Misconceptions of Chronic Low Back Pain?

Moving will make my back pain worse?

Initially some movements can be uncomfortable when you first develop back pain, it is well documented that returning to movement and work as soon as you are able, is much better for recovery and preventing recurrence than bed rest. People fear bending and twisting, but it is essential to keep moving. Gradually increase your movement and try to stay on the move. This is not a new concept by any means, but it is an unfortunate misconception which continues to endure.

I should avoid exercise, especially weight training!

All exercise is generally accepted amongst all respected authorities to be the best modality for treating your low back pain in both the acute and chronic phase.

Back pain should not stop you enjoying exercise or regular activities. In fact, studies have found that continuing with exercise helps you recover sooner. Interestingly, there is no one type of exercise that proves to be better or worse than another, so simply do what you enjoy and can ultimately tolerate. Gradually build up as your confidence and ability as your pain improves.

A scan will tell me what is wrong

There is an abundant and developing body of research that shows that not only do results of scans poorly correlate  with actual symptoms in people with Low Back Pain, but also that most people even without Low Back Pain have some changes on scans and X-rays that do not cause any symptoms at all.

For this reason and more, imaging alone does not tell us exactly why someone is experiencing pain. 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.

Pain equals damage

The level of pain experienced is rarely proportional to the amount injury sustained to the back. Pain is more complex than this, as pain levels are also a reflection of how threatened each human perceives itself to be. For example, previous experiences, general health, their beliefs, sleep and exercise levels as well as their psychological well-being, all play important roles in how much pain each individual might experience.

I hurt my back, so I will probably have bad back pain forever!

While LBP can be very painful initially, most people will make a full and quick recovery. Rapid improvements in pain can occur within a few weeks for most people, with continuing improvement over a few months. Most people can return to their work and hobbies relatively quickly.

Of more importance is identifying the small number of people with LBP who may be at risk of developing ongoing problems. There are a number of factors such as distress, anxiety, and fear of movement, which are associated with an increased risk of ongoing back pain. If identified at an early stage with clinical examination and advice on self-managed recovery, their prognosis is significantly improved.

My back pain is due to something being ‘out of place’

There is no evidence that LBP is caused by a bone or joint in your back being out of place, or your pelvis being out of alignment. Common suggestions that LBP is caused by spinal subluxations, pelvic asymmetries, alterations in leg length and other simple structural issues, are incorrect.

If you get occasional episodes of pain, this is not because of developing a serious structural problem, which must be put back into place. As a result, we can focus on the strategies such as exercise that have been proven to be effective for treatment.

It is particularly important for Physiotherapists and health care practitioners to be careful to suggest structures have moved out of place, as this is potentially frightening and may lead to heightened levels of fear, stress and anxiety, all of which have been shown to be associated with poorer outcomes in LBP.

Research Papers

Balagu, F. et al. (2012). Non-specific Low Back Pain. The Lancet, 379(9814), pp.482–491.

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.

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-Analysis