Back pain myth busters
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The evidence
You've seen the facts, now read on for the evidence behind them. The evidence below has been provided by the Physio Matters podcast team - Rob Tyr, Jack March and Mark Reid.
Myth – Moving will make my back pain worse
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Although it is true that some movements can be uncomfortable when you have back pain, it is well established that returning to movement and work as soon as you are able, is better for recovery and preventing recurrence than bed rest [1][7].
This is not a new concept by any means [6], but it is an unfortunate misconception which is continues to endure, due in part, to the complex nature of pain [2][3][4][5]. #MotionIsLotion
Balagu, F. et al., 2012. Non-specific low back pain. The Lancet, 379(9814), pp.482–491.Darlow, B. et al., 2015. Easy to Harm, Hard to Heal. Spine, (August 2016), p.1.Picavet, H.S.J., Vlaeyen, J.W.S. & Schouten, J.S.A.G., 2002. Pain catastrophizing and kinesiophobia: Predictors of chronic low back pain. American Journal of Epidemiology, 156(11), pp.1028–1034.Pincus, T. et al., 2002. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine (Phila Pa 1976), 27(5), pp.E109–20. Swinkels-Meewisse, I.E.J. et al., 2006. Acute low back pain: Pain-related fear and pain catastrophizing influence physical performance and perceived disability. Pain, 120(1-2), pp.36–43.Waddell, G., 1993.Simple low back pain: rest or active exercise? Annals of the rheumatic diseases, 52(5), p.317. Wynne-Jones, G. et al., 2014. Absence from work and return to work in people with back pain: a systematic review and meta-analysis. Occupational and environmental medicine, 71(6), pp.448–56.
Myth – I should avoid exercise, especially weight training
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Exercise is generally accepted amongst all respected authorities to be the best modality for treating low back pain in both the acute and chronic phases [1].
Studies have shown great benefits and long-term safety of various types of exercises [2][3][4][5] including high load resistance training [5][6].
Interestingly, no one type of exercise proves to be better or worse, [7] so simply do what you enjoy and can tolerate! Gradually build up as your confidence and ability improves. #StrongerForLonger
O’Sullivan and Lin (2014) Acute low back pain Beyond drug therapies; Pain Management Today, Volume 1, Number 1.Steele et al (2015) A Review of the Clinical Value of Isolated Lumbar Extension Resistance Training for Chronic Low Back Pain; American Academy of Physical Medicine and Rehabilitation Volume 7, Issue 2, Pages 169–187.Searle et al (2015) Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials; Clinical Rehabilitation 2015, Vol. 29(12) 1155 –1167.Bjorn et al (2015) Individualized Low-Load Motor Control Exercises and Education Versus a High-Load Lifting Exercise and Education to Improve Activity, Pain Intensity, and Physical Performance in Patients With Low Back Pain: A Randomized Controlled Trial; Journal of Orthopaedic & Sports Physical Therapy, Volume:45 Issue:2 Pages:77-85.Pieber et al (2014) Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain; Eur Spine J 23:779–785.Vincent et al (2014) Resistance Exercise, Disability, and Pain Catastrophizing in Obese Adults with Back Pain; Med Sci Sports Exerc. 46(9): 1693–170.Smith et al (2014) An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskeletal Disorders 15:416 DOI: 10.1186/1471-2474-15-416
Myth – A scan will tell me exactly what’s wrong
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There is a large and growing body of research that shows that not only do results of scans correlate poorly with symptoms in people with Low Back Pain [2, 4, 5], but also that most people without Low Back Pain have changes on scans and x-rays that do not cause any symptoms at all [1, 3, 5].
For these reasons and more, imaging alone isn’t capable of telling us exactly why someone is experiencing pain.
Of course this does not mean that all MRI scans are irrelevant in all cases, but it does mean that they are not always necessary or helpful. In fact, there is evidence to suggest that in some cases, having a scan can make situations worse [6]. #ThePlanNotTheScan
Teraguchi et al, (2013) Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: the Wakayama Spine Study.Videman et al, (2003) Associations Between Back Pain History and Lumbar MRI FindingsCheung et al, (2009) Prevalence and Pattern of Lumbar Magnetic Resonance Imaging Changes in a Population Study of One Thousand Forty-Three Individuals.Endcan et al, (2011) Potential of MRI findings to refine case definition for mechanical low back pain in epidemiological studies: a systematic review.Brinjikji et al, (2015) MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-AnalysisWebster et al, (2010) Relationship of early magnetic resonance imaging for work-related acute low back pain with disability and medical utilization outcomes.
Myth - Pain equals damage
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The level of pain experienced is very rarely proportional to the amount injury sustained to the back. Pain is far more complex than this, as pain levels are a reflection of how threatened each human perceives itself to be.
For example, past experiences, general health factors, beliefs, sleep and exercise levels as well as psychological wellbeing, all play important parts in how much pain each individual might experiences. [1][2][3][4][5][6] #SoreButSafe
Shiri et al (2013) The role of obesity and physical activity in non-specific and radiating low back pain: The Young Finns study; Seminars In Arthritis and Rheumatism June 2013, vol.42(6):640-650Taylor et al (2014) Incidence and risk factors for first-time incident low back pain: a systematic review and meta-analysis: The Spine Journal October 2014, Vol.14(10):2299-2319Manchikanti et al (2014) Epidemiology of Low Back Pain In Adults. Neuromodulation: Technology at the Neural Interface, Vol.17: 3–10.George et al. (2012) Predictors of Occurrence and Severity of First Time Low Back Pain Episodes: Findings from a Military Inception Cohort. PLoS ONE 7(2): e30597Wilkens et al (2013) Prognostic Factors of Prolonged Disability in Patients with Low Back Pain and Lumbar Degeneration in Primary Care: A Cohort Study. Spine. Jan 1;38(1):65-74Campbell et al (2013) Prognostic Indicators of Low Back Pain in Primary Care: Five-Year Prospective Study. The Journal of Pain. August 2013. Vol.14(8):873-883
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