Despite my physiotherapy career being in its relative infancy, back pain has maintained a common theme in private practice, and shows no sign of wavering. From sports injuries resulting from direct trauma, workplace injuries from poor manual handling, strains from deadlifting, squatting or pre/post pregnancy – I have seen it all! Over the last few years, a huge body of publications and research has surfaced on the topic, both conflicting and in agreement on the best assessments and treatments for lower back pain (LBP). It can be a minefield for any practitioner looking to further their practice in order to offer a high standard of care to their client base. With this in mind, I have compiled some the most common myths and misconceptions regarding back pain -
#1 Spinal degeneration is the cause of weakness, pain and disability.
Back pain is something that will affect most of us over the course of our lives, but 98% of it is not dangerous or serious. Similarly with spinal degeneration, as the years pass the percentage of age-specific prevalence increases. This has no direct correlation with weakness, pain and disability however. Looking at a slide from a recent lecture below, it is a natural part of the aging process.
#2 Bed rest is the best treatment for LBP.
Staying in the same position for a long time, lying in bed for example, can make pain worse and create more pressure on the spine. Research backs those who say exercising recovers them more quickly. A study published in the Annals of Internal Medicine involving 134 workers with back pain found that those who exercised during their recovery time took 58 days to return to work, versus 87 days for those who did not.
#3 A hard mattress in the best for LBP.
A frequent question received from clients deals with which mattress works best. It is completely subjective in my opinion and no mattress is tailor made for one person or has proven to prevent or treat LBP. Choose a mattress that you feel allows you the most comfort from night time to morning.
#4 Poor core strength is causing my lower back pain.
A common misconception that a litany of research has looked to dispel. Personally I believe strengthening core muscles allows for better health and performance of daily activities. This does not mean though that you will suffer LBP if you have poor core strength/control. To quote Stuart McGill, a professor of spine biomechanics - “True spine stability is achieved with a balanced stiffening (co-contraction) of the entire trunk musculature, including the abdominals, the latissimus dorsi and the back extensors. Focusing on a single muscle generally results in less stability.”
#5 A slipped disc means the disc has slipped from my spine.
Otherwise known as a herniated or prolapsed disc, A slipped disc means that one of the discs of cartilage in the spine is damaged and possibly extruding, irritating or pressing on the nerves. It does not mean it is no longer a part of your spine.
#6 An ergonomic chair/desk/keyboard should mean I suffer no LBP at work.
Musculoskeletal injuries account for 29% of all workplace injuries and illnesses requiring time away from work – Back Injuries account for HALF of all these injuries -“Bureau of Labour Statistics. Despite having an ergonomic workstation, back pain can still inflict workers. If you continuously slouch, do not take regular breaks or stay hydrated, despite being positioned in a haven of excellent ergomonics, back pain is statistically still a possibility.
It is a mistake to attempt to prevent or treat back pain based on general assumptions relating to flexibility, posture or strength. Pain can be driven by a number of factors including physical, psychological. lifestyle and social factors. An individualised assessment along with emphasising pain free activity and avoiding pain provoking positions looks to be the best course of action from my experience. Contact a health professional if you feel you could benefit from an assessment, treatment and/or exercise programme to deal with your back pain.
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