the NeuRA blog

By Edel O’Hagan

We know our body, right? We know our back? We know what our back likes and dislikes, its limits and strengths.

But what if everything you thought you knew about your back and lower back pain were, in fact, wrong or maybe not completely wrong but not quite true. I would like to tell you about three commonly held myths surrounding low back pain.

 

It is not surprising that there are some misunderstandings around low back pain. If you “Google” low back pain, you will find hundreds of supposed causes and equally as many treatments for low back pain. Despite all this information, for the vast majority of people low back pain cannot be attributed to any particular cause. This is called non-specific low back pain.

 

So here is our first myth, you may think you know what “caused” your low back pain but despite all of the tests that we have we still cannot tell you what causes your low back pain. Therefore whatever you have been told that causes your back pain; slipped disc, disc protrusion, degenerative changes, osteophyte formation or osteoarthritis, is not accurate. These terms describe normal processes that happen as we get older, rather than pathological processes requiring further investigation or treatment. That is all, there is no evidence that any of these changes cause low back pain, actually, in some cases, they are not even present in people with low back pain or conversely, they are present in people without low back pain. At best these terms provide a convenient explanation for low back pain, something tangible. But these explanations are over simplistic, untrue and are a toxic contribution to a sea of confusion that already surrounds low back pain among the general public.

 

Myth number two: medical imaging is necessary to diagnose the cause of low back pain. From what you have read so far you could well be thinking, what is the point in having imaging if it is only going to show some normal age-related changes? Yes, exactly, there is no point, if you have imaging (you can choose your flavour – x-ray/MRI/CT), it will likely show some changes in your back structure, but it does not tell you anything about your pain. It can’t tell us what you are feeling or why you are feeling it. In fact, it will likely cause you to worry about things, which are essentially normal, leading to more pain and disability.

 

This information might help with our third myth. A lot of people believe that pain is a reflection of damage, the bigger the pain, the worse the tissue (muscles, bones, ligaments etc.) damage. This one is not true either. Pain is a sign of protection. Sure, in the very early stages of an injury, pain can accompany tissue damage but, pain is not an accurate reflection of what is happening in the body tissues.

 

Think of a paper cut, usually, there is considerable pain, but minor tissue damage. To produce pain our brain assesses information from multiple sources, including our tissues, but also our environment, our emotions, our thoughts and beliefs, our memories, among others.

 

Pain is a complex experience, where things aren’t always as they seem. In fact, in the case of chronic low back pain, which is low back pain that has persisted longer than 3 months, we are confident that, if there were any tissue damage involved when the pain started, healing would have occurred by 3 months. After this time, pain is a particularly unreliable indicator of what’s happening in your body tissues.

 

You are not alone if you believed in any of these myths. There have been several very large surveys investigating the level of agreement that people have with statements that researchers consider “myths” about low back pain. In general, these studies found that myths about low back pain are common among the general public. Examples include “If your back hurts, you should take it easy until the pain goes away’ or “Everyone with back pain should have a spine x-ray”’.

 

Unfortunately, some myths about back pain can be a problem as they can influence recovery. When we believe these kinds of false statements about low back pain, our recovery will take longer. There is good news, however; an intervention as simple as delivering accurate, evidence-based education to those who are experiencing an episode of low back pain reduces fears, worries and disability and leads to reductions in future episodes of low back pain. Debunking some of these myths can be an important starting point on the difficult but achievable road to recovery.

 

I invite you to challenge the myths and try some alternatives for size, these are some of my favourites;

 

Backs are strong and resilient.

Pain is not a reliable indicator of damage.

Imaging is rarely needed for low back pain.