Did you know that low back pain is one of the leading causes of disability worldwide? 80% of people will experience an episode of back pain at some point in their life. There are a lot of common misconceptions out there about back pain, many of which are reinforced by the media, industry groups and well-meaning clinicians. These misconceptions can lead individuals to unhelpful beliefs about their back pain, which resultingly may lead to unhelpful behaviours. Some of these behaviours include avoiding movement or certain postures, protective mechanisms such as guarding and bracing ‘core’ muscles, and limiting meaningful/valued activities like social gatherings or everyday tasks. 


Here are 10 helpful facts that every person should know about back pain.

  1. Back Pain can be scary, but it’s rarely dangerous. Back pain can be very worrisome and stressful at times, but it is rarely a serious, life-threatening medical condition.
  2. Getting older is not a cause of back pain.  Age is not indicative of pain.  We often hear about how old age is the reason for having so much back pain, but there is no evidence to support this.  Most episodes of back pain improve over time and do not get worse as we get older.  In fact, the highest prevalence of back pain occurs in mid-life (30’s to 50’S), and starts to decrease as we get into our golden years.
  3. Persistent back pain is rarely associated with serious tissue damage.  The severity of pain that is experienced is not always indicative of the severity of damage in the body.  Our backs are very strong and resilient.  Any tissue damage that does occur in the body heals a lot faster than we think.  Within 3 months, our tissues are on the way to being healed.  Pain can be influenced by several factors incuding fears, exercise levels, stress, coping style, previous experiences and perceptions.  Our nervous systems have a funny way of turning the volume of pain up or down based on these factors.  So, these negative beliefs and behaviours that we have are more strongly associated with persistent pain than is tissue damage itself.
  4. Scans rarely show the cause of back pain.  Scans can be very intimidating.  Often times, a lot of scary-sounding things are found on the scans that aren’t necessarily associated with the pain of being felt.  Studies have recently shown that people without back pain also have these scary-sounding findings on their scans: disc bulges are found in 52% of people, degenerated discs in 90% of people, herniated discs in 28% of people and arthritic changes in 38% of people.  Unfortunately, when people with back pain are told that these findings are the cause of their back pain, they begin to believe their back is damaged and tend to become fearful or avoid activities that they love.  Instead, try thinking about these things as ‘wrinkles in the back’, common findings in the majority of spines (with or without pain) rather than debilitating, scary conditions.
  5. Pain with exercise and movement doesn’t mean you are doing harm.  When someone experiences pain, the spine and surrounding muscles can become very sensitive to touch and movement.  Back pain during exercise and movement are a reflection of this hyper-sensitivity, not damage to the tissues.  In fact, exercise and movement are one of the best things you can do to help treat back pain!  Not only will it reduce pain and discomfort, but it can relax the muscles, improve mood, and strengthen the immune system.  Regular exercise helps keep you, your body and your mind healthy-this is something I am a huge believer of!  All types of exercise are good.  There is no one perfect exercise to do for back pain.  Understand that there is a difference between muscle soreness and pain.  Muscle soreness is very common when you are new to exercise, it just means that you are using your muscles and challenging your body in ways that you never have before!
  6. Back pain is not caused by bad posture.  This may be hard to believe, but there is actually no specific posture that has been shown to prevent back pain!  Everyone’s body is different, so some people might find it more painful to be slouching while others will find sitting upright to be more comfortable.  The current research tells us that spinal posture while sitting, standing and lifting does not actually predict the risk of low back pain or its intensity.  Putting the body in a variety of postures throughout the day is actually very healthy for the back and is highly recommended.  It is a safe to perform everyday tasks like sitting, bending and lifting with a round and straight back!
  7. Back pain is not caused by a ‘weak core’.  Having weak ‘core’ muscles in actually not associated with back pain.  In fact, people who suffer from back pain often tense their ‘core’ muscles and have an overactive ‘core’ as a way to protect themselves from the pain.  It sounds counterintuitive, but this can actually be worsening your back pain!  Imagine clenching your fist and turning on all of those wrist muscles when you have a sprained wrist-how painful would that be!?  It is important to be able to have control over your core muscles and use them when they are needed, but bracing and guarding all the time, especially when in pain, isn’t always helpful.  Learning to relax your ‘core’ muscles during daily tasks will more likely than not help with lowering your pain levels.
  8. Backs do not wear out with everyday loading and bending.  Our backs are built to move, bend, twist and lift.  Loading the back is actually what will make it stronger, healthier and more resilient!  Sure, someone can strain their back if they lift something that is heavier than what they normally lift or move in an awkward way, but that does not mean this movement is bad for you and should be avoided.  It is important to start doing this gradually and practice regularly so that the body can build tolerance and get accustomed to it, but in no way is it bad for your back!  Think about people who begin to start running after spraining an ankle-we need to load the joints again after an injury, to make them stronger and healthier.
  9. Pain flare-ups don’t mean you are damaging yourself.  Pain flare-ups are scary, painful and frustrating.  Often times, they come on with no actual mechanism of injury or even with simple, everyday movements.  Similar to headaches, common back pain triggers include things like stress, tension, worries, low mood, poor sleep, low water intake and lack of physical activity.  Modifying these factors can help to prevent or lessen the intensity of flare-ups.  So, next time you’re experiencing one, try to stay calm, keep moving and maybe even try some meditation to help relax!
  10. Injections, surgery and strong drugs usually aren’t a cure.  Spine injections, surgery and opioids usually aren’t very effective for back pain in the long run.  More so than not, they come with risks and negative side-effects that outweigh the amount of pain relief that is felt.  Treating back pain through a more conservative approach is not only more effective, but cheaper and safer than these extreme measures.  Incorporating patient-centered education, a positive mindset, physical activity, manual therapy, and ways to optimize mental health (such as social activities, healthy sleep habits, weight management and stress-relief techniques) will be more beneficial for individuals suffering from back pain in the long term.

Reframing some of these beliefs about low back pain and creating a positive mindset will help to decrease pain levels, build confidence and lessen the fear.  Let’s flip the script here so back pain doesn’t look as scary as we make it out to be!

 

References:
Beales D, Smith A, O’Sullivan P, Hunter M, Straker L. Back pain beliefs are related to the impact of low back pain in baby boomers in the Busselton Healthy Aging Study. Physical therapy. 2015 Feb 1;95(2):180-9.
Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, Straker L, Maher CG, O’Sullivan PP. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. British journal of sports medicine. 2020 Jan 1;54(2):79-86.
Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ. What low back pain is and why we need to pay attention. The Lancet. 2018 Jun 9;391(10137):2356-67.
O’Sullivan PB, Caneiro JP, O’Sullivan K, Lin I, Bunzli S, Wernli K, O’Keeffe M. Back to basics: 10 facts every person should know about back pain.