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Back Pain – Myths and Realities

Back Pain – Myths and Realities

02Jun

It is believed that up to 80% of us will suffer from back pain at some point in our life (mayoclinic.org). Physiotherapists at Ballsbridge Physiotherapy Clinic have many years’ experience dealing with the effects of such pain. While back pain is very common, there are a number of myths around what causes affliction , both in the lower and upper regions of the back. Here are just a few of those myths and the corresponding realities.

 

Myth: Only Surgery will Ease Back Pain

In cases of disc prolapse, the majority of cases recover and the prolapse reduces in size over time. Long term outcomes for surgical intervention are no different to usual care (Benson, Tavares et al. 2010). Those who do not recover, can normally not be predicted by the size of prolapse or degree of nerve root compression. This suggests that other affliction mechanisms are involved in back pain, rather than those found on MRI.

The role of decompressive surgery (micro-discectomy) should be limited to nerve root pain. This is associated with progressive neurological loss (e.g., leg weakness) and cauda equina symptoms (O’Sullivan and Lin 2014). Surgery for radiculopathy is unlikely to be useful in the absence of neurological compromise. This is the pain mechanism is likely to be associated with other pain mechanisms and biopsychosocial factors. Micro-discectomy is not a treatment for back pain. Most people tend to benefit from a range of other treatments, physiotherapy being high among them.

 

Myth: MRI scans are needed to identify causes of lower back pain.

95% of low back pain is aspecific, which means no serious pathology. MRI and other imaging has an important role in the triage of people with back affliction to identify fractures, cancer and nerve root compression in 1-2% of people. It also puts the spotlight on many patho-anatomical findings that are not related to back pain (O’Sullivan and Lin 2014). Disc degeneration, disc bulges, annular tears and prolapses are highly prevalent in affliction free populations. They are not strongly predictive of future low back affliction and correlate poorly with levels of pain and disability (Deyo 2002, Jarvik JG 2005). Early MRI imaging for lower back affliction can cause adverse effects. If not communicated properly and matches to pain presentation (Webster BS 2010, McCullough, Johnson et al. 2012).

 

Myth: The Only Thing to Make You Better is Bed Rest

While rest, for example, after an injury may be initially beneficial, there is strong evidence that trying to keep active can in fact aid recovery. It’s important to realise that gradually getting back into your routine can help. Staying in bed can aggravate your symptoms. 90% of individuals with back pain don’t take sick leave. With recovery rates higher in this population rather than those who do take time off to rest.

 

 Myth: Exercise Causes the Pain in Your Back

Regular exercise helps prevent discomfort. Stopping all forms of exercises due to lower back pain can lead to deconditioning and reduced mobility. Lack of movement and exercise can also lead to a heightened perception of affliction. As your body can become accustomed to lower activity levels. It is important in the early stages that you are careful of what exercises you do.  Not too aggravate or overload the lower back. Exercise based interventions in the management of lower back affliction have all shown to be superior when compared with medical or surgical management, where there are no neurological signs and symptoms.

 

Myth: A Back Injury means Long Term Pain

An injury to your back does not need to mean long-term pain. There are normally many social and psychological factors in addition to biomechanical factors which when combined can sometimes lead to back affliction becoming chronic.The sooner you address the pain, the quicker you will recover.

 

Myth: Pain is a Normal Part of Ageing

Serious discomfort does not have to be a regular feature of getting older. While you may be more susceptible to pain as you get older, there is no reason why suffering should be part of your daily life. The incidence of back affliction is highest between the ages of 35 and 55. After age 55, people usually have less pain – especially discogenic pain (back affliction or other affliction or symptoms caused by disc problems). While disc degeneration is a natural part of the aging process, it is not always accompanied by pain.

 

Myth: It is due to something being “Out of Place”

Terms such as ‘your sacrum, pelvis or back is out place’ are common among many clinicians. There is no evidence to suggest that affliction in your back means that there is a bone or joint out of place. Back pain can occur for a range of reasons, from injury to strain to stress.  Promoting these beliefs can increase fear, anxiety and hypervigilance. The patient may be led to believe that there is something structurally wrong that they have no control over, resulting in dependence on passive therapies for affliction relief (possibly good for business, but not for health). Apparent ‘asymmetries’ and associated clinical signs relate to motor control changes secondary to sensitised lumbo-pelvic structures, not to bones being out of place (Palsson, Hirata et al. 2014).

Patients need help in understanding that back affliction does not normally mean spinal structures are damaged, but sensitised. It is your physiotherapist’s job to determine what mechanisms are causing this sensitivity. In many cases, there is a simple biomechanical explanation to affliction , others are more complex and can include a combination of genetic, pathoanatomical, physical, lifestyle, cognitive and social factors.

If you have been experiencing back pain, either acute or chronic, contact us here today.

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