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Common Misconceptions About Low Back Pain (Part 1)

Continuing with my mini-series on low back issues I wanted to address some of the more common “myths” about the lower back and back pain. The lumbar spine and its relationship to pain are very complex concepts. There is a lot of misinformation out there regarding the spine leading to a lot of fear and misunderstanding that doesn’t help anyone. Today I’ll highlight a few of the most common “myths” below:

#1: When I get hurt I need to get an MRI

Fact: Your MRI is bullshit. Ok, so MRIs can be a great tool for a lot of things in medicine, especially for the more serious things people can be dealing with, but the truth of the matter is that they really aren’t that useful when it comes to the lower back. There is an extremely poor correlation between findings on a scan and the source of pain(1). A huge percentage of adults without low back pain will show changes in the anatomy of the spine on an image that don’t cause any problems. In fact, finding anything on the scan of the spine that is strongly related to pain or a more sinister health threat is extraordinarily rare, under 1%.

There is actually strong evidence that states a thorough subjective and physical examination by a physical therapist is effective at diagnosing and treating low back pain, without the use of any imaging (2). Couple that in with the evidence that MRI results are often variable between different radiologists leading to wildly different results (3), and you may want to just talk to your physical therapist first. The crazy stat of the day with MRI and low back pain is that in the study, 49 different findings were reported from 10 different radiologists on the same individual who presented with low back pain. None of the findings were reported in all 10 findings, and only one finding was reported in 9/10. Pretty crazy disagreement for something that is supposed to be the gold standard.

#2:The best thing I can do when I injure my back is stay in bed and rest

Fact: The sooner you can return to normal motion, the better. You definitely don’t want to continue to aggravate an injury, however there is an increasing amount of evidence that shows those who stay in bed due to low back pain end up having a longer recovery time compared to those that stay active (4). You should look to gradually return to exercise and activities that don’t flare up your symptoms. Start with lower intensity versions of your previous exercises or stay within motions that don’t hurt, and steadily expose yourself to more intense motions based on how you’re feeling. You and your back are strong, and it will get better.

#3: It’s bad to load the spine/my spine is delicate

Fact:Fact: Your spine is strong and resilient. The spine, its surrounding muscles, and ligaments are well-designed and extremely robust. Strengthening, flexibility training, and conditioning are vital to maintaining health and wellbeing. These activities will further support the spine (as well as everything else) and should be included in those who have had an episode of low back pain. The only thing that should be modified is intensity and type activity related only to aggravation of symptoms. Exercise is not inherently bad, and the lower back does not need to be overprotected following a low back injury.

While we’re on the subject of loading, I’ll reference a great article by Dr. Zach Long (The Barbell Physio) that covers deadlifts being used to treat low back pain. Great stuff and really helps solidify my point of loading/strengthening being GOOD for the low back. Check it out when you get a chance: https://thebarbellphysio.com/fixing-back-pain-using-deadlifts/
**There are exceptions to this in the form of things like an unstable spinal fracture. The above statements are related to the more common sources of low back pain.

There is a ton of misinformation out there regarding low back pain (and pain in general for that matter), and it really doesn’t help an individual dealing with an injury. If you take one thing away from this article series, I hope it’s that you realize your back is strong and resilient. Back pain is a bitch, to put it lightly, but it does get better, and understanding the mechanisms behind your pain as well as the safety in returning to exercise gradually will help you move better, faster. I love meeting and talking to new people about this stuff so as always, if you have questions, concerns, or are looking for advice regarding your low back issues or any other activity, please reach out either in the comments, on the Breakthrough Performance Facebook page, by email (dan@breakthroughperformanceavl.com), or by phone (or better yet, come on in and talk in person!). Keep an eye out for Part 2 dropping in just a few days!

Citations

1. Deyo RA, Weinstein DO. Low Back Pain. N Engl J Med. 2001 Feb;344(5):363–70.

2. Zhong M, Liu JT, Jiang H, Mo W, Yu PF, Li XC, Xue RR. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis. Pain Physician. 2017;20(1):E45–E52.

3. Herzog R, Elgort DR, Flanders AE, Moley PJ. Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period. Spine J. 2016 Nov.

4. Petersen T, Laslett M, Juhl C. Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews. BMC Musculoskeletal Disorders. 2017;18:188. doi:10.1186/s12891-017-1549-6.