Low Back Pain: Common Misconceptions
Updated: May 19, 2022
About 1 in 4 Americans have experienced low back pain at some point in their life. So why is low back pain so common, but yet so misunderstood? There are so many myths and so much misinformation spread in our culture about the back. Let me give you some examples.
Have you ever heard anyone say,
“My back went out”, or
“My chiropractor is going to put my back, back into place”, or
“My doc said my back looks like I’m 80”, or
“My back hurts so I need to rest.”?
These false messages lead
us into thinking our spine is weak, that pain=injury and that we should avoid the things that “hurt our back”. My friends, these statements are so far from the truth and today we're going to help you understand why.
Can my back “go out” or be “put back into place”?
The short answer is NO, absolutely not! Think about these statements for a second. They indicate that the joints in your back have enough movement in them that they can just go out of place regularly. The spine is so much stronger than you are giving it credit for. Let me explain.
There are 3 joints that are involved with each spinal segment pairing. The first joint consists of where the body of the spinal segments are attached together. This joint is classified as a symphyseal joint. These joints are known for being connected by strong fibrocartilage and allowing for very little movement. Another example of a symphyseal joint is your pubic symphysis, where your pelvic bones meet. These joints are very stable and allow for very minimal movement.
The other 2 joints involved are called facet joints. These are classified as synovial joints which typically allow for increased motion but studies have found that in the low back each facet joint allows only 2-4mm of motion. That’s not very much. The alignment of the facet joints dictates the direction of movement allowed. In the lumbar spine the facet joints are positioned to allow for flexion and extension. To add this stable framework there are 2 wide, thick ligaments that travel up the front of the bodies of all of the segments and up the back of the bodies of the segments adding to the stability of the lumbar spine.
Don't get held up with the complicated anatomical terms. We just hope understanding the truth about anatomy helps to build a picture of the inherent strength and stability of the spine. It does not just “go out” regularly. If someone has a lower back injury that causes increased motion in the involved areas of the spine, it should be thought of more like a chronic ankle sprain where structures are stretched out and there is a need for more muscular strength around the area rather than something like a dislocated shoulder, that needs to be put “back into joint”.
If the MRI of my back looks like I’m 80, does that mean I’m doomed to a life of back braces, pain and sitting?
No. It is well-documented that what is seen on an MRI is not always directly associated with symptoms. Things such as “bulging disks” and “degeneration” are normal anatomic variations that have not been shown to have a meaningful linkage to pain. Read that again. Things such as “bulging disks” and “degeneration” are normal anatomic variations that have not been shown to have a meaningful linkage to pain.
This study took a look at imaging results from people who did not have back pain. They found that >50% of asymptomatic 30-39 year olds showed some sort of disc degeneration and that this percent increased to 90% for individuals 60 years of age or older. This means that imaging findings of degenerative changes such as disk degeneration, disk signal loss, disk height loss, disk protrusion, and facet arthropathy are generally part of the normal aging process rather than disease processes that require surgical or other invasive treatment.
MRI can be very useful to identify the presence of compression of the spinal cord, cauda equina or compression of spinal nerves, but outside of that it does not tell you what is causing your back pain. Fortunately over 99% of patients with back pain do not have those serious conditions. Therefore, your MRI is not a sentence to pain. It can be a useful tool in ruling some of the scary things out, but is not a good tool to tell you what is causing your back pain.
You might be asking yourself, "so what if I do have back pain AND some of these image findings are present? Does that mean I need surgery?" NO, most of these things don't occur over night and were probably there before your back even started hurting. That's great news because you can go back to being pain-free with the right strengthening regiment.
If I have back pain, shouldn't I rest to make it better?
Nope! Gone are the days of recommending bed rest for back pain. Welcome to the 21st century where we don’t treat concussions with a dark room, we don’t promote smoking, we know icepick lobotomies don’t cure mental illness, and we know that rest doesn’t fix back pain.
There have been countless studies showing the benefits of early return to normal activity in people with low back pain. One of the leading treatments for low back pain is physical therapy. Good physical therapy for the back looks like progressive loading and strengthening for the structures surrounding your back. Your glutes, core and lumbar extensors are all key players. Rest is not going to get you where you want to be. TENS units, ice and heat are cool for an at home pick me up but probably aren't the best use of your time in rehab. Strength is your greatest defense against back pain.
Strength is your greatest defense against back pain!
Back pain can be scary because it’s poorly understood. Hopefully now you have a little better understanding about some of the greatest myths surrounding back pain. Have you been struggling with back pain? Have you been skipping your workouts because you don’t want to “mess your back up” or “put it out of place” or “hurt it more”? Proper loading is key in getting you back to doing the things you love. If you are struggling with back pain, don’t really know where to start with exercises, or just have some questions on this blog, we’d love to hear from you. Drop us a line!