Image 5 - myths about low back pain chiropractic rozelle

14 Myths and Truths of Low Back Pain

Myth #1: Back pain won’t happen to me
 Approximately 80% of people will experience an episode of low back pain at some point in their lifetime. In Australia, low back pain is:

  • The third highest leading cause of disability in 2011 (behind cancer and cardiovascular disease)
  • The cause of approximately 10% of significant disability
  • The second most common reason for a visit to a primary care practitioner

Myth #2: Bad back pain can result in paralysis
 The spinal cord ends in the upper part of the low back (lumbar vertebra 1). Further down the low back there are only nerve roots, which are very tough structures. In most cases, a great deal of back pain does not usually indicate a back problem that could lead to paralysis. Examples of rare cases where paralysis may be a risk include spine tumours, spinal infections and unstable spine fractures. However, it is important to note that these conditions constitute less than 1% of total back pain episodes.

Myth #3: Severe back pain is related to the level of back damage
 With acute pain, the level of pain correlates to the level of damage (e.g., if you touch a hot iron, you will immediately feel a great deal of pain). However, with chronic back pain (more than 6 weeks), the amount of pain does not typically correlate the amount of damage. One reason for prolonged pain experiences in chronic low back pain is pain sensitisation. Pain sensitisation is the brains ability to modify pain signals when subjected to long-standing pain and disability, so that patients become more sensitive to non-painful stimuli and get more pain with less provocation.

Myth #4: I’m physically active, so I shouldn’t get back pain
 While it is true that well-conditioned individuals are less likely to have an episode of back pain than sedentary individuals, back pain can affect all people regardless of the level of activity. Some sports are more likely to cause back pain, such as golf, cricket and gymnastics. However, in all cases, the back and associated structures should be considered a priority in conditioning, because it creates a robust platform from which the arms and legs function.

Myth #5: The spine is delicate and easily injured
 The spine and its surrounding muscles, tendons and ligaments comprise a robust structure that is incredibly strong, flexible and supportive. To help maintain the back and spine, proper conditioning is required – including strengthening, flexibility and aerobic conditioning. While there are some exceptions to the rule (such as an unstable spinal fracture), the back does not need to be overprotected after recovering from a typical episode of back pain.

Myth #6: If I have back pain when I am young, it will worsen as I age.
Fact: The incidence of back pain is actually highest between 35 and 55 years. After age 55, people usually have less pain – especially disc-related pain (such as back pain due to a disc bulge). While disc degeneration is a natural part of the ageing process, it is not always associated with pain.

Myth #7: My father/mother had bad back pain, so I’m likely to get it.
 There is no genetic predisposition for non-specific (mechanical) low back pain, which means that parents do not pass their back conditions onto their children. However, long-term twin studies have found moderate-quality evidence to suggest that spinal degeneration (e.g., disc-related back pain) has some genetic predisposition. However, low back pain and disability was not associated with the level of spinal degeneration.

Myth #8: An MRI scan or other diagnostic investigation is required to diagnose my back problem.
 Most health care professionals, such as general practitioners, chiropractors and physiotherapists, can differentially diagnose musculoskeletal disorders and develop successful treatment approaches based on a thorough medical history and physical examination. Scans are often not indicated, yet overprescribed in healthcare. Only specific symptom patterns (e.g., red flags signs and symptoms) in a minority of cases indicate the need for an MRI scan or further investigation. Typically, an MRI scan is used when patients are not responding to appropriate conservative care for their back pain after 6-8 weeks.

Myth #9: The abnormality/back problems on my MRI scan needs to be cured.
 An abnormality that is seen on an imaging test (MRI, CT scan) does not necessarily cause back pain or other symptoms. In fact, the vast majority of patients who never have had an episode of low back pain will have abnormalities (such as a herniated disc or degenerative spinal changes) on an imaging investigation. For patients experiencing low back pain, 92%-96% can be treated successfully without back surgery.

Myth #10: If no specific back problem is found, my pain must be psychological.
Fact: Most cases of back pain will not follow the typical medical approach of specific structural diagnosis and remedy, but the pain is still real. While psychological factors, such as stress, depression and anxiety will often need to be included as part of a comprehensive management program for back pain, there are also a variety of nonsurgical options that can help to alleviate back pain. However, persistent back pain symptoms should be investigated by a qualified spine specialist to rule out serious problems such as tumour or infection.

Myth #11: There is a standard ‘cure’ for most causes of back pain.
 Compared to other medical conditions, there are relatively few standardised approaches to diagnosis and manage back pain. Diagnoses and the most appropriate management plan for back pain will differ among health care professionals, and specialists within a discipline will also frequently have different opinions. The management of back pain relies on the recent scientific evidence or consensus, the practitioner’s clinical experience, and the patient’s expectation and presenting condition. Assessment and management is therefore tailored to an individual. A few diagnoses for back pain as a result of back pain are relatively straightforward (such as a spinal tumour, infection, or fracture) and there is generally more consensus for diagnosis and management of these back problems.

Myth #12: Rest is the key to recovery from back pain.
  In most instances of mechanical low back pain, more than 1 or 2 days of rest can be detrimental to recovery, potentially leading to increased pain and other adverse results, such as:

  • Muscle atrophy (1% to 1.5% per day)
  • Cardiopulmonary deconditioning (15% loss in 10 days)
  • Bone mineral loss
  • Risk of blood clots
  • Loss of wages
  • Creating an ‘illness’ mindset.

However, the two main reasons bed rest may be recommended for back pain are to reduce pressure on the discs in the spine and to stop the mechanical stresses that are irritating pain receptors. Generally speaking, encouraging movement and return to sport or activities of daily living is an important clinical goal for the management of low back pain.

Myth #13: Heat and massage feel good so they must be helping back pain and back problems.
 These therapies can reduce acute back pain in the short-term, but do not provide a long-term solution to back problems. They are used to manage pain during the recovery phase, allowing patients to complete a rehabilitation program and participate in daily activities.

Myth #14: Long-term back pain indicates the need for surgery
 Spine surgery actually has a reduced likelihood of being successful when treating chronic back pain. Typically, back pain symptoms that suggest back surgery might be helpful if they occur early in the course of pain and are relatively apparent.


Chris Knee

Chris is an experienced and qualified chiropractor, sports chiropractor, McKenzie Credentialed practitioner, nutritionist and Certified Strength and Conditioning Specialist (CSCS) and is finishing of his Doctor of Physiotherapy at Macquarie University.