Updated: Mar 30, 2021
While low back pain is the leading cause of disability worldwide, and often associated with costly, ineffective, and sometimes harmful care, unhelpful beliefs about low back pain are associated with greater levels of pain, disability, work absenteeism, medication use, and healthcare seeking.
Here are 10 unhelpful MYTHS, followed by 10 FACTS about low back pain.
1) Low back pain is usually a serious medical condition
2) Low back pain will become persistent and deteriorate in later life
3) Persistent low back pain is always related to tissue damage
4) Scans are always needed to detect the cause of low back pain
5) Pain related to exercise and movement is always a warning that harm is being done to the spine and a signal to stop or modify activity
6) Low back pain is cause by poor posture when sitting, standing, and lifting
7) Low back pain is cause by weak core muscles and having a strong core protects against future low back pain
8) Repeated spinal loading results in wear and tear and tissue damage
9) Pain flare ups are a sign of tissue damage and require rest
10) Treatments such as strong medications, injections, and surgery are effective, and necessary, to treat low back pain
Believing these myths is damaging as they may lead to unhelpful behaviors such as avoidance of normal postures, movements, and activities. Unhelpful behaviors may also lead to unhelpful protective reactions such as excessive muscle guarding, bracing, or slow and cautious movements. These behaviors may lead to increased medical intervention such as medication use, procedures, and treatments.
All these can contribute to negative psychological responses including fear, worrying, decreased self image, poor coping, stress, anxiety, and depression.
Let's set the record straight and get some FACTS about low back pain.
1) Low back pain is not a serious life threatening medical condition
2) Most episodes of low back pain improve and low back pain does not get worse as we age
3) A negative mindset, fear avoidance behavior, negative recovery expectations, and poor pain coping behaviors are more strongly associated with persistent pain than is tissue damage
4) Scans do not determine prognosis of the current episode of low back pain, the likelihood of future low back pain disability, and do not improve low back pain clinical outcomes
5) Graduated exercise and movement in all directions is safe and healthy for the spine
6) Spine posture during sitting, standing, and lifting does not predict low back pain or its persistence
7) A weak core does not cause low back pain, and some people with low back pain tend to overtense their core muscles. While it is good to keep the trunk muscles strong, it is also helpful to relax them when they aren't needed
8) Spine movement and loading is safe and builds structural resilience when it is graded
9) Pain flare ups are more related to changes in activity, stress, and mood rather than structural damage
10) Effective care for low back pain is relatively cheap and safe. This includes education that is patient centered and fosters a positive mindset, and coaching people to optimize their physical and mental health
Educating ourselves as both patients and providers helps maintain clear communication and productive conversation that directs recovery from low back pain.
Find a provider that speaks to you sincerely, and educates you on what is right and wrong. Using dialogue that includes superlatives of "the worst back I've ever seen", or statements like "I can't believe you are even able to stand" only feed a negative mindset that we know is so strongly related to chronic pain.
If you feel that your provider is feeding into negativity, and not appreciating your progress and victories, walk out of that office and find a new provider. You can't win the battle with someone who doesn't believe in the fight. #snowbeastperformance