- Robert Drenning, PT, OCS,FAAOMPT
Top Three Myths About Back Pain
Low back pain is something that most of us are familiar with on some level. It is estimated that 80% of Americans will experience low back pain at some point in their lives, and that number is on the rise. One in three adults say back pain impacts their everyday activities, and we spend $50 billion annually in the United States on treating this condition. Yes, that’s Billion...with a ‘B’! Due to the high demand that low back pain places on our society, there is an increasing push in the medical community to reduce unnecessary care. And this starts with getting the right message and information out there from the get go! So I wanted to share with you the three most commonly held misconceptions about low back pain:
I just hurt my back and every movement is excruciating. The best thing would be for me to rest in bed until I start feeling better. Actually no! Staying in bed for prolonged periods is one of the worst things you can do. Now, that’s not to say that rest isn’t important when you first experience pain. It can be beneficial initially to reduce pain and inflammation, but should be limited to an hour or two at a time and for no more than a day or two. There are multiple studies showing that an early return to activities leads to faster pain relief than prolonged resting. In addition, early movement helps reduce the onset of muscle deconditioning that can make pain last longer. I know back pain can be severe, but don’t be afraid to move around a bit! It’s OK if it hurts...it’s important to understand that pain does not mean you are creating more damage in your back. I know that seems a little counter-intuitive, but there is a lot of research telling us that pain and tissue damage in your back are NOT well correlated! If you need help deciding how much movement is too much or too little, reach out to your Physical Therapist for some guidance.
In order to keep my back healthy, I should avoid flexing my spine when bending forward by keeping as straight as possible. This is probably the most common piece of advice given by medical providers, and unfortunately, often creates an unnecessary fear of bending forward. What happens when you have to lift groceries out of the trunk of your car? Are you supposed to leave them there forever because you shouldn’t bend your spine? Of course not! Our spine is actually quite robust and adaptable to repetitive loads. It is made to move and bend! In fact, research has shown us that even when trying to move with a perfectly straight back (squatting or kettle-bell swings for example), our spine actually bends quite a bit. So it may even be impossible to keep your back rigidly straight despite your best efforts! On top of that, there are quite a few biomechanical studies now finding that loads on the discs may be similar in straight and in bent spine positions, and that keeping a straight spine may not prevent injuries as much as we once thought. Now, if bending hurts, it is perfectly fine to avoid it...temporarily. Or if you’re lifting a heavy object, it may be a good idea to try to keep your back straight. But for the vast majority of daily tasks, let your spine do what it is made to do...move. If you’re not sure what is the right movement pattern for your unique body type, ask your Physical Therapist for some help.
I should get an MRI to find out what’s going on. Here’s another big no-no for pain just in your back. Often in an attempt to satisfy a patient’s desire for answers, medical providers will order imaging for back pain. The problem here is that in addition to being expensive, MRIs almost always show normal age-related changes, such as ‘bulging discs’ or ‘degenerative discs’. These findings are now considered to be normal findings, ‘wrinkles on the inside’ if you will, and are not correlated to pain in the back. These results only serve to perpetuate misguided fears about the causes of one’s back pain. In fact, we now have several studies showing that getting an early MRI actually worsens your outcomes! Pain is worse and takes longer to go away...not good! And finally, an MRI won’t change the course of your initial management for low back pain, unless surgery is your first choice of course. Treatments are tailored to pain presentations, not imaging findings. So when in doubt, skip the scan for recent onset low back pain!
Hopefully tackling some of these misconceptions about low back pain will help you feel more informed should you or a loved one ever experience a similar episode yourselves. Please keep in mind, these are general guidelines discussed here briefly to provide some basic information. Every person has a unique presentation of symptoms and it is best to get an individualized evaluation done to get the most accurate recommendations and treatment plan. If you are experiencing back pain or just want more info, please give us a call at any of our four locations.