Back pain is a common condition that has many beliefs which have become popularized in the general public. Some of these are based on facts and some are myths, but not many people know which is which. This blog post aims to dispel the common myths related to low back pain.
- I have a “slipped disc”
- There is a common belief that the cause of their lower back pain is due to a “slipped disc”. This language is inaccurate and can even negatively influence one’s pain perception. Discs cannot simply “slip” out of place. Rather, what can potentially happen is a disc herniation, in which the gel-like inner portion of the disc protrudes beyond it’s normal position. Furthermore, mechanical low back pain can be caused by a variety of different reasons which can differ person to person. The cause of pain may not always be a problem within the discs!
2. I need to maintain perfect posture all day. Bad posture causes back pain.
- This is not entirely true. Studies have shown that there is only a weak relationship between posture and pain (1). In other words, “bad” posture does not always result in back pain. Instead of worrying about maintaining perfect posture all the time, it is more important to vary your posture throughout the day. This allows you to distribute the stresses to your body, rather than focusing the stresses in the same places, during your normal daily activity (2).
3. Spinal flexion (bending forward) is always bad for your back.
- Many people believe that bending forward while lifting can cause damage to the lower back, especially disc herniations, therefore resulting in pain. This is a common misconception which vilifies spinal flexion (bending the spine forward) as “bad”. But it is not entirely true! Studies have shown that damage to the disc can occur even in neutral postures (3), meaning disc damage is poorly linked to spinal posture. Furthermore, “damage” to the spine does not always result in pain (4). Maintaining neutral posture is only recommended with heavyweight lifting, but otherwise in most cases, low-load spinal flexion (e.g. bending over to pick up a laundry basket) is fine and does not need to be avoided (5).
4. I shouldn’t move because I’m in pain.
- This is false! As mentioned above, movement variability throughout the day is better than staying in one position for prolonged periods (2). In other words, variable, low load movement is better than resting/not moving at all. The key is to move within your tolerable or pain-free range of motion in order to desensitize the injured tissues, with the goal of gradually increase your pain free range of motion and load tolerance over time. In fact, clinical practice guidelines strongly recommend maintaining activity or starting a structured exercise program in the treatment of low back pain (6).
- Christensen, S. T., & Hartvigsen, J. (2008). Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. Journal of manipulative and physiological therapeutics, 31(9), 690–714. https://doi.org/10.1016/j.jmpt.2008.10.004
- Hargrove (2014) Does Bad Posture Cause Back Pain? https://www.bettermovement.org/blog/2014/does-bad-posture-cause-back-pain#:~:text=Although%20the%20results%20from%20these,length%20inequality%20and%20back%20pain.
- Veres SP, Robertson PA, Broom ND. (2010) ISSLS prize winner: how loading rate influences disc failure mechanics: a microstructural assessment of internal disruption. Spine (Phila Pa 1976). 35(21), 1897-1908. doi:10.1097/BRS.0b013e3181d9b69e
- Takatalo J, Karppinen J, Niinimäki J, et al. (2009) Prevalence of degenerative imaging findings in lumbar magnetic resonance imaging among young adults. Spine. 34(16), 1716-1721. DOI: 10.1097/brs.0b013e3181ac5fec.
- Lehman (2016) Revisiting The Spinal Flexion Debate: Prepare For Doubt http://www.greglehman.ca/blog/2016/01/31/revisiting-the-spinal-flexion-debate-prepare-for-doubt
- Delitto, A., George, S. Z., Van Dillen, L., Whitman, J. M., Sowa, G., Shekelle, P., Denninger, T. R., Godges, J. J., & Orthopaedic Section of the American Physical Therapy Association (2012). Low back pain. The Journal of orthopaedic and sports physical therapy, 42(4), A1–A57. https://doi.org/10.2519/jospt.2012.42.4.A1