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Getting BACK to Basis - The Myths & Facts of lower back pain
MDC Physiotherapy
Low back pain (LBP) causes more global disability than any other condition (1). It causes a significant economic and societal burden, which will become more imposing over the coming decades with the number of people living with LBP expected to increase substantially. Up to 85% of LBP is classified as chronic non-specific low back pain (CNSLBP), recognised with no specific pathology or diagnosis (2). Chronic pain can be classed greater than 6 months. Unfortunately, there are many myths and unhelpful beliefs when it comes to LBP. Let’s get straight into it.
Recent research by Kieran O’Sullivan (3) highlighted some unhelpful beliefs and facts with low back pain.
The Myths:
►Myth 1: LBP is usually a serious medical condition.
► Myth 2: LBP will become persistent and deteriorate in later life.
► Myth 3: Persistent LBP is always related to tissue damage.
► Myth 4: Scans are always needed to detect the cause of LBP.
► Myth 5: Pain related to exercise and movement is always a warning that harm is being done to the spine and a signal to stop or modify activity.
► Myth 6: LBP is caused by poor posture when sitting, standing and lifting.
► Myth 7: LBP is caused by weak ‘core’ muscles and having a strong core protects against future LBP.
► Myth 8: Repeated spinal loading results in ‘wear and tear’ and tissue damage.
► Myth 9: Pain flare-ups are a sign of tissue damage and require rest.
► Myth 10: Treatments such as strong medications, injections and surgery are effective, and necessary, to treat LBP
The Facts:
► Fact 1: LBP is not a serious life-threatening medical condition.
► Fact 2: Most episodes of LBP improve, and LBP does not get worse as we age.
► Fact 3: A negative mindset, fear avoidance behaviour, negative recovery expectations, and poor pain coping behaviours are more strongly associated with persistent pain than is tissue damage.
► Fact 4: Scans do not determine prognosis of the current episode of LBP, the likelihood of future LBP disability, and do not improve LBP clinical outcomes.
► Fact 5: Graduated exercise and movement in all directions is safe and healthy for the spine.
► Fact 6: Spine posture during sitting, standing and lifting does not predict LBP or its persistence.
► Fact 7: A weak core does not cause LBP, and some people with LBP tend to over tense their ‘core’ muscles. While it is good to keep the trunk muscles strong, it is also helpful to relax them when they aren’t needed.
► Fact 8: Spine movement and loading is safe and builds structural resilience when it is graded.
► Fact 9: Pain flare-ups are more related to changes in activity, stress and mood rather than structural damage.
► Fact 10: Effective care for LBP is relatively cheap and safe. This includes education that is patient-centred and fosters a positive mindset, and coaching people to optimise their physical and mental health (such as engaging in physical activity and exercise, social activities, healthy sleep habits and body weight, and remaining in employment).
What’s important to note is that there is no one specific way to build structural relicense of your back. The truth is there are plenty of ways, an important aspect is the enjoyment factor for everyone who has NSCLP. It is very unlikely that anyone will commit to a form exercise when it is not enjoyable for that individual. And this is backed up with research! In 2018 Booth (4) included six studies with over 300 people with NSCLBP. The results of study suggest that exercise over a 6-week period reduced LBP intensity, however neither aerobic or progressive strength training were superior in this particular study. What I like from this study is that the authors emphasise the enjoyment factor from the form of exercise. Which is a significant factor when it comes to rehabilitation of LBP.
It’s worth mentioning that resistance training did improve psychological wellbeing of the participants to a greater quantity. Psychological wellbeing aspects such as fear avoidance and harmful beliefs regarding their LBP. So, with that strength training can be deemed superior for reducing pain for NSLBP. If an individual has not experienced resistance training I would certainly recommend they sample it. The great thing about resistance training it can be done at home with minimal equipment. If we increase our low back strength gradually it is very likely tasks such has bending down to tie your shoes or emptying the dishwasher will become a lot easier.
As previously mentioned by Kieran O’Sullivan moving our back is absolutely safe! Our backs are designed to bend. To add to that, robust evidence (5) has shown there has been no difference in the number of adverse events between progressive resistance training of the low back and general exercise programmes. It showed that pain, disability, and muscular strength improved in patients with chronic low back pain to a significantly greater extent when treated with progressive resistance training of the low back over general exercise. The results of the study showed highly favourable outcomes for resistance training of the low back relative to general exercise, especially when assessed over 12 to 16 weeks.
So, to recap. You can’t go wrong with getting strong!
References
- Musculoskeletal Fact Sheet: Back Problems. Canberra: Australian Institute of Health and Welfare; 2015
- Koes BW, Van Tulder M, Thomas S. Diagnosis and treatment of low back pain. Bmj. 2006 Jun 15;332(7555):1430-4.
- O’Sullivan, P.B., Caneiro, J.P., O’Sullivan, K., Lin, I., Bunzli, S., Wernli, K. and O’Keeffe, M., 2020. Back to basics: 10 facts every person should know about back pain. British journal of sports medicine, 54(12), pp.698-699.
- Wewege, M.A., Booth, J. and Parmenter, B.J., 2018. Aerobic vs. resistance exercise for chronic non-specific low back pain: A systematic review and meta-analysis. Journal of back and musculoskeletal rehabilitation, 31(5), pp.889-899.
- Tataryn, N., Simas, V., Catterall, T., Furness, J. and Keogh, J.W., 2021. Posterior-chain resistance training compared to general exercise and walking programmes for the treatment of chronic low back pain in the general population: a systematic review and meta-analysis. Sports medicine-open, 7(1), pp.1-17.
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