often use the expression, hurt does not equal harm to explain that the level of pain felt does not always correlate well with the degree of tissue damage. Many factors can influence our pain perception, such as the context of the injury, your previous pain experience, your mood, fears and beliefs regarding your injury, your fitness and stress level, and your coping strategies. This is particularly true when in comes to persistent pain. A trained health care professional can help people with persistent pain develop a plan for graded return to activity and help distinguish between hurt and harm. ‘My back pain is due to something being

out of place’

A very common misconception regarding LBP is that something in your spine or pelvis must be displaced. In fact, there is very little evidence that minor structural asymmetries are related to pain. However, many people will report feeling relief from manipulating or “popping” joints. It is now understood that the relief associated with joint manipulation has more to do with calming the nervous and muscular system down, allowing easier joint movement rather than putting something back in its place. In some specific cases, when mobility is restricted, these types of treatments combined with appropriate reassurance and education can be useful to calm things down.

‘I hurt my back, I need a scan or X-ray…’ In the majority of LBP cases, diagnostic imaging such as X-ray or scans are not necessary and often do not help guide the treatment plan. They are most often useful when signs of more serious problems are present and need to be ruled out. A simple clinical exam can guide clinicians to the relevance of pursuing with a diagnostic test. One of the main challenges related to these types of examinations is that a large number of adults with no LBP will present with degenerative changes like arthritis and bulging discs on their scan or X-rays. Therefore, it is sometimes hard to determine whether these changes are at all related to a person’s pain.

There is no simple recipe in the treatment of LBP but general consensus highlight the following points. If you are suffering from LBP for the first time, get yourself screened by your health care provider. Although pain may be intense initially, it is not always related to serious tissue damage and diagnostic imaging will be prescribed in very specific cases. Most people with LBP should avoid bed rest and return to their usual activities as soon as possible. Your health care provider or physio can help you with sound advice on how to protect your low back in the initial phase of recovery. People who experience persistent LBP can benefit from a supervised exercise program that addresses their attitudes or beliefs regarding their pain and physical activity.

If you would like to learn more on the subject of this column, a free English educational conference will be presented at the Lac Brome Community center on February 26, at 6:30 p.m. People are invited to sign up by calling the community center at 450-242-2020.

Resource: www.move4health.ie

Article written by Karine Tcholkayan pht and Amy Rogerson pht

Amy and Karine are registered physiotherapists, both holding a master’s degree in Physiotherapy and bachelor of science in Exercise Science.