Here are 3 big myths I hear every single week:
1. My back pain will go away if I just rest.
2. My neighbour / friend said magnets and massage will fix it.
3. I’ll Google back pain and that will tell me how to fix my back.
Let’s look at the science behind chronic low back pain (CLBP) rather than urban myths, because once you begin to understand how complex back pain is, you’ll quickly realise how foolish these myths are:
1. If I rest will my pain go away? Not likely.
A. Bed rest is very strongly NOT recommended as a treatment for back pain as people actually do better with exercise, remaining active and professional Physiotherapy treatment. Every low back pain clinical guideline published for the past 3 decades has recommended avoidance of pure rest.
B. Research studies have found that for all of the different types of low back pain about half of your pain typically settles within a month and 82% of people are able to be resume work. This implies that most people still have a lot of pain and reduced physical ability one month after their episode began (Pengel etal 2003).
C. The chance of recurrence of your back pain if you do nothing is very high – between 33% and 75% within 12 months depending on which study you look at (Maher et al 2016). This stands to reason: if you didn’t do anything to deliberately address all of the causes of your back pain then you are simply asking for it to recur! The nature of low back pain is best characterised as chronic episodic pain rather than a simple acute one-off episode. By now you are hopefully realising that low back pain is very different to a traumatic injury such as an ankle ligament sprain and should not be considered as being even remotely similar.
2. Back pain is a SYMPTOM not a diagnosis. Magnets and massage (or anti-inflammatories for that matter) treat symptoms not causes, so it should come as no surprise there is no evidence they offer any long term benefit. If you have seen someone for your back pain and did not receive a diagnosis, a credible explanation about the causes of your individual circumstance and a plan to treat the underlying causes then you did not see an expert and are unlikely to get better. Best go and see someone who actually knows what they are doing rather than listen to your well-intentioned neighbour.
3. Low back pain is multifactorial in origin (Kent & Keating 2008) – in other words multiple causes are present, not a single one (hence the second statement above implying it’s a simple thing is totally wrong). Treatment must address your specific causes, and not just be a generic recipe-based approach if it is to provide any measure of long term relief (hence good ‘ole Dr Google won’t be any help either as it can only offer generic, non-specific advice).
4. Can my GP sort this out for me? Again no. Much of the literature on chronic low back pain is written by doctors labelling it as “non-specific” meaning that no structural damage causing the pain can be identified. However, there are many highly specific causes of non-structural back pain that are readily treatable – your GP lacks the training to identify and manage them. This is where a highly trained Physiotherapist comes in.
5. Can Google or the internet fix my back? Hell no! How is the internet going to diagnose your specific individual causes? Way back in 2008 there had already been 1501 specific factors identified as causative or contributing factors to low back pain (Kent & Keating 2008), so what chance has a computer got of physically examining you, taking a proper history and then being able to identify the key factors in your case? If you can’t examine yourself accurately, if you don’t know what all the possible factors are and how to find them, and then tell the computer exactly what they are, then the computer has no chance at all.
Chronic low back pain is very common, with around 18-30% of people suffering worldwide (Swain et al 2014). LBP is very common in adolescents and SHOULDN’T BE IGNORED: childhood low back pain predicts adult chronic low back pain very well. Here are some stats on the matter (Swain et al 2014):
A. 37% of all adolescents experience low back pain.
B. The incidence of low back pain increases with age:
i. 27% in 11 yro
ii. 37% in 13yro
iii. 47% in 15yro
If your teenager has a sore back please do something about it NOW before they develop chronic issues. We happily treat younger people with spinal pain and are passionate about setting them up for a healthy future.
If you have back pain what do you need to do?
See a skilled Physiotherapist experienced in chronic spinal pain who can accurately diagnose your complaint and identify your unique risk factors, then create a plan to address them. In expert hands this means that the treatment for any two people with back pain will never be the same if it is to be effective. A specific individualised treatment approach is the key. Treatment, in a very broad sense, should include things like explaining and educating you about your individual problem, teaching you what you can do about it and how to prevent recurrence, reassurance about how to get better and the time frames that may be involved, manual therapy to remove some of the obstacles for rehab out of your way, and rehab of strength and fitness. Your Physiotherapist should educate you about the specific order in which such things need to take place in order to be effective, as some treatment options don’t work unless obstacles to progress are first addressed.
I hear every now and then people don’t want to spend money on their back pain. Well here’s a sobering statistic: those who ignore their low back pain or inadequately treat it accumulate less wealth. Those who retire early due to back pain accumulate on average 87% less total wealth and income producing assets than those who remain in full time employment (Schofield et al 2011). Yes, 87%!!! If you ever needed a financial incentive to sort your back out now then surely this is it! It’s way cheaper to get treated, start getting fit and staying strong and fit than to lose THAT much money! Invest in yourself and your own health.
Exercise for improving strength (in specific muscle groups) and general (cardiovascular) fitness is one of the best preventative measures for back pain – so get treated and then get fit and strong. Don’t stop because your pain stops! The exercise is what keeps the pain away. The long term consequences of CLBP can be terrible so tackle it early, especially in your teenager. There are no shortcuts when it comes to getting strong and staying strong, so stop making excuses and get into it.
Kent, P. M., & Keating, J. L. (2008). Can we predict poor recovery from recent-onset nonspecific low back pain? A systematic review. Man Ther, 13(1), 12-28.
Pengel LHM, Herbert RD, Maher CG, Refshauge KM (2003): Acute low back pain: systematic review of its prognosis. BMJ 327:323-8.
Swain MS, Henschke N, Kamper SJ, Gobina I, Ottova-Jordan V, Maher CG. An international survey of pain in adolescents. BMC Public Health 2014; 14: 447.
Schoﬁeld DJ, Shrestha RN, Percival R, Callander EJ, Kelly SJ, Passey ME. Early retirement and the ﬁnancial assets of individuals with back problems. Eur Spine J 2011; 20: 731–36.