My back hurts. If I move it, surely I'm causing it damage! Right?
It might be no surprise that low back pain is by far the most common conditions a physiotherapist will treat.
Can you identify whether the following statements are true or false?
1. Moving will make my back pain worse 2. I should avoid exercise, especially weight training 3. A scan will show me exactly what is going wrong 4. Pain equals damage
Answer: They're all WRONG!
However, these are the most common misconceptions people have when suffering low back pain.
Let's analyse these in more detail:
Moving will make my pain worse.
The majority of low back pain that we see are due to muscle tightness due to fear of moving their back! This is normally a self-fulfilling downward spiral. They've overdone it digging the garden, their back hurts so they fear moving it for damage when in fact their pain is coming from the muscles tightening up. To resolve most low back pain problems, we suggest gentle stretches.
I should avoid exercise, especially weight training.
This follows on from the above really. The reason most people with low back pain have muscle tightness following what we call a mechanism of injury, is down to a muscle weakness somewhere in the kinetic chain. Remember a time whereby if you had done your back in you'd be advised to lay up until it eases? That advice has been outdated for over 20 years. Numerous studies have been conducted to show that movement and exercise including strengthening will vastly reduce your low back pain
A scan will show me exactly what is going wrong
Will it? The 2 images enclosed hopefully demonstrate why we as physiotherapists are reticent to offer you an MRI. Not withstanding that most people do have muscular pain, only 1/25000 have something sinister going on inside their spines. If we took a snapshot of the general population and offer them an MRI of their low back, these results would be typical of the population, yet many of them may be asymptomatic (without pain)! Therefore, we don't necessarily reach for the scanner as it will almost certainly show something and this something will not be causing you your pain. We tend to go down the MRI route if we feel that surgical intervention is necessary. Once we start discussing this with a patient, then they soon change their facial expression. A physiotherapist is able through assessment, special testing, differential diagnosis and sound clinical reasoning able to establish the root of your back pain.
Pain equals damage
This is a very common misconception and not just limited to the low back. People with a pain in any area of their body, fear damage is being done. Unless your mechanism of injury identifies a major fall or traumatic impact resulting in a fracture or a significant tissue damage, then it is unlikely that damage is being done. Pain is the body's way of saying something is wrong, be it mis-alignment or muscle imbalance. The majority of the time, it is the pain itself that inhibits normal movement. If we can manage the pain with appropriate pain relief in order to commence corrective exercise then the cause of the problem can be eradicated. There we go. I hope this can go towards eradicating some of the myths surrounding low back pain. It's common, it's normal, as you get older, changes happen to all of us. Your back is not getting damaged. Keep it moving, manage your pain and get an appropriate exercise regime from your physiotherapist.
