The prevalence of low back pain has been increasing steadily over the past 10-20 years. During
this time we have seen the birth and consolidation of core stability, an increased availability to diagnostic scans and an increase in low back surgical procedures. So what is really going on here? You would think that the rates of low back pain would be decreasing with our improved knowledge of the body. We now know that low back pain is an extremely complex condition and can be influenced by many factors. What we thought was true and factual for low back pain has not been backed up in the latest research we have available to us.
Some common myths and misconceptions regarding low back pain include:
- Low back pain is usually something to be concerned about
Low back pain affects 80-90% of us at some time during our lives. In most cases, low back pain is painful but not dangerous and that very often it’s “bark” is bigger than it’s “bite”. Only 5% of all cases are due to something serious such as a fracture, inflammatory disorder, infection or a malignancy. When these are present, there are other factors involved such as persistent night pain, pain not relieved by rest, fever, weight loss and fatigue.
We also know that low back is pain very closely related to poor sleep, being run down and stress (See here) and that 90% of low back pain incidents will resolve in around 4-6 weeks by keeping a relatively normal lifestyle, doing some simple movement based exercises and limiting prolonged periods of rest.
- Having a scan on your back will let you know what the problem is.
In recent times, scans such as MRI have become much more available to people presenting with pain. These scans can see everything and anything that’s inside us. We would think this is a great thing, however, detailed images from scans can show things which we have previously assumed are abnormalities but are in fact normal changes in our bodies. Disc bludges, disc degeneration and facet joint degeneration are more common than we think and can be seen frequently in people without back pain. See here
The problem here is that we have now created a situation whereby in the search for the 5% of individuals who may have a serious problem, we have taken this belief that we need to scan everyone with back pain. This has resulted in people being told that disc bulges and disc degeneration are dangerous which in turn produces fear avoidance behaviours, unhelpful beliefs which has been shown to perpetuate the pain cycle. See here
Scans are only required when there is neurological deficits such as weakness of lower limbs, progressive numbness or bladder and bowel function, or a history which suggests that there is something more serious going on.
- If you have low back pain then you need to do specific exercises to strengthen your “core”
Just because you have back pain does not mean that you need to specifically strengthen your “core”. The hype of “core stability” has enveloped the physiotherapy and fitness industry with the promise that if you can selectively isolate a few key muscles in your trunk, you will be able to stiffen and stabilise your back. This really insinuates that a few small muscles are the crux of a very complex condition that is low back pain. Our backs need a complex interaction of many muscles to act together to produce both movement and strength.
Trying to pre-stabilise or “switch on your core” before movement has not shown to improve the outcome of low back pain and in fact can reinforce negative behaviours and fear which can lead to even more pain. It has also been shown in the research that selectively activating core muscles was no better than other forms of exercise for rehabilitating low back pain. See here and here
Another interesting study looking at core stability demonstrated that an improvement in low back pain and function was not associated with improvements in abdominal muscle functioning suggesting that other factors were involved. See here
In my experience, I have seen people rehabilitate successfully from incidents of low back pain with a variety of exercises such as yoga, pilates, general strengthening at the gym and swimming to name a few. It is clear that there is no “magic bullet” for rehabilitating low back pain and a combination of movement, exercise and addressing other lifestyle factors are recommended.
- If you sit incorrectly then you will develop low back pain.
This is a widely held belief in our society that is not well backed up with the latest evidence. A perfect sitting posture has not yet been found and the relationship to developing low back pain is questionable. See here and here
Evidence suggests that varying your position on a daily basis is probably better than keeping in one position be it upright or slouched. I have previously seen people with high levels of muscle activity and discomfort in their lower back because they tried to sit in the upright position for extended periods of time. It is also ok to slouch but of course if you stay slouched all day then you may have some low back discomfort. The best advice is to get up and move every 30 minutes to maintain movement in the low back.
Unfortunately low back pain has been given some bad press in the past, which has created more fear around this condition. Scans and medical procedures have become more prevalent, as well as advice to stiffen the spine to prevent injury. All of these have not been able to curb the rise and disability of low back pain. A more holistic approach which includes movement, general conditioning and addressing lifestyle factors and negative beliefs surrounding pain is required to produce effective outcomes.