Back pain will affect approximately 80% of us at some point in our lives, and is the leading cause of disability in the UK. It is variable in severity and cause, and sometimes complex to treat. It is also a condition surrounded by some pretty scary sounding myths, which can hinder recovery, and may lead to a cycle of inactivity, disability and pain.
So let’s explore the truth behind these myths, and take an evidence based approach to managing our back pain.
1/ “I have a slipped disc”
A variety of structures in and around the spine have the ability to cause pain. One frequently, sometimes incorrectly, blamed culprit is the intervertebral disc. The disc is like a jam doughnut sitting between each spinal bone (vertebra). You may have heard someone say they have ‘a slipped disc’….well this isn’t actually correct. Disc’s do not slip anywhere! Thinking back to the jam doughnut analogy, what actually happens is a bit of ‘jam’ leaks out of the centre of the doughnut (disc). This squidgy substance can then touch/compress/irritate the other structures around it, causing pain. Nerves exit the spinal cord close to the disc, so if the squidgy substance compresses or irritates the nerve tissue, it can cause pain in that nerve, or in the body area that the nerve supplies. This is one of the mechanisms that can cause sciatica in the leg. But rest assured, the disc stays firmly in place and doesn’t slip anywhere else!
Why is the truth important? The idea of a disc slipping somewhere it shouldn’t be within the body can conjure quite an alarming visual image, which may cause fear of movement, and an increase in pain and disability.
2/ “I can’t exercise”
Exercise….some love it, some tolerate it for the greater good! However, there are many people out there who want to exercise more, but are afraid, or reluctant to try. This feeling is complex, it could have arisen from doing the wrong exercise which increased pain or caused injury, it may be financial, or could originate from issues with self-esteem, confidence or body image…the list is endless. Wherever that fear comes from, it is important to know you CAN exercise safely and confidently with the right guidance, and this could lead to feeling healthier, happier, and experiencing less pain. Evidence supports the use of exercise to treat, and lower the incidence of back pain. The hardest bit is getting started, but you won’t regret it once you find what works for you! A physiotherapist is well placed to listen to your fears, assess any pain or injuries, and make recommendations for the best way to start.
3/ “It’s caused by my chair”
Although poor environments can contribute to, or exacerbate back problems, they are not the sole issue. Our habits, strength and feelings also have an impact on our pain experience. For example, with millions of people now working at home due to the coronavirus pandemic, our working environments may not be the most ergonomic! However, if you sat for 5 hours without moving in even the most supportive chair, I’m sure your back would be aching a bit by the end of that time! Now do that 5 days per week, for months, or years….you can see how pain can develop. So dont blame the furniture!
Ergonomic chairs and the correct desk layout can all help, but habit change is key. Try not to sit or stand for too long in one position without movement. Any repetitive movements may also be a cause of pain, so try to vary postures or tasks throughout your day. If you would like more specific information, view my article ‘staying active when working from home’.
4/ “I need a scan”
Xray, MRI, CT – common scans that you may have heard of, or even experienced. However, where back pain is concerned, they are often not needed. Back pain is complex, and can be influenced by a number of biological, psychological or socialogical things, therefore with non-specific back pain presentations an offending structure can often not be identified, and we need to change the way we view our pain. Back pain is most commonly addressed through asking questions, competent physical assessment, and by recognising a pattern of symptoms, in order to formulate a personalised treatment plan. For a simple back pain presentation, scans will most likely not be needed, and can actually be very unhelpful to the treatment process. Scans can lead to a whole host of red herrings being found which have nothing to do with your pain, and cause no issues to your life. Reading the report of a completely normal scan can have you thinking you have a million things wrong with you due to the complex medical terminology used. And of course, having an Xray or CT scan would expose you to radiation. There are a group of symptoms that warrant urgent investigation, as listed if you follow this link, and if you are concerned by any symptoms you must visit a medical professional promptly. However, for the majority of back pain presentations, scans are not recommended in the short term, and will not impact on the success of your treatment.
5/ “I need bed rest”
Rest is important when managing pain. Pain can be there as a warning that we are pushing too hard, and that our bodies need some restorative time. However, too much rest has the opposite effect, and can lead to more discomfort, especially where back pain is concerned. Exercise, when performed appropriately, is far superior to rest alone when managing back pain. A view with a strong evidence base, supported by the National Institute for Health and Care Evidence (NICE), who provide guidance on the best treatment practices to improve outcomes for patients.
When pain is severe, exercise should be gentle, such as supported walking, or bed exercises, teamed with rest periods and pain relieving modalities. However, as that sharp pain eases, it is important to get your back strong and flexible in order to help prevent recurrent episodes of pain. Ineffective rehabilitation from back pain can result in the pain becoming a longstanding issue.
6/ “my spine is crumbling”
Many people will have been diagnosed with ‘degeneration’ in their spine. I have lost count of the number of clients who believe this means their spine is ‘crumbling’, and as a result, have become inactive.
The term ‘degenerative’ can sound scary, but what does it really mean?
As we age we can develop areas of wear and tear in some of our joints.
Degeneration in the spine is usually characterised by intervertebral discs becoming flatter and more dehydrated, and there may also be evidence of cartilage loss and wear in the joints. But fear not, these are normal age related changes and this doesn’t mean you have to make drastic changes to your life! A study reviewing high quality research showed that over 50% of people aged 30 with no back pain at all had signs of degeneration in their spine on scan, and I repeat, were completely symptom free!
There are of course conditions such as osteoporosis, and inflammatory joint conditions which can make the spine more vulnerable. However a simple diagnosis of ‘degeneration’ is completely different to these, and isn’t ‘abnormal’ as we age. Remaining active is important for our spine, as well as our overall health and wellbeing. A competent physiotherapist will be able to assess you, and help you find a way of exercising in comfort, which can keep your spine functioning well and aid you in your back pain management.
We shouldn’t fear back pain. Instead, try to see it as a way of your body communicating with you about your movement, postures, strength, attitudes, and routines. There is so much we can do to gain control over our pain with the right guidance and encouragement. Professional discussion and assessment by a physiotherapist or GP will help to provide reassurance, or prompt investigation if needed. Physiotherapists are also very well placed to help you start making changes to your activity levels, which if continued, can create positive, lasting change to your health and wellbeing.
*Any medical information published on this website is not intended as a substitute for informed medical advice. If you have concerns regarding your health please consult with a medical professional.