8 (and a half) Biggest Myths about Low Back Pain

Despite information being abundant and easy to find nowadays, we find there are still many myths (and downright lies) that still seem to persist when it comes to pain and injury. Unfortunately poor understanding or unhelpful beliefs about your injury tend to lead to prolonged recovery of failure to recover at all.

Here are some of the biggest low back pain myths, and what you should really believe.

1. Once you hurt your back it never gets better

This is a myth that has persisted for a long time. It’s funny, because patients seem to think about their back differently to the rest of their body. If you pull your hamstring playing soccer, you wouldn’t automatically expect that it will never get better. It’s really no different with your back. By and large everyone gets better – your body is a fantastic healing machine! Research does show that there is a high-ish rate of recurrence with low back pain, but this has more to do with poor management and proper rehabilitation. Injuries heal! Your back is strong and designed to move. Injuries are very rarely permanent.

2. If I hurt my back I need to rest it/stay in bed

Bed rest has actually been shown to be worse for back pain than active recovery. It prolongs the time to recover, and increases the chances of recurrence. You also end up stiffer, weaker and more sensitized to your pain. The best advice is to try and stay active (even if you can only tolerate a little bit of activity) and try to move normally. This promotes good healing, reduces sensitivity and normalises movement.

3. Your back is weak/fragile – that’s why you get hurt

Your back/spine is actually very strong. There are lots and lots of connective tissue and ligaments, as well as muscles around your spine to keep it functioning well. You can transmit and tolerate significant amounts of weight through your spine. Your back is strong and designed to move.

if you have recurring low back pain, you may be suffering from deconditioning of the muscles around your back, or loss of functional movement control. You may also be avoiding certain movements and actually aggravating your pain by doing so. People need rehabilitation to ensure they get back to 100% strength and function after any injury, and back injuries are no different. Your spine itself, however, will heal and recover.

4. The worse my pain is, the more my back is damaged

Actually pain and damage are very poorly related. If you’ve ever stubbed your toe when it’s cold you will know that you can experience very high pain levels without any damage at all. Pain is very complex, but remember that it is a warning system. In acute injuries, you will often feel pain well before you suffer any damage. I often use the example of touching something hot – you feel pain and pull away automatically, but you don’t get burned. This is because you experienced pain to warn you of potential danger and you behaved accordingly.

When it comes to ongoing pain, our mental state, attitudes, beliefs, past experiences (etc. etc.) all contribute to our pain experience. High pain levels often don’t correlate with high levels of damage on scans.

5. I need an x-ray/scan for my back

Studies have shown that early imaging for acute (meaning recent) low back pain is actually associated with slower recovery and increased health care costs. It’s very common for people who have NEVER had back pain to have findings that people might interpret as ‘damage’ on scans. Early scans (and poor understanding of what those scans actually represent) medicalises patients, convincing them that there is something ‘wrong’ or ‘damaged’ when in fact they probably had exactly the same findings before they suffered from pain. Numerous studies have shown that findings on MRI/CT/x-ray do not correlate to pain or loss of function. See the graphs below as an indication of just how common this is. 

You can see that about 1/3 of people in their 20s who have never had back pain have signs of disc bulges, "disc degeneration", etc. in their low back. Heck, the first graph shows the 2/3 of people in their 20s have signs of a disc bulge in their neck on MRI, when they've never had pain! So eventually if you do get some neck pain, then go and get a scan, all you may be seeing is something that was already there before you had pain, and is actually irrelevant.

And while we’re at it:

5 1/2. My spine is damaged so there’s nothing I can do

See the images above and then tell me your spine is still damaged. These findings are NORMAL, and gradually increase over time. I like to describe these as ‘time-related changes’. Much like wrinkles on your skin or grey hairs. Many people start to develop grey hairs or wrinkles – some much earlier than others. this does not mean that your hair is ‘painful’ or ‘damaged’. The wrinkles in your skin will not stop you from playing soccer ever again. They are just normal changes that occur in your body as time goes on.

(Obviously sometimes people do suffer injuries that are serious, and CT/MRI is very important when it is indicated. The point is that just because you are in pain doesn’t mean a scan will help, or the incidental findings on your scan are that important to your injury or recovery)

6. Something is ‘out’ and that’s why my back hurts

While the description of something going ‘out’ in your spine is an easy way to describe and understand a complex problem, it is actually physiologically incorrect. As you saw in the image earlier, there are significant ligament and soft tissue structures stabilising your spine. Your joints simply cannot go ‘out’ and ‘back in’. Not without dislocating them (which would hurt a lot more).

” but what about when I have my back cracked?” I hear you ask. “doesn’t that mean it is going back in?”

Well, no. Think about another part of your body – your knuckles. Chances are you, or someone you know, cracks their knuckles regularly. Were their knuckles ‘out’? Or subluxed/dislocated before you cracked them? Are they ‘back in’ now?

No. Cavitation (the technical term for cracking) occurs when you stretch two synovial joint surfaces apart quickly. It affects the surface tension between the two joint surfaces, and the pressure and volume within the joint. This results in a ‘crack’.

(And before any of you get too picky, yes sometimes something in your body could possibly be dislocated/subluxed, and will crack when it is enlocated. But that’s not what we’re talking about with back pain though).

7. Bending your back is bad for you

Your body is a fantastic machine capable of amazing feats of strength, endurance and skill. Do you really think that you would be able to bend your back if you weren’t supposed to? There are certainly more or less ideal ways to move depending on the task you are completing and the load you are under, but to think that you should never bend (as some people seem to) is ludicrous. I have certainly treated many people who have been told that bending is bad for them, and literally never bend at their spine EVER! This fear of movement is usually contributing to their ongoing problems, and they need to relearn how to move ‘normally’.

Try telling these guys that bending their spine is bad for them.

8. There’s nothing I can do about it

If you’ve read this far (and congratulations that you did) you will hopefully have guessed that there is a lot we can do to address low back pain and dysfunction.

In general, the best advice for acute spinal pain is to try and stay active and do normal activities. It’s true that most low back injuries will resolve on their own within 6-12 weeks, regardless of how bad it was to start with. As I mentioned, the rate of recurrence is quite high, which has a lot to do with good management and proper rehabilitation following the initial injury.

If you are markedly restricted, it is a good idea to see your physiotherapist to get an idea of what you’ve done and what needs to be done to get better. We can also help to speed up that recovery time, and ensure you aren’t one of the unlucky ones with ongoing low back pain (or recurrent pain).

The key to good management and the fastest recovery is accurate assessment and diagnosis. You can then identify the optimal management for your individual situation to recover as fast as possible and reduce the risk of recurrence as much as possible.

Unfortunately, too many people either just take pain killers and do nothing about it. Or you get caught up in the myths and end up taking longer to get better. A back injury is really no different to any other injury. People often just don’t get looked after properly (or get bad advice from well meaning people).

If back pain is slowing you down – feel free to get in touch and see how we can help you get back to normal faster.

So there you have it. The 8 (and a half) biggest myths we hear about low back pain. Happy Mythbusting!

Julian Bowen

Julian is a Director and Senior Physiotherapist at BodyWise Physiotherapy.  He has spent  over a decade working exclusively in private physiotherapy practice, and estimates he would have performed over 35,000 individual treatments in that time. He has worked with everyone from Paralympians, elite athletes, WAFL Footballers, the Defence Forces and weekend warriors; to thousands of everyday people with all manner of issues.  He is passionate about injury prevention and has a special interest in the treatment of headaches, shoulder issues, hypermobility management and exercise rehabilitation for the prevention and treatment of injuries.