Back Facts

Low back pain is definitely one of the things I treat the most.  The statistics surrounding how many of us will suffer from low back pain at some stage in our lives is staggering.  What is more concerning is the number of people who are hugely affected and left unnecessarily incapacitated by low back pain.

Over the years I have attended many courses, lectures, workshops and read many articles, research papers and the like all to do with the assessment, treatment and rehabilitation of low back pain.  My approach varies between hands on manual therapy, exercise based rehabilitation, and self management techniques.   I strongly believe that movement, exercise and strength work as well as a change in attitude to pain is key.  Fear of pain can be a major cause of delayed progress with regard to rehabilitation.

A recent article by Peter O'Sullivan and his colleagues published in the British Journal of Sports Medicine sums it up nicely!  I have taken the liberty to reproduce their list of ten unhelpful Low Back Pain beliefs and Ten Helpful Facts with regard to low back pain.

Ten unhelpful LBP beliefs

Unhelpful LBP beliefs are common, culturally endorsed and not supported by evidence.

  • Myth 1: LBP is usually a serious medical condition.

  • Myth 2: LBP will become persistent and deteriorate in later life.

  • Myth 3: Persistent LBP is always related to tissue damage.

  • Myth 4: Scans are always needed to detect the cause of LBP.

  • Myth 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.

  • Myth 6: LBP is caused by poor posture when sitting, standing and lifting.

  • Myth 7: LBP is caused by weak 'core' muscles and and having a strong core protects against future LBP.

  • Myth 8: Repeated spinal loading results in ‘wear and tear’ and tissue damage.

  • Myth 9: Pain flare-ups are a sign of tissue damage and require rest.

  • Myth 10: Treatments such as strong medications, injections and surgery are effective, and necessary, to treat LBP.

Ten helpful facts about LBP

A positive mindset regarding LBP is associated with lower levels of pain, disability and healthcare seeking. Once red flags and serious pathology are excluded, evidence supports that:

  • Fact 1: LBP is not a serious life-threatening medical condition.

  • Fact 2: Most episodes of LBP improve and LBP does not get worse as we age.

  • Fact 3: A negative mindset, fear-avoidance behaviour, negative recovery expectations, and poor pain coping behaviours are more strongly associated with persistent pain than is tissue damage.

  • Fact 4: Scans do not determine prognosis of the current episode of LBP, the likelihood of future LBP disability, and do not improve LBP clinical outcomes.

  • Fact 5: Graduated exercise and movement in all directions is safe and healthy for the spine.

  • Fact 6: Spine posture during sitting, standing and lifting does not predict LBP or its persistence.

  • Fact 7: A weak core does not cause LBP, and some people with LBP 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.

  • Fact 8: Spine movement and loading is safe and builds structural resilience when it is graded.

  • Fact 9: Pain flare-ups are more related to changes in activity, stress and mood rather than structural damage.

  • Fact 10: Effective care for LBP is relatively cheap and safe. This includes: education that is patient-centred and fosters a positive mindset, and coaching people to optimise their physical and mental health (such as engaging in physical activity and exercise, social activities, healthy sleep habits and body weight, and remaining in employment).

It may seem a little controversial in places especially around posture not causing low back pain and core weakness not being a contributing factor!  However my thoughts on these two points are as follows:

  • The best posture is a varied one.  No one posture is bad for your back.  Inactivity and sustained amounts of time in any posture can overload tissues
  • Core strength and Core control are two different things.  Core control is about having a good network of core muscles which are able to control spinal movement and contribute to efficiency of movement and distribution of load as we move.  Individual muscle strength of core muscles is less important, rather how we move as a unit

Source: O'Sullivan PBCaneiro JO'Sullivan K, et a lBack to basics: 10 facts every person should know about back pain

Here is a lovely graphic for you: