World Spine Day 2021

On this year’s World Spine Day, the members of the BCA Communications Committee explain the most common misconceptions about back pain and debunk the most common myths surrounding the condition. 

 

Myth: Back pain means damage or injury 

In a lot of cases, back pain doesn’t mean damage or injury. We like to use the analogy of a paper cut. Everyone knows how much a paper cut hurts – it’s a lot of pain but minimum damage. The level of pain you experience is very rarely proportional to the amount of injury sustained to the back.  

Added to this, more pain doesn’t mean that more damage has been caused. Your actual pain level is a reflection of the threat level that your brain perceives itself to be going under. Your brain creates this level of pain based on all of the information it receives from your body, your environment and internally as well, such as memory of past experiences of certain situations and beliefs about pain. If your brain deems there’s a threat, it will create pain to alert you that there is a problem and that you need to make a change. It’s our in-built protective mechanism, which will create pain even if there is only a chance of potential damage. 

Moseley, G.L., 2007. Reconceptualising pain according to modern pain science. Physical therapy reviews, 12(3), pp.169-178. 

If your pain persists, it’s always advisable to seek a professional opinion from a registered health professional.  

 

Myth: Painkillers will speed up your recovery 

Most back pain is mechanical in nature so even though painkillers can be helpful, some sort of hands-on treatment or movement or exercise is more likely to manage the problem than painkillers.  

Painkillers can be useful when it comes to reducing pain in the short term and so helping people to start moving earlier after onset of back pain, and that movement through the pain can be helpful.  But we would recommend more conservative therapies, such as use of a heat pack, manual therapy (massage, spinal manipulation, or acupuncture), gentle home stretching, short walks within your pain tolerance; activities that help your back to relax, pain to reduce and allow you to return to higher levels of activity. Too much rest is the enemy when it comes to back pain. 

Qaseem, A., Wilt, T.J., McLean, R.M. and Forciea, M.A., 2017. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of internal medicine, 166(7), pp.514-530. 

Balagu, F. et al., 2012. Non-specific low back pain. The Lancet, 379(9814), pp.482–491. 

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: Lifting causes more back pain than sitting

Bending and lifting are often portrayed as causes of back pain and sometimes we avoid them in fear of damaging our backs. If you pick up something awkwardly, however, it’s more likely to cause a mild strain or a sprain than an injury in most cases.  

Different activities cause more back pain for some people than others. Some might experience more pain with sitting, others with lifting. For those who sit for a long period of time, I recommend moving and changing your posture every 20-30 minutes so you’re not stuck in the same position for too long. Most people believe that bad posture causes back pain, but actually posture causes a relatively low load on your back. It’s the absence of activity that causes pain. If you have back pain already, you may find some postures are more relieving than others when sitting; a perfect posture does not exist. 

Those who lift should focus on gradual strength training over time, to build up and get used to the weights they’re lifting, not only in the gym but also at home and at work. It is not that lifting is a cause of back pain, it is because we are unaccustomed to the loads that we are lifting or how often we are lifting them, whether this is lifting boxes at home or weights in the gym. 

 

Myth: You need a scan to diagnose the cause of back pain

There is no scan available that can tell you where your pain is. Imaging or scanning is just one piece of the puzzle when diagnosing the cause of back pain. It is very common to find changes such as “degeneration” on scan reports, research has shown that these are found in people with back pain and even without back pain, so are not necessarily the cause of your pain and are often part of completely normal aging like “wrinkles of the spine”. Somebody’s clinical history and a physical assessment can help to create a more complete picture when it comes to determining what is causing somebody’s back pain.  

Brinjikji, W., Luetmer, P.H., Comstock, B., Bresnahan, B.W., Chen, L.E., Deyo, R.A., Halabi, S., Turner, J.A., Avins, A.L., James, K. and Wald, J.T., 2015. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), pp.811-816. 

 

Myth: Exercise, especially weight training, will make back pain worse

Exercise generally has been shown to be the best intervention for treating low back pain in acute back pain (six weeks) and chronic back pain (three months and over). There are also recent studies on the long-term safety of lots of different exercises, including weight training, and it’s been shown to have great benefits.  

If you’re weight training and your back pain is getting worse, it likely comes back to going up through the weights too quickly and lifting beyond your capacity. In this case, we would recommend graded exercise over time, slowing building up the amount and intensity.   

If you find that you’re experiencing an increasing amount of back pain and exercise isn’t helping, it‘s always worth going to a registered health professional, such as a chiropractor, to treat your pain and to find a better exercise for you 

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. 

 

Myth: Doing too much causes wear and tear

Our bodies thrive on being used, and are more likely to ‘rust’ than to ‘wear out’. Several research pieces show that marathon runners have less knee wear and tear in later life than people who don’t run.

Ponzio DY, Syed UAM, Purcell K, Cooper AM, Maltenfort M, Shaner J, Chen AF. Low Prevalence of Hip and Knee Arthritis in Active Marathon Runners. J Bone Joint Surg Am. 2018 Jan 17;100(2):131-137. doi: 10.2106/JBJS.16.01071. PMID: 29342063.