10 Facts about Low Back Pain

We were lucky enough to attend our annual APA breakfast and hear Peter O'Sullivan speak about recent advances in treatment of lower back pain.

Here are 10 facts about low back pain, backed by a review of the latest medical research evidence(O’Sullivan et al 2019):

1. Persistent back pain can be scary, but it’s rarely dangerous. It can be distressing and disabling, but it’s rarely life-threatening and you are VERY UNLIKELY to end up in a wheelchair.

2. Getting older is not a cause of back pain. Although it is a widespread belief and concern that getting older causes or worsens back pain, research does not support this, and evidence-based treatments can help at any age.

3. Persistent back pain is RARELY associated with serious tissue damage. Backs are strong – if you have an injury, tissue healing occurs within three months. So if pain persists beyond this timeframe, it usually means there are other contributing factors. A lot of back pain begins with no injury or with simple, everyday movements. These occasions may relate to stress, tension, fatigue, inactivity or unaccustomed activity which make the back sensitive to movement and loading.

4. Scans rarely show the cause of back pain. Lots of scary-sounding terms can be reported on scans such as “disc bulges”, “protrusions” or “prolapse” etc. However, the reports don’t say that these findings are very common in people without back pain symptoms and they don’t relate to how much pain you feel or how disabled you are. Scan results can also change and most disc prolapses shrink over time.

5. Pain with exercise and movement doesn’t mean you are doing harm. When pain persists, the spine and surrounding muscles can become really sensitive to touch and movement. The pain you feel during movement and activities reflects how sensitive your structures are, NOT how damaged you are. So it’s safe and normal to feel some pain when you start moving and exercising, and it usually settles down with time as you get more active. In fact, exercise is one of the most effective ways to treat back pain.

6. Back pain is not caused by poor posture. How we sit, stand or bend does not cause back pain even though these activities may be painful. A variety of postures are healthy for the back. It is safe to relax during everyday tasks such as sitting and bending.

7. Back pain is not caused by a “weak core”. Weak “core” muscles do not cause back pain, in fact, people with back pain often tense their “core” muscles as a protective response. Imagine this is like clenching your fist very tightly after you’ve sprained your wrist, which can cause your forearm muscles to feel tense all the time and doesn’t help in relieving the ache that has now spread to the forearm muscles. Learning to relax the “core” muscles will be more helpful in managing back pain.

8. Backs do not wear out with everyday loading and bending. In the same way, lifting weights makes muscles stronger, moving and loading make the back stronger and healthier. So activities like running, twisting, bending and lifting are safe if you start gradually and practice regularly.

9. Pain flare-ups don’t mean you are damaging yourself. While pain flare-ups can be very painful and scary, they are not usually related to tissue damage. The common triggers are things like poor sleep, stress, tension, worries, low mood, inactivity or unaccustomed activity. Controlling these factors can help prevent exacerbations, and if you have a pain flare-up, instead of treating it like an injury, try to stay calm, relax and keep moving!

10. Injections, surgery and strong drugs usually aren’t a cure. Spine injections, surgery and strong drugs like opioids aren’t very effective for persistent back pain in the long term. They can have unhelpful side effects. Finding low-risk ways to put yourself in control of your pain is the key.

Reference:

O’Sullivan, P., Caneiro, J., O’Sullivan, K., Lin, I., Bunzli, S., Wernli, K. and O’Keeffe, M., 2019. Back to basics: 10 facts every person should know about back pain. British Journal of Sports Medicine, 54(12), pp.698-699.