Facts & Fallacies: Lower Back Pain
Updated: Jul 14
If you are reading this and you live in America, chances are you will have such bad lower back pain at least once in your life, you’ll visit the doctor for it. It is the 5th most common reason we seek medical help. Is there something wrong with the way our spines are designed? Or are we doing things to our back that it hasn’t evolved to withstand? Engineers marvel at the simple yet unbelievably strong and agile human spine. Due to its natural S curve, it can withstand more axial loads (squishing in a vertical direction) than if it were straight. Our sedentary modern life has created a malicious environment for the lumbar spine.
Lower back pain is a common condition that affects millions of people worldwide. Unfortunately, there are a lot of myths surrounding the causes and treatment of lower back pain. This post will debunk 10 of the most common fallacies about lower back pain and provide evidence-based information to help you better understand this condition.
Myth #1: Bad posture causes lower back pain.
Fact: The notion of a 'perfect posture' is a misconception. 'Good' posture doesn't prevent back pain, and 'bad' posture doesn't cause it. While it is possible that poor posture can contribute to lower back pain, it is not the primary cause. Studies show no significant relationship between posture and lower back pain, highlighting the importance of understanding the complex factors that contribute to pain, such as genetics, stress, and lifestyle habits. Poor postures are not necessarily more likely to result in back pain than good postures.
Myth #2: Bed rest is good treatment for lower back pain.
Fact: Rest may offer temporary relief for acute lower back pain; however, bed rest can actually do more harm than good. Inactivity can lead to muscle weakness and stiffness, exacerbating the pain. Maintaining a moderate activity level and engaging in gentle exercises to promote blood flow and prevent muscle atrophy are essential. Spines crave motion.
Myth #3: Stretching can prevent lower back pain.
Fact: While stretching can improve flexibility and range of motion, it is not an effective preventative measure for lower back pain. Data have shown that stretching does not significantly reduce the risk of developing lower back pain. In general, stretching is overrated. In some cases, stretching can actually aggravate the soft tissue and nerves that are already inflamed due to injury.
Myth #4: Lower back pain is usually caused by a structural problem.
Fact: While structural problems such as herniated discs and spinal stenosis can contribute to lower back pain, they are not always the primary cause of the condition. In fact, studies have shown that up to 85% of cases of lower back pain have no identifiable structural cause. This highlights the importance of taking a biopsychosocial approach to pain management and considering factors such as stress and lifestyle habits.
Myth #5: Surgery is an effective treatment for lower back pain.
Fact: While surgery may be necessary in some rare cases of lower back pain, it is not the most effective treatment option. It should be a last resort treatment option. Conservative treatments such as physical therapy, exercise, and manual therapy are more effective in reducing pain and improving function. It may be essential to work with a healthcare professional to develop a comprehensive treatment plan that addresses the root cause of the pain.
Myth #6: The more pain you have, the more damage there is in your back.
Fact: While it is natural to assume that more pain means more damage, this is not always the case. Evidence has shown that there is not always a direct correlation between the amount of pain a person experiences and the severity of their condition. It is important to focus on managing the pain and identifying the root cause rather than assuming that more pain equals more damage. Just because you are experiencing pain in your lower back does not necessarily mean there is damage to the tissues.
Myth #7: Lower back pain is usually caused by a physical injury
Fact: While physical injuries such as strains and sprains can contribute to lower back pain, they are not always the primary cause. Psychological factors such as stress and anxiety can also play a significant role in the development and persistence of lower back pain. This highlights the importance of taking a biopsychosocial approach to pain management. “The evidence that tissue pathology does not explain chronic pain is overwhelming (e.g., in back pain, neck pain, and knee osteoarthritis).”
Myth #8: Low back pain is caused by weak core muscles
Fact: Weak ‘core’ muscles do not cause back pain, in fact, people with back pain often tense their ‘core’ muscles as a protective response…Being strong is important when you need the muscles to switch on, but being tense all the time isn’t helpful. Learning to relax the ‘core’ muscles during everyday tasks can be helpful.
Myth #9: MRI and X-ray for low back pain are reliable
Several studies have shown that there is a high prevalence of abnormal findings on MRI and X-ray scans among people without any symptoms of low back pain. For example, herniated discs, spinal degeneration, and other structural abnormalities are frequently observed in individuals who are completely asymptomatic. Conversely, many people with significant low back pain may not show any noticeable abnormalities on imaging scans. A lot of back pain begins with no injury.
Myth #10: Inhibited gluteal muscles cause lower back pain
Fact: Data show inhibited gluteal activity is poorly correlated with incidents of lower back pain. Moreover, there is some research that shows increased gluteal activation and lower back pain. Weakness can certainly be a factor in LBP but to blame it all on the glutes is inaccurate. That being said, you can't go wrong getting strong.
Back pain can be perceived as more severe than it actually is due to the pain it causes. However, the most concerning types of back pain typically do not involve intense pain, and common issues like slipped discs are usually less serious than people fear. Only around 1% of back pain is worrisome, and even then, it is often treatable. The majority of this 1% is attributed to conditions like cancer, autoimmune disease, and spinal cord damage. The spine is not fragile. It is a strong and resilient structure that can handle a significant amount of load and stress. It is designed to provide support, flexibility, and protection to the spinal cord and nerves while withstanding various forces.
Remedy: When it comes to treating lower back pain, incorporating exercise and movement into your routine stands out as one of the most powerful approaches. However, the remedy extends beyond physical activity. Patient-centered education, which prioritizes your unique needs, fosters a positive mindset and equips you with valuable knowledge about your condition and effective pain management strategies.
Furthermore, guidance in optimizing both your physical and mental health plays a vital role. Engaging in regular physical activity and targeted exercises can strengthen your body, and can contribute to pain relief. In addition, social activities, adopting healthy sleep habits, maintaining a balanced body weight, and remaining busy, where possible, all form part of the comprehensive approach to enhancing your overall well-being.