Low back pain is the most common condition seen in the physiotherapy clinic. According to the World Health Organisations, up to 70% of the population will at one point experience low back issues.
One of the biggest problems seen the profession, is the amount of misleading advice regarding low back pain. Brace this. Take this. Stop moving. Unfortunately, this type of advice is not helpful and can actually lead to more harm than good.
As a physiotherapist, I have heard so many factually incorrect statements. These beliefs can lead to negative attitudes about the condition and can worsen outcomes.
Using the latest science and research from the past 20–30 years, I will be busting 3 of the most common myths heard in the clinic.
1. Bed rest and inactivity is the best treatment
For far too long, inactivity and bed rest has been recommended to help with low back pain. Although rest can help ease the discomfort in the first 1–2 days, long term inactivity can be detrimental. A lack of physical activity can lead to stiffness, reduced muscle mass and delayed recovery.
High quality research by Dahm et al. (2010) suggests that prolonged inactivity does NOT help with pain relief either. This report also showed that more active workers with low back pain took less sick leave and returned to work earlier than those who rested.
Appropriate management of back pain should instead include returning to normal daily activities such as exercises, walking, work or home duties. Initially it may be a bit uncomfortable but normalising movement is essential for physical recovery and pain management.
Clinical bottom line: Inactivity and rest might be necessary to manage low back pain initially, but a gradual increase to normal physical activity is recommended for optimal recovery.
2. Back pain is a sign of spinal damage.
“Most likely a bulging disc.”
“It’s probably arthritis, it will always be there”
“My back is not aligned”
These train of thoughts are inherently not true and does not help with recovery. In fact, it’s widely accepted that in the medical community that around 90% of back pain is classified as non-specific. Non-specific meaning that this is no clear structural cause of the condition. So why does pain exist?
In many cases, the structures in the back (e.g. muscles, ligaments) can be sensitised by certain triggers such as awkward movements or prolonged postures. Clinically, individuals with low back pain present with significant muscle guarding or tightness. In many cases, it’s the body’s conscious or/and subconscious way of protecting the back to avoid further triggers.
Mood, anxiety and poor lifestyle choices can further increase the sensitivity of these structures. Sub-optimal sleep patterns and negative outlooks (as quoted above) are some examples of these unfavourable behaviours. Unfortunately, these actions can adversely impact the central nervous system which can amplify the sensitivity from structures in the back.
Clinical bottom line: Pain does not solely represent what is going on with the body’s physical state. A multitude of factors such as negative attitudes, stress and poor sleep contribute to our perception of pain. Changes should be made in many aspects of life to manage low back pain.
3. X-rays and scans should be done immediately to see what is going on.
“I need scans to see what’s going on in my back…”
These type of comments are heard far too often in the clinic (although understandable). Most doctors or physiotherapists will not advocate for imaging unless the findings change the course of management. Certain cues will often help determine whether scans are required, such as worsening sciatic symptoms or relentless night pain. Unnecessary imaging can not only be a waste of time or resources but can be actually be detrimental.
The table on the left summaries the results from a collection of 33 relevant studies by Brinjikji et al. (2015). Their findings showed the sheer number of ‘abnormal findings’ in asymptomatic individuals. Many of these findings are not related to pathological changes but rather seen as age-related changes.
As mentioned before, around 90% of low back pain cases are classified as ‘non-specific.’ When x-rays are unnecessarily taken, such findings (table 1.) can often be misinterpreted as more sinister or degenerative changes. This isn’t to say imaging is not required, as certain positive findings are associated with increased back pain
Based on my clinical experience, imaging often won’t change management and can instead lead to unnecessary medical/surgical interventions. In fact, discovering these findings may actually lead to more harm, as recipients are left feeling dis-empowered and apprehensive of movement.
Clinical bottom line: For most low back pain cases, imaging is not required unless advised by a health professional such as a medical doctor or physiotherapist. These results can often be misleading as healthy asymptomatic individuals will often have age-related changes in their spine.
The following article is NOT medical advice but for educational content. If you have any low back pain, please consult a relevant health practitioner such as a physiotherapist or general practitioner. For any low pain sufferers in Melbourne looking for assistance, please feel free to book a consultation with the following link https://linktr.ee/clinical_physio.
- Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., … & Wald, J. T. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811–816.
- Dahm, K. T., Brurberg, K. G., Jamtvedt, G., & Hagen, K. B. (2010). Advice to rest in bed versus advice to stay active for acute low‐back pain and sciatica. Cochrane database of systematic reviews, (6).
- Nees, F., Löffler, M., Usai, K., & Flor, H. (2019). Hypothalamic-pituitary-adrenal axis feedback sensitivity in different states of back pain. Psychoneuroendocrinology, 101, 60–66.
- O’Sullivan, P, & Lin, I. (2014). Acute low back pain. Pain, 1(1), 8–13.
- Word Health Organisation (2013). https://www.who.int/medicines/areas/priority_medicines/BP6_24LBP.pdf. Accessed on 14/1/2020.