Myths about Low Back Pain
Myth 1: If you have a herniated/ruptured disk, you must have surgery. Surgeons agree on who should have surgery.
Fact: Most specialists agree that disc surgery is only appropriate when there is a combination of:
- definite disc herniation on an imaging test
- corresponding physical examination findings, e.g. signs of nerve root irritation (brachialgia, sciatica, pinched nerve in neck/back)
- failure to respond to non-surgical treatment (at least six weeks) (e.g. specialized Physical Therapy, as we provide at 'Back In Motion')
Most patients who have disc surgery have faster pain relief in the short term. However, in long-term follow up studies, there is no difference between the surgical and non-surgical/conservatively managed groups!
Myth 2: tests (X-ray, ST-scan, and MRI) can always identify the cause of a person’s pain.
Fact: Large numbers of pain-free people show spine abnormalities on X-rays, MRI and CT-scans. People who say to have never experienced back pain or sciatica (leg pain from a back pain condition) demonstrate in 20-30% of the cases a herniated/bulging disk on a MRI. Spinal stenosis, rare in younger adults, occurs in about one fifth of the over-60, pain-free group. Detecting an abnormality on an imaging test therefore only proves one thing: the patient has a spinal abnormality! (Relationship between abnormality and pain always needs to be established).
Myth 3: If your back hurts, you should take it easy until the pain goes away.
Fact: People who remain active despite acute back pain do better, experience less future chronic pain (more then three months) and use fewer healthcare services than those who rest and wait for the pain to diminish. Modify your activities when needed, but stay active!
Myth 4: Injuries or heavy lifting causes most back pain.
Fact: Heavy lifting or injuries are risk factors, but do not account for most episodes. Lots of patients do not seem to remember a specific incident that brought on the pain; 'it just seemed to happen.' With spontaneous recovery being the rule, pinpointing an exact cause may not even be necessary in most cases.
Myth 5: Back pain is usually disabling.
Fact: Fear that activity will make the situation worse and delay recovery is unfounded. Actually, patients with acute back or neck pain who continue routine activities as normal as possible do better than those who try either bed rest or immediate exercise.
Myth 6: Everyone with back pain should have some form of imaging (X-ray, MRI, and CT scan) before starting any kind of treatment.
Fact: Most patients with acute back pain simply will get better on their own (about 90 percent). Many physicians now advocate imaging tests (after serious conditions are ruled out) only for those patients that fail to recover naturally and after conservative management. The imaging should always support the physical examination findings in order to consider further intervention. An example of conservative management is specialized Physical Therapy as we provide at 'Back in Motion'. Don’t forget, at 'Back in Motion' we treat the impairment, not the imaging!
Myth 7: Bed rest is the mainstay of therapy.
Fact: Patients with bed rest miss more work due to back pain. At three weeks and three months, there is no difference in pain relief, days of limited activity, daily functioning or satisfaction with care. Continuing with regular daily activity has proven to give the fastest recovery when experiencing acute low back pain. Modifying activities is appropriate, but keep moving! Only if really needed, one or two days of bed rest can be appropriate.