By Lauren Kendall – Physiotherapist and Clinical Pilates Instructor
Low back pain (LBP) is a very common condition. In fact, it is estimated that up to 75% of people will experience low back pain at some time in their lifetime (Fatoye, Gebrye & Odeyemi, 2019). For up to 30% of this population, LBP can become persistent and debilitating, however, rarely is it considered a dangerous condition.
LBP can be divided into three different categories. The first category is LBP that is attributed to a serious or systemic pathology such as cancer, inflammatory disorders or infections, and it accounts for only 1-2% of LBP patients. Next, there is LBP with a specific pathology, such as spondylosis or spondylolisthesis, bone fractures or disc prolapse with radicular pain, which is experienced by 5-10% of the LBP population. Finally, a huge 90% of LBP patients experience “non-specific LBP” which describes LBP with no pathoanatomical contribution. Fortunately, acute LBP has a favourable natural history with up to 80% of episodes resolving in 3 weeks.
Unfortunately, there are a lot of negative misconceptions regarding low back pain which may instill fear and worry in patients, and heighten their pain experience. Let’s debunk common misconceptions about low back pain, and empower patients to tackle their pain.
Misconceptions #1 #2 #3
“Rest is the only solution” …
… “Bending my back is bad”
… “I have to avoid heavy lifting”
In some instances, relative rest may be required during the first couple of days following an acute episode of low back pain to avoid aggravating intense pain during this early recovery phase. However, beyond this timeline, rest is counterproductive both in acute and chronic LBP.
There is strong evidence that suggests that prolonged rest and avoidance of activity for people with low back pain actually leads to higher levels of pain, greater disability, poorer recovery and longer times spent away from work (Gordon & Bloxham, 2016). Additionally, more research shows that physical activity and regular exercise is especially helpful for improving low back pain, and is effective in the prevention of future episodes.
Unfortunately, the body loses muscle strength and endurance much faster than it can regain it. Therefore, it is so important to stay as active as possible – start slowly, and build up the amount and intensity of the activity in a gradual manner.
Misconception #4 – “Pain equals damage”
It is important to remember that the back is a strong and resilient structure that is not easily damaged. Rather, the pain experience is a product of various contributing factors, and not necessarily attributed to anatomical changes which may or may not have been revealed on clinical imaging.
Overall, pain is a good thing – it is a protective mechanism, and warns the body about any threats of harm. However, if pain has been occurring for long periods of time – particularly in chronic low back, central sensitisation can occur. In this instance, the central nervous system becomes amplified and makes people much more sensitive to pain. Therefore, activities or movements that would normally not be painful, become painful.
Additionally, the perception of pain may become amplified due to:
- Poor sleep
- Fear-avoidance behaviours
- It can lead to reduced physical activity which can prolong pain as outlined above, and may also contribute to muscle guarding and restricted movement patterns which contribute to pain chronicity (Synnott et al., 2015
- Research also suggests that a lack of social support and demanding jobs are also associated with musculoskeletal back pain.
“I have to get an X-ray and MRI to tell me what the problem is”
Among health care professionals, there is an overreliance of medical imaging for LBP. However, current research indicates that LBP does not correlate with the structural abnormalities that may be reported on an X-ray or MRI. Rather, imaging findings are often attributed to normal age-related changes, and are not necessarily the primary reason for LBP (Morgan et al., 2019).
Interestingly, some literature also report that degenerative changes are present in nearly 37% of 20 year olds, 66% of 50 year olds and 96% of 80 year olds of individuals who do not experience LBP, and who lead pain-free and active lives (Brinjikji et al., 2015).
Additionally, the outcome of medical imaging may often contribute to low back symptoms and prolong recovery. This is because it can contribute to psychosocial factors of pain, including catastrophic thoughts and beliefs, unhelp expectations, poor motivation, perceived disability which act as catalysts for chronicity, contributing to poorer recovery, prolonged disability (Synnott et al., 2015).
“Surgery is the only way to fix a ‘slipped’ disc”
Research suggests that over 85% of patients with acute lumbar herniated discs experience resolution of symptoms within 8-12 weeks (Dydyk, Massa & Mesfin, 2020), with a lot of literature suggesting that physiotherapy is effective in controlling disc herniation-related pain and help reduce and eliminate pain.
Image source: Pexels (4506109, 7218596, 4498158)
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., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American journal of neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173
Dydyk, A. M., Massa, R. N., & Mesfin, F. B. (2020). Disc Herniation. StatPearls [Internet].
Fatoye, F., Gebrye, T., & Odeyemi, I. (2019). Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatology international, 39(4), 619-626.
Morgan, T., Wu, J., Ovchinikova, L., Lindner, R., Blogg, S., & Moorin, R. (2019). A national intervention to reduce imaging for low back pain by general practitioners: a retrospective economic program evaluation using Medicare Benefits Schedule data. BMC health services research, 19(1), 1-10.
Synnott, A., O’Keeffe, M., Bunzli, S., Dankaerts, W., O’Sullivan, P., & O’Sullivan, K. (2015). Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: a systematic review. Journal of Physiotherapy, 61(2), 68-76. doi: 10.1016/j.jphys.2015.02.016
Wertli, M. M., Eugster, R., Held, U., Steurer, J., Kofmehl, R., & Weiser, S. (2014). Catastrophizing—a prognostic factor for outcome in patients with low back pain: a systematic review. The Spine Journal, 14(11), 2639-2657.