Truths & Myths of Back Pain

Low back pain (LBP)?is one of the most common health problems leading to frequent medical consultations. LBP is a major cause of disability affecting daily activities, performance (work or sports) and our general well-being. Absenteeism from work due to LBP imposes high economic burden on families, companies and governments. Non-specific (common) LBP is experienced by 60% to 70% persons in industrialized countries some point in their life (2013, WHO).?

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Cause of Low Back Pain?

About 10% of patients with LBP have specific pathologies causing their pain such as disc problems, radicular syndrome, arthritis, fractures, scoliosis, metastases etc. Internal structures like the kidneys and bladder can also be sources of LBP.??

?However, about 90% of patients have?Non-Specific LBP?(no specific pathology is identified). Possible risk factors for this is staying in one position/posture for several hours, stress, depression, strain on back tissues, long standing/walking (more than what a person is used to), functional weakness, poor health, poor relationships at work, lack of sleep and others.?

?Back Pain, a Symptom Not a Disease/Condition??

Back pain is not a disease, it is a symptom of other problems.?Each person needs an evaluation, which involves carefully listening to your problems, reviewing your medical history, a physical examination and looking at psychological and social factors surrounding your life, all of which could contribute to LBP. This is very important because the back is not always the cause of LBP.??

?Making Treatment Easier?

"Sticks and stones may break my bones but words will never hurt me", or so they say. Researches now show that things we are told, and believe can actually cause us to experience pain. Studies have shown that educating the public about LBP is very effective in decreasing LBP and its economic burden. This education involves dispelling many myths and old beliefs about back pain.?

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The benefit of Pain Education?

Professor of Clinical Neurosciences, Lorimer Moseley in 2002 published a research which showed that physiotherapy with correct low back pain (LBP) education, significantly decreases pain and disability. In 2004, he published another study, showing that pain education improved patients' outcomes by changing their perception of pain and what is happening when they feel it.?

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The MYTHS and The TRUTHS?

Myth #1 : Once I have back pain, I will always have back pain?

Initially LBP may be very painful, but majority of persons have a good and quick recovery. Others have short periods of back pain/discomfort throughout their lives. Few persons develop long-standing and disabling problems, risk factors include distress, anxiety and fear of movement (for example being told you cannot bend or lift anything). These persons when identified earlier, clinically assessed and given sound advice to guide them on self-management, tend to have a better prognosis.?

?Myth #2 : Stay in bed and rest, if your back hurts?

Few days after the initial injury, avoiding aggravating activities is important. However, keeping active and gradually returning to normal activities aids in recovery. Doing some common tasks at home or work maybe painful initially, but an earlier and gradual return to these activities (even better with the guidance of a physiotherapist) does more good for the back than prolonged bed rest. Prolonged bed rest is associated with higher pain levels, greater disability, poorer recovery and more absence from work.??

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Myth #3 : More back pain = More Damage?

?More pain does not always mean more damage. Factors affecting the extent of pain felt, includes previous pain experiences, coping mechanisms, mood, fears, fitness and stress levels. Hence, the intensity of pain felt by two persons with the same injury may differ.??

?The brain regulates pain and has the ability to alter its intensity. The nervous system and brain maybe more active in persons experiencing LBP. This might explain why when a person engages in more activities, they feel more pain and not actually damaging the spine.?

?Strategies to decrease pain and disability experienced include, gradual return to activities, exercise, education, and cognitive-behavioural techniques. Dispelling concerns about ‘harm’ being done to the back, makes it easier for persons with LBP to participate in physiotherapy.??

?Myth #4 : My back pain is due to something being?‘out of place’??

?Majority of persons with back pain, their X-rays and scans do not show any evidence of bones or joints being ‘out of place’. Some persons have their spine manipulated thinking they are putting things back in place, but nothing was neither "out of place" nor "slipped out" (Discs can't slip). Yes, the discs are potential sources of LBP, but not always. Disc bulges seems to be more apparent as we age and there are persons with bulges and have NO pain. Many people actually have these bulges resolved and shrink over time without requiring surgery.?

The persons who have experienced decreased in pain after manipulations (or cracking their backs) maybe due to neurophysiological effects, improved range of motion and not necessarily anything "popping into place". Health care practitioners have to be careful to not suggest structures have moved out of place. This is potentially frightening, leads to greater disability and may result in increased levels of fear, stress and anxiety (these are related to poorer outcomes in LBP).??

?Myth #5 : I need a scan or X-ray??

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Many times X-rays or scans are not needed, sometimes a good clinical assessment will suffice. These tests are generally reserved for a few persons with signs of more serious problems. Findings such as?‘disc degeneration’, ‘disc bulge’ and other anatomical changes seen on scans can be incidental, and are found in people of the same age without LBP. Additionally, a lot of persons with chronic LBP have no significant findings on these scans and their pain is described as "non-specific LBP".??

The results of these?scans can cause a poor perceived prognosis by patients, if not explained correctly . A US study showed that patients who were sent for an early MRI had more functional decline and underwent more surgeries than those who had no MRI scan done. Sometimes scans are done by patients requests, but this can be improved when patients are properly educated.??

?Myth #6 : I need surgery to fix my back pain?

?There is very few people who actually require surgery for back pain. Many persons manage their back pain by better understanding pain and staying active. Surgery is not considered until physiotherapy and exercise have failed. Sometimes spinal surgery?results are no better than other interventions such as physiotherapy/exercise and medication.?

?Myth #7 : I need "Special/fancy" treatment??

There are many popular treatment techniques with limited effectiveness when used by themselves to treat LBP. Some of these techniques include spinal manipulation, traction, massage, acupuncture, injections, anti-depressants, NSAIDs, opioids and muscle relaxant. Many persons have managed their LBP effectively without these treatments, after their understanding of pain improved and they became more physically active.?

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The Truths About The Back: The New Way of Thinking?

These truths stand firm especially for persons with non-traumatic Back pain:?

1. I can trust my back?
2. Pain does not usually equal to damage?
3. It is safe to bend?
4. Back pain needs movement and gradual increase in physical activities and not bed rest?
5. If it hurts, relax, breathe and move normally?
6. Activities you enjoy are safe and best for you?
7. Back pain is not all about scans, lifestyle factors are important too?
8. Movement and loading makes the back happy and strong.?

?Conclusion?

Low Back Pain (LBP) affects many people and their lives, and its proven that their beliefs about LBP can affect their recovery. Patients with LBP who are very fearful, rest plenty, poorly copes or controls their pain, or who believes their backs have serious structural issues, these persons are at the greatest risk of developing chronic (long lasting) LBP.?

?There is hope, because these beliefs can be changed. Researches also show that exercise is safe and effective in managing LBP and also comes with many health benefits.?

?If you have specific concerns and questions about how low back pain?should be treated, please contact a?Registered Physiotherapist/Physical Therapist??who should be able to provide answers.??

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ADRIAN PALMER, PT,?PgDip?SEM,?BScPT, PAPHS?

Registered Physical Therapist (RPT)?

Postgraduate Diploma Sports & Exercise Medicine (PgDip?SEM)?

Physical Activity in Public Health Specialist?(ACSM/NPAS PAPHS)?

Phone/WhatsApp: 868-314-3639?