Misconceptions of Chronic Low Back Pain?
Moving will make my back pain worse?
Often 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. 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!
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.
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, no one type of exercise proves to be better or worse, so simply do what you enjoy and can tolerate. Gradually build up as your confidence and ability improves.
A scan will tell me what is wrong
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, but also that most people without Low Back Pain have changes on scans and X-rays that do not cause any symptoms at all.
For these reasons and more, imaging alone isn’t capable of telling 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 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 well-being, all play important parts 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.
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