Low back pain is extremely common. As a matter of fact, the point prevalence of low back pain is reported to be as high as 10-12% (Hoy 2010), which means that 10-12% of everyone, at a given random moment in time, is experiencing some kind of low back pain. That’s a lot of people! Fortunately, the overwhelming majority of people who experience low back pain will get better without surgery and without long-term disability (Gurcay 2009, Vos 2008). To help alleviate some concerns you may have about low back pain, here are some of the common myths and misconceptions about it and some information to help you form a more accurate picture of what back pain is and is not:

1. Low back pain means something is wrong.

In ~95% of low back pain cases, the suspicion of serious pathology is very low (Maher 2017). What this means is that the majority of low back pain is considered “non-specific”, meaning that there is nothing broken, torn, or otherwise seriously “wrong”. The severity of the pain you experience makes it easy to assume that there is some sort of serious problem, but the degree of pain rarely if ever correlates to the degree of damage in low back pain. New activities, life stress, unaccustomed travel, even a new mattress can all contribute to low back pain, and none of these are damaging. Our bodies are simply very protective, particularly of places like our neck and low back, likely due to its proximity to our spinal cord (which is very much worth protecting!).

1. Low back pain is long-lasting and debilitating.

Across the board, most cases of low back pain improve in 6 weeks (Darlow 2017). Although recurrence of back pain is common, having multiple episodes of back pain also does not mean that anything is wrong. In addition, well-managed back pain does not have to stop you from doing the things you enjoy - some short-term modifications may be necessary while your symptoms calm down, but the goal is always to get you back to as much of your prior level of function as we can. Back pain should not exclude you from living your life.

1. Disc bulges, degenerative discs, and other imaging findings are closely tied to low back pain.

Significant imaging findings are very common in MRI’s of people who do not have low back pain (Brinjikji 2015) - in fact, by the time you are in your 40’s, you are almost certain to have something show up on an image even if you do not have any pain at all. In addition, imaging only presents a single, static snapshot of your back, which does not accurately capture you or your symptoms. You cannot see pain on an MRI! You can see plenty of anatomic variance, but only at that one point. A lot of these things also change over time. For example, current evidence indicates that about ⅔ of disc bulges spontaneously resolve (Jiang  2017), and there is some evidence that bigger bulges are actually more likely to go away all by themselves.

1. Certain exercises cause low back pain.

Among the common culprits blamed for back pain, running and lifting weights take top billing. However, this blame is almost certainly misplaced. Running actually keeps your discs healthy and hydrated (Belavy 2017), resistance training can help people with degenerative discs improve their function and pain (Steele 2020), and there are no measurable differences between spinal discs in weightlifters and non-weightlifters (Jentzsch 2020). Furthermore, young athletes actually have thicker discs than less active people (Owen 2021). On top of all of this, exercise continues to be one of the top-rated interventions for low back pain. So keep working out! (Within reason - taking a temporary break from irritating activities is also not a bad idea in the case of an acute flare-up.)

1. Low back pain is associated with certain postures or positions

The relationship between posture and pain has been studied pretty extensively, and there has yet to be a solid causal connection drawn between the two. In fact, a recent review states that, “There is no consensus regarding causality of physical exposure to LBP. Association has been documented but does not provide a causal explanation for LBP” (Swain 2020). In other words, it may be the case that people who e.g. spend more time at a desk may be at higher risk for having some low back pain, but this is hardly set in stone. This relationship may actually be due to entirely different factors. For instance, one study of 243 young female desk workers found that a moderate level of daily physical activity and maintaining a healthy body weight were associated with a lower risk of low back pain in these individuals (Kayihan 2014). So regardless of posture or position, there are likely bigger factors at play (e.g. overall health, level of physical activity) as far as your risk of developing low back pain.

At the end of the day, back pain remains a very common issue across the board. However, it is rarely as bad as the fear-mongering in social media (or doctor’s offices, unfortunately) can make it out to be. It is generally not associated with any significant pathology, it almost always gets better over time (even on its own!), you can still exercise and sit at a desk if you have back pain, and just because you have stuff on your images (“wrinkles on the inside”, as we call them) does not mean that you are destined for a lifetime of pain and disability. If, however, you are experiencing some back pain that does not seem to be getting better, are worried that it might be something more serious, or have a history of back pain that just keeps returning to haunt you, talking to a physical therapist would be an excellent next step. We can help you figure out what is going on in more detail, give you strategies to help deal with it, and guide you through the murky waters of rehab and recovery.

Author: Jason Hubbard, DPT, PT, OCS, USAW-2

References

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