Low Back Pain: Myth-busting

Physiotherapist educating patient with 3D spinal model, pointing at lower back.

Having the facts about back issues and what is likely to help and what might not, is an essential starting point for anyone’s rehabilitation.

What we know about back pain has advanced significantly over the past few years but unfortunately, not all that information is either easy to find, consistently offered or easy to understand or accept.

Why is it so important to know the facts?

It doesn’t take too long or need too much effort to find information on the internet or via a friend or magazine about back pain. There is a lot of information available to people suffering from back pain, however there is a huge variation in the quality (and sometimes accuracy) of what you might read/be told.

A simple internet search can reveal all manner of scary, worrying and sometimes traumatising information about back pain. If you are exposed to this type of worrying information it's only natural to start getting concerned about where your back pain is coming from and whether or not it can get better.

An interesting study by Setchell and colleagues (2017) found that 24% of people got their information about back pain directly from the internet. What they also found was that the information these patients received/found led them to consistently have worrying thoughts that their back pain was because something was wrong and needed to be fixed; that their back pain was permanent and wouldn’t get better and that back pain in general is abnormal and something to be feared. We have therefore created a dedicated page to ensure you can get the facts about back pain in an easy-to-understand, accessible way.

Having the facts about what back pain is, and more importantly what it isn’t, means that you are hopefully able to work through your rehabilitation with a better understanding and relationship with your back.

But why haven’t you got a myth-busting page for shoulder pain or knee pain?

Good point. It seems that back pain above pretty much every other type of pain is something that most people have an opinion on. Unfortunately, a lot of the information that is available about back pain seems to push the idea that your back is weak, that it is a vulnerable or fragile part of your body and that it needs to be protected. This is simply wrong and not at all helpful. For other aches and pains, including shoulders, knees, necks and toes, people often find themselves worrying less than they would if it was their lower back. This is likely due to the fact that a lot of information about backs and back pain seems to be negative, worrying and inconsistent.

As managing lower back pain often comes with the challenge of trying to help patients understand the facts, not necessarily the fiction, we felt it was essential to develop a specific page.

picture of woman from behins with her arms up flexing muscles

Are you trying to tell me that what I might know about back pain might not be right?  

Not necessarily, but we will all have a different level of understanding and that includes healthcare professionals like GPs, physios, osteopaths and chiropractors. In a lot of cases, the information that is offered to people with back pain can vary depending on where you read/saw it or who you spoke to. You may even find that 2 doctors or 2 physios might think differently about back pain and therefore the information you get might vary between those professionals. You might actually feel a bit lost in all the information and not know which way to turn. This is why we have created this page to try and help you get the facts as we know it about back pain.

 

What are these facts about back pain?

Well, we think it’s only fair to let you know that the following points might challenge the way that you have thought about your back and your back pain. They might challenge what you’ve been told, even by people within the healthcare system. They might challenge views that you’ve held or your friends/family have held for a long time, but the following points are the facts about back pain that you need to know in order to help you recover from your back issue/reduce the likelihood of it coming back.

The following points have been adapted (with permission) from Peter O’Sullivan and colleagues’ journal article on ’10 facts that every person should know about back pain’ written in the British Journal of Sports Medicine in 2019.

Top 10 back facts:

1. Back pain can be scary, worrying and even frightening, but it is rarely because of anything dangerous.

 

Where has it come from? What is going on? Is it going to get better? Is there something really wrong? These are common questions asked by people in pain, particularly those with back pain. At times, pain can interfere with every aspect of your life and be on your mind more often than you’d like. It is only normal to find yourself worrying about your back pain, however it is rarely caused by anything nasty or dangerous.

2. Getting older is not a cause of back pain.

 A lot of people think or have been told that back pain gets worse as you get older or your back deteriorates with age. We all get older on both the inside and outside, but it doesn’t mean that an older back will be a problem back. Rehabilitation which includes understanding your issue, making lifestyle changes, being kind to yourself and exercising regularly (including lifting weights) can help at any age.

3. Pain doesn’t always mean damage. 

We don’t normally get taught about pain at school; it’s just something you experience. Pain is most often a useful thing as it can help you stay safe. Putting down a hot saucepan or taking your foot off a rusty nail is when pain will tell you to take action to protect yourself. Modern understanding of pain tells us that stress, worry, sleep and fitness levels and many other things can influence pain, which means that sometimes pain can exist either without any need to protect you or longer than is needed. This doesn’t mean that anything has gone wrong, it just means that pain can be inconsistent, unpredictable and often not necessarily linked to what is going on in your tissues.

4. You are not your scan result. 

Scans are important, but normally only for the minority of people. Despite what most people might think, scans cannot show you your pain or why things might be stiff or why you can’t bend forwards without being in pain. They are simply a picture on a particular day at a particular time. They are very good at showing you what you look like on the inside, but not always why something is sore. Scan results also often come with long, complicated, scary-sounding names and phrases that can sometimes sound concerning but often are simply medical terminology to describe things that are normal or should be there.

An effective assessment will take into account all aspects of you and your life when considering why something is sore. Understanding your strength, your movement, your confidence or trust in your back and what it can do, along with things like your sleep quality, expectations, impression of what’s going on and belief/values regarding back pain, are all considered to be vitally important when working with someone with pain. All of this means that you are not just a scan result and shouldn’t be considered so.

X-ray of a human neck (bones).

5. A bit of discomfort with exercise is ok.

As mentioned above, pain can make you feel vulnerable. One particular worry is that exercising might hurt and that the pain might mean you are damaging your back or making matters worse. Your back is strong, robust and designed to lift, twist, pick things up and put them down again, but it can be sore from time to time. Moving your back, including with exercise, might be sore but it is safe. You will not damage your back by using it normally.

6. Back pain is not caused by a ‘weak core’.

Weak or poorly functioning ‘core’ muscles do not cause back pain. In a lot of cases, the opposite can be true. Instead of having weak or poorly functioning muscles around the ‘core’, people with back pain often tense or overwork these muscles and find it hard to relax them. This often leads to moving stiffly or rigidly, which in turn means that the muscles around the ‘core’ don’t get encouragement to relax. Learning to relax these muscles, regaining the confidence to move normally and developing a positive relationship with your back can be some of the most helpful ways to manage back pain.

7. Back pain is not caused by poor posture.

It is a common and long-held belief that if you have ‘bad posture’, you are more likely to get problems. This is not the case; there is no such thing as a ‘good posture’ and ‘bad posture’. Everyone’s posture is individual to them and will be different to the next person. The concept of a ‘bad posture’ is based more on what it looks like rather than whether it causes a person issues or not. It is safe to relax, slump or twist whilst lying, standing or sitting. In fact, it is good for your back and much better than holding yourself rigid and stiff to try and obtain a so-called ‘good posture’.

8. Backs do not wear out with lifting and bending. 

Your back is strong, robust and built to lift things. Most people know that lifting weights can make your muscles stronger and interestingly, the same is true for your back. Along with normal movement, exercises aimed at improving your back strength can help with back pain.

9. Flare-ups don’t mean you’ve gone backwards.  

It is quite normal for back pain to come and go. If you have a flare-up of your back pain (when it is not so good), it can be easy to think you’ve gone backwards as the pain has returned. Disappointment, worrying thoughts and old habits can start to emerge again, however, often a flare-up has little to do with your tissues on the inside. Poor sleep, increased stress and doing a bit more or less than you’re used to are often triggers for a flare-up of pain. Spending some time and effort looking at these ‘triggers’ and making some changes (looking at your sleep routine/what might be causing you stress/trying to be more active etc.) can be effective at helping things settle and preventing any flare-ups in the future.

If you do have a flare-up, try not to worry and keep moving as best as you can. Look at the things that might have been a ‘trigger’ and change something about it to help things calm down.

 

Dice with letters on spelling 'Comfort/ Discomfort'.

10. Surgery, injections and strong drugs aren’t the cure.

Everyone wants a quick fix for their issue, why wouldn’t you? Unfortunately, there is no quick fix for low back pain and often the best way to manage it is to look at a number of things like your movement, confidence in your back, fitness levels, sleep quality and expectations etc. All these things take time and energy to look at and potentially address, therefore the temptation to seek a quick fix is often very high in people with low back pain.

Things like surgery, spinal injections and strong pain relief aren’t usually effective for a lot of back pain sufferers and can sometimes come with a range of unwelcome side-effects. Looking at you as a person both physically and emotionally and treating both of those things as equally important, is often a very good way of effectively managing low back pain.

Below are a few of our favourite videos produced by Body Logic that take a deeper dive into some of the most important facts about back pain.

"10 facts about back pain"

"Scary but rarely dangerous"

"Backs don’t wear out"

If you’re interested, you can watch the amazing Body Logic podcast series below.

Empowered Beyond Pain Podcast Series:

Here are some other things that you might be interested in exploring regarding back pain facts and our current understanding of back pain management:

Independent Ireland Article (2019)

RTE (Ireland's National TV and Radio Broadcasting Company) (2019)

Chartered Society of Physiotherapy (2017)

So what shall I do now?

What we’re hoping you do is consider the information that you’ve read/seen and see if that challenges your understanding or views on lower back pain. You might need a little while to digest the information or even a few goes with it to let it sink in, so feel free to re-read or revisit this page as many times as you like.

When you feel that you’re ready, you can dive a bit deeper into back pain and how to manage it with our dedicated information and exercise pages here:

Recent Low Back Pain (Less Than 3 Months)

Longstanding Lower Back Pain (Longer Than 3 Months)

Need more help? Refer yourself here.

O’Sullivan, P.B., JP Caneiro, J.P.,  Kieran O’Sullivan, K.,‍‍

Ivan Lin, I.,  Bunzli, S., Wernli, K. and‍‍ O’Keeffe, M. (2019). Back to basics: 10 facts every person should know about back pain. British Journal of Sports Medicine. doi: 10.1136/bjsports-2019-101611. Accessed 22/06/2021.