Myths about low back pain
Myth #1 - Low back pain (LBP) is an old person’s problem
FACT - 85% of the population will experience LBP at some stage of their life – regardless of how many candles were on your last birthday cake. I explain to my clients that it is more often a matter of “when, not if” and there is never one single reason for LBP, but rather several contributing factors. It’s a physiotherapists job to identify these and address them accordingly.
Myth #2 – Strength will protect your back
FACT – Obtaining or maintaining strong ‘core’ muscles does help prevent LBP, but before you strengthen what is weak, you must re-educate what is inhibited and stretch what is tight.
Myth #3 – An MRI or other image is required to diagnose my LBP
FACT – A successful treatment plan can be based on a thorough medical Hx (history) and a physical examination. Most imaging will display problems that may not be generating any pain. As such, we need to treat the person, not the scan. Typically, I will only refer for further imaging if the patient is not progressing as expected and looks like they will need to visit a specialist.
Myth #4 – Sit-ups are safe & will strengthen my back
FACT – Traditional sit-ups use more of the hip flexor muscles. Tight hip flexors can place an excess load on the lumbar spine. In addition to this, sit-ups bring the lower spine into flexion which puts an increased load onto the disk. In fact, a recent study of intervertebral disk pressure showed that performing traditional sit-ups exceeded the recommend safe loading limit for occupational health and safety.
Myth #5 – Increased flexibility is beneficial
FACT – When seeing patients with LBP, I like to break them down into what I call ‘stiffies’ and ‘floppies’. ‘Stiffies’ tend to be short and stocky and will benefit from a good stretching program to manage their LBP. On the other hand, ‘floppies’ tend to be tall and lanky with increased joint hypermobility. This demographic requires a specific strengthening program ‘to hold everything in place’.
Myth #6 – Rest is the key to recovery from LBP
FACT – Bed rest and lounging around on the couch will only lead to increased pain and a slower recovery. Walking and gentle activity is strongly recommended. While it is important not to aggravate the injury, we need to find a delicate balance between keeping active and not overdoing it.
Myth #7 - LBP is job specific
FACT - While it is true that you are at a high risk of injuring your LBP doing manual labour, in the consulting room, we see just as many (if not more) office workers with LBP. The primary reason for this is poor sitting posture and ergonomics.
Myth #8 - It is the weight of the object I lift that caused my injury
FACT - It is true that lifting a heavy object might be the mechanism of injury for LBP, but more often that not it is “the straw that broke the cammel's back”. In other words, it is a cumulative effect. I use the analogy with patients that “when a bridge collapses, it's not the car that drove over it that mde it collapse, it's everything that has happened previously”. Commonlly, acute LBP can arise from a trivial event such as bending down to pick up the keys or sneezing.
Myth #9 - As long as I take my medication, I will be fine
FACT - Adequate pain relief is only one part of the jigsaw puzzle. Identification and correction of contributing factors and a combination of manual therapy, a specific home exercise program, core stability retraining, medication and activity modification is required to achieve a great outcome.
Myth #10 - I'm physically active, so I shouldn't get LBP
FACT - While it is true that well-conditioned individuals are less likely to have an episode of LBP than the sedentary, some activities have a higher risk of LBP. These include gold, gymnastics, volleyball, weiights training in the gym, even running.
BONUS Myth #11 - I'm feeling better, so my problem is resolved
FACT - There is an 82% reoccurence rate for LBP. The primary reason for this is because of a loss of your “core stabilisers”. Core stability is a term that gets thrown around a lot. It is really an interaction of four muscles - the diaphragm, pelvic floor, multifidus and transverse abdominus. These muscles essentially act like a cylinder to help stabilise the spine. Clinical research has shown that an episode oof LBP will result in inhibition of multifidus and transverse abs. If these muscles are not re-engaged a re-injuury will occur.