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Common Misconceptions About Low Back Pain (Part 2)

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. I've listed Part 2 of the most common myths below:

#4: More pain = more damage

Fact: Chronic low back pain does not correlate with the amount of damage suffered. Pain levels have a very small relationship to damage to the spine (5). Pain in this circumstance is much more related to the brain’s conscious and unconscious interpretation of the threat the pain presents to the person. Other factors like cultural influences, work history, stress, and past experiences have a stronger relationship with pain than simple physical damage. Check out just about anything by Dr. Adriaan Louw or Dr. David Butler for more info on pain sciences.

#5: Something is out of place

Fact: As already mentioned, the MRI/imaging completed of your lower back does not dictate pain/injury. Secondly, no clinician has the ability to detect if something is truly out of place. That level of minute detail is completely unreasonable to be consistently and accurately applied by any human. Spinal manipulation, mobilization, or adjustment may ease pain and help you move better in the short-term, but that is more likely related to other factors such as short-term changes in the nervous system that decrease pain sensitivity and lead to some short-term improvement in mobility (6,7). As already mentioned, your spine is robust and resilient. While there may be a tiny number of legitimate spinal instability cases, more likely than not you are not unstable, and can continue to move safely without fear that your back will snap like a twig. If our spines were that poorly designed there is no way we would have evolved to this point.

#6: Long-Term Back pain means I need surgery

Fact:Fact: No no no no no no no…no. I can’t even begin to say how many times I have had this conversation. There is a mountain of evidence that says this is a bad idea for the majority of people with low back pain. And for those mentioning that the only fix for a herniated disc is surgery, consider that more and more research is supporting the concept that discs will spontaneously resorb. One study in particular reported that the incidence is approximately 66.66% resorption (8). That’s a pretty solid percentage considering how a great deal of people treat a disc herniation as a death sentence. Yes, there is a subset of people that will need surgery to address their lower back pain. That said, the majority of people with low back pain do NOT need surgery and would benefit perfectly well from conservative treatment including things like physical therapy, behavioral therapy, and a strength/conditioning program (9). Most studies are now showing that while you may see some short-term benefit from surgery, the outcomes are the same within 1 or 2 years (10). Aside from the long-term outcomes being about the same, there is the fairly significant risk of a failed surgery (11). This can lead to further complications regarding pain and functional level. Considering all the potential risks, side effects, and extra time off from work, you may just want to go with conservative care (unless you can’t feel both legs and/or are having some pretty severe neurological symptoms).

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!).

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.

5. Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010 , Issue 6 . Art. No.: CD007612.

6. Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811–6.

7. Coronado RA, Gay CW, Bialosky JE, Carnaby GD, Bishop MD, George SZ. Changes in pain sensitivity following spinal manipulation: a systematic review and meta-analysis. J Electromyogr Kinesiol. 2012;22(5):752-67.

8. Fritz JM, Koppenhaver SL, Kawchuk GN, Teyhen DS, Hebert JJ, Childs JD. Preliminary investigation of the mechanisms underlying the effects of manipulation: exploration of a multi-variate model including spinal stiffness, multifidus recruitment, and clinical findings. Spine. 2011;36(21):1772-1781. doi:10.1097/BRS.0b013e318216337d.

9. Gugliotta M, Da costa BR, Dabis E, et al. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ Open. 2016;6(12):e012938.

10. Jacobs, W.C.H., van Tulder, M., Arts, M. et al. Eur Spine J (2011) 20: 513. https://doi.org/10.1007/s00586-010-1603-7

11. Thomson S. Failed back surgery syndrome – definition, epidemiology and demographics. British Journal of Pain. 2013;7(1):56-59. doi:10.1177/2049463713479096.