Myth Busting Lower Back Pain

There are many misconceptions perceived by the general public when it comes to lower back pain. The following are a few of the common myths that I regularly come across in my days as an Athletic Therapist.

Myth 1: Rest is Best

Many people think that resting and avoiding physical activity is the best way to relieve lower back pain. This is generally due to misinformation spread by healthcare professionals and through social media. Ok, resting for shorts periods of time might give you some initial relief. But lying down in bed all day and avoiding exercise can actually make back pain worse and delay your recovery.

To protect the spine, the body’s natural reaction is to stiffen up and the surrounding tissues become much tighter and less mobile. This doesn’t get any better by resting for long periods of time and avoiding physical activity. In fact, it can make stiffness worse and increase discomfort, making it even more difficult to return to normal activities.

Regularly engaging in gentle exercise is more beneficial for relieving lower back pain and promoting healing than rest alone (1). Not only does exercise help strengthen muscles to support the spine and improve flexibility, but it increases blood flow to the injured area which can speed up the healing process. Of course, not all types of exercise are suitable for people with lower back pain, so it is important to get expert advice to manage and treat symptoms appropriately.

Myth 2: You should avoid exercise

Many people fear that physical activity will make their symptoms worse, so they take anti-inflammatory medication and prioritise rest. Yes, there will be certain high-impact exercises that may place strain on the lower back and make pain worse in the early stages (e.g. running or heavy weightlifting) and these should initially be avoided. However, there are many low-impact exercises that can help remain active and relieve pain including swimming, resistance training, walking, yoga and Pilates.

Swimming: water provides buoyancy, which supports the body and reduces the impact on the joints and spine. This is a great option for improving cardiovascular fitness and strengthening the core and back muscles.

Resistance Training: This doesn't imply that you have to do heavy squats and deadlifts. In the majority of cases of back pain you will be able to continue to strength train in a modified way. This may involve reducing load and modifying technique for the short-term, but there is still lots you should be able to do!

Walking: going for a short walk can help with circulation and will limit stiffness in the spine and surrounding joints. This is a simple yet effective form of exercise that can be easily incorporated into your daily routine!

Yoga: the combination of gentle stretching, strengthening and mindfulness techniques releases tension in the muscles and can promote relaxation.

Pilates: this is different to yoga in that it emphasises core strength and stability. Developing a strong core is generally recommended in the management of lower back pain, and although it isn't a 'magic bullet' it will also have crossover to other activities outside of Pilates. For more on how to develop your core, read our blog here. Note: certain core exercises may not be suitable for you so it is important to get professional advice and guidance for this.

Myth 3: Pain is a normal part of ageing

While age is a factor that can increase the risk of lower back pain, it doesn’t mean you will definitely experience it as you get older. There are many factors that can contribute to the development of lower back pain as we age, including reduced flexibility, loss of muscle mass and strength, changes in posture, and degenerative changes in the spine (2).

Degenerative changes in the spine typically involve the intervertebral discs. The discs are fibrous structures that have an inner nucleus made up of mainly water (see image below) (3). They sit between the bones (vertebrae) in the spine and act as a shock absorber when we walk, run, bend and twist. As we age, the discs may lose water and elasticity leading to degeneration and potentially lower back pain. Other conditions that involve degenerative changes include osteoarthritis (a disease that affects the cartilage of joints) and spinal stenosis (the narrowing of the spinal canal where the nerves exit the spinal cord).

While we cannot fully control the degenerative changes that take place in our bodies, we can do our best to manage these changes by adopting a healthy lifestyle that includes regular activity and exercise. It is important to note that joint 'degeneration' is also a normal part of ageing and is not something that can be avoided. Just because an MRI shows 'degenerative changes', it does not mean you are destined for pain.

Myth 4: You have a ‘slipped disc’

There are many reasons why lower back pain can develop, but it is not always specific (read our blog here). A common thing you may hear people say is that they have a 'slipped disc'. However, your discs can not 'slip'. Your spine is an extremely strong and mobile structure, not a fragile one. There are so many causes of lower back pain, with the majority of cases being 'non-specific' in nature. You have a multitude of joints, muscles, and neurovascular structures in your lower back which may contribute to the painful experience. Some cases may result in neurological symptoms (e.g. pain, tingling, numbness, weakness in one or both legs). This is an indication you should get assessed by a professional.

Myth 5: Surgery is the only solution

There is a common misconception that surgery is the only way to treat lower back pain, especially for people who have chronic pain and have not found relief from conservative treatments. Although surgery may be necessary in some cases (e.g. spinal deformities or herniated discs with neurological compromise), it is not the only solution and should generally be considered as a last resort after trying other forms of exercise and treatments. With any surgery there are risks and potential complications, so this should be considered after a thorough evaluation and discussion with a healthcare provider. Recent research shows that surgery has no benefit for improving lower back pain in the long-term when compared to conservative treatment alone.

Tips for avoiding and managing lower back pain

• Use proper techniques when lifting or carrying heavy objects.

• Avoid prolonged periods of sitting or standing - regular movement is key

• Stay active and exercise regularly. Engage in activities that promote flexibility and improve global strength and conditioning. 

• Don't delay seeking advice or treatment for your symptoms. Address them early to prevent prolonged pain. Waiting until your back pain worsens can make it harder to manage

References:

1. Olaya-Contreras, P., Styf, J., Arvidsson, D. et al. The effect of the stay active advice on physical activity and on the course of acute severe low back pain. BMC Sports Sci Med Rehabil 7, 19 (2015). https://doi.org/10.1186/s13102-015-0013-x

2. Diwan, A. D., & Melrose, J. (2022). Intervertebral disc degeneration and how it leads to low back pain. JOR spine, 6(1), e1231. https://doi.org/10.1002/jsp2.1231

3. Erwin, W. M., & Hood, K. E. (2014). The cellular and molecular biology of the intervertebral disc: A clinician's primer. The Journal of the Canadian Chiropractic Association, 58(3), 246–257.