The Seven Myths of Back Pain

(Adapted from the Irish Society of Chartered Physiotherapists move4health campaign in 2011)

1. I hurt my back so I will probably have chronic back pain from now on.

80% of people will experience only one episode of back pain in their lives that resolves on its own in roughly 4-6 weeks.  The cause of pain can be injury to the muscles, ligaments (non-stretchy supportive attachments between the bones) or even a disc that becomes irritated, inflamed or even bulges a bit.  But like most tissue in the body there is enough blood flow in these areas to support healing and the pain resolves 100% as the tissue heals.

2. I have back pain so I should stay in bed and rest.

The research has found that activity is actually better for the healing of back pain and the associated injured tissues in this area.  Trying to maintain your daily activities as best as possible as well as gentle cardiovascular activity will help to heal the tissues and over time will decrease pain.  If you have chronic back pain, then a cardiovascular program is very important to keeping pain levels down and decreasing them over time.

3. The more back pain I have the more my spine is damaged

The research in this area is quite clear—you can have LOTS of pain in the spine area without a lot of tissue damage.  In fact, patients with really severe spine conditions often don’t have much pain at all.  Think of it this way—have you ever found a bruise on your body or a bleeding cut, and had no idea where you got it?  You CAN experience tissue injury, even severe injury, and not feel any pain at all.  On the flip side, you can experience A LOT of pain but have only a small amount of tissue injury.  There are many structures in the spine that can send pain messages and these structures are very sensitive to change, so even a little bit of tissue damage can set off really LOUD alarm bells.

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

There are many causes of pain in the spine.  One of them can be a joint that has moved a little bit and surrounding muscles that have gotten tight as a result of this.  However, the research has found that in a population of people having similar symptoms of back pain the scans have been very different and often times do not reveal any changes in the spine at all, let alone revealing that a joint has moved.  Discs also are not able to “pop” or "slip" in and out of position.  They are a stiff material that can stretch and move some but often if they bulge or get injured they will heal and become smaller again over time.

5. I need a scan or X-ray for my back pain

X-rays show changes in bone and are a great resource for checking for fractures or any breaks in the bone as well as the presence of arthritis.  The term arthritis includes over a 100 separate diagnoses and is any change to the bony or joint surfaces of the spine.  A joint is anywhere where two bones meet and often there is protective cartilage between the surfaces of bone.  Arthritis, or changes in the bones of the spine, start in our 20s!  An MRI is used to look at the soft tissue of the spine—the muscles, ligaments and discs.  The discs are semi-circular and the outer surface (annulus) is a stiff cartilage and the very center (nucleus) is made up of a more viscous fluid-like material.  If you take about 100 people who have NO back pain and put them in an MRI, almost 75% will have changes in the spine.¹   Starting in our 20’s these changes include disc degeneration (37%) bulging discs (30%), disc protrusions (29%), and annular tears (19%).  As we age the percentage of each of these goes up.²

6. I need an operation to cure my back pain

While there are some specific conditions that require surgery, most back pain heals on its own or is not an indicator of severe tissue injury.  There are some conditions in which a surgery would be beneficial or is even necessary.  For those who have severe pain, numbness and tingling down one or both legs, a surgery may be indicated to take pressure off the spinal nerve(s) and/or spinal cord.  If someone is having leg weakness and is losing function in one or both legs (can’t lift the foot, or control the ankle, knee, hip) or is not able to control bowel or bladder function, a spine surgery may be necessary to take pressure off the nerves or spinal cord and allow the nerves to heal again.  These are serious and extreme situations in which a surgery may be indicated in order to prevent permanent nerve injury.  However, for patients who are having low back pain only, surgery is usually not indicated, has a 50/50 shot of reducing pain and can increase pain and dysfunction.

7. My job is dangerous for my back

Whether you sit all day, stand all day, or do a lot of bending, twisting or heavy lifting, your back can handle a lot of stress.  There is little to no evidence that your job is the reason you have chronic back pain.  That is not to say that you can’t injure your back on the job.  But the injury will heal and making ergonomic changes to reduce repetitive stressors on the spine can go a long way to preventing further injury.  However, if you continue to perform movement in proper ways or sit in good posture, and your back still hurts, you may benefit from a visit with a physical therapist to assess these and see if there is something else going on.