15 things you didn’t know about back pain
Back pain affects many people and is a huge cost to society. There is much we do not know about back pain, but research is giving us more and more answers. Unfortunately, there are a number of misconceptions about musculoskeletal disorders in general and the back in particular; in fact these can often make people more anxious than necessary. A group of Irish researchers and clinicians have described some of what we should know to better manage the ailments. This article is inspired by an article in Independent.ie that was written by Mary O’Keeffe (University of Limerick), Dr Kieran O’Sullivan (University of Limerick), Dr Derek Griffin (Tralee Physiotherapy Clinic).
1 Back pain is common and normal
Eighty percent of the population will experience at least one episode of back pain during their lifetime. Getting pain in the back is like being tired or sad; we don’t necessarily like it, but it happens to almost everyone at some point. In reality it is uncommon not to recover.
Most often, acute pain is the result of a minor strain or sprain, and the prognosis for recovery is good. Within the first two weeks after an acute episode of pain, most people will report a significant improvement in symptoms and almost 85% will be fully recovered within three months. Only a very small number of people develop long-term and disabling conditions.
2 Scans and images are rarely needed
Both healthcare professionals and the public often want to take a picture “just in case” something serious is involved. But all research suggests that diagnostic imaging only shows something really important in less than 5% of people.
Healthcare personnel (e.g. GP or physiotherapist) will usually be able to identify, during a short consultation and based on a person’s symptoms and medical history, whether a scan is really necessary.
3 Interpretation of scans should come with a health warning
We used to think that if we got a good enough picture of the spine it would be a big help diagnose the problem. But now we know that this is often not the case.
When people take scans of the back it often show things that are not directly related to the pain. In fact, studies have shown that even people who do not experience pain can have bulging discs (52%), degenerative or dried out discs (90%), prolapsed (28%) and visible arthritic changes (38%).
Remember, these people are NOT in pain! Unfortunately, people with pain are often told that these changes indicate that their back is damaged. That in itself can lead to further fear, stress and avoidance of activity. The fact is, many of these changes reported in photos are more like baldness – an indication of aging and genetics that doesn’t have to be painful.
4 Back pain does not come from something being out of position
There is no evidence that back pain is caused by a bone or joint in the back being out of place, or the pelvis being misaligned. For most people with back pain, scans show no evidence that discs, bones or joints are ‘out of position’.
In the very small number of people with some changes in back curvature, this does not seem to be particularly related to back pain.
Of course, it is worth noting that many people feel better after undergoing treatments such as joint manipulation. However, this improvement is due to short-term reductions in pain, tension and fear, NOT due to realignment of body structures.
5 Bed rest is not useful
In the first few days after an acute episode, avoiding activities that provoke can help relieve pain, just like when you have pain in another body part, such as a sprained ankle. However, there is very strong evidence that staying active and gradually returning to normal activities, including work and hobbies, is important for recovery.
Prolonged bed rest is not helpful at all, and is associated with more pain, reduced function, poorer rehabilitation and longer absences from work. In fact, it seems that the longer a person stays in bed, the worse the pain becomes.
6 More pain in the back does not mean more back damage
This may seem strange, but we now know that more pain does not always mean more damage. Two people with the same injury can feel very different amounts of pain. The degree of perceived pain can vary based on a number of factors, including the situation in which the pain occurs, previous pain experiences, mood, fear, physical condition, stress level and how one copes with the situation. For example, an athlete or soldier may experience little pain after an injury, but it comes later when they are in a less intense environment.
Furthermore, the nervous system has a good ability to regulate how much pain a person experiences at any given time. If a person feels pain, it may be that the nervous system has become oversensitive, causing the person to experience pain, even though the initial strain or sprain has healed.
This can mean that you experience more pain when you move or try to do something, even if there is no actual damage to the spine.
When people with back pain can distinguish between the “pain” they feel and emotional concerns about an “injury” they may inflict on their back, it will be easier to tackle rehabilitation.
7 Surgery is rarely necessary
Only a few people with back pain require surgery. Most people with back pain can avoid it by staying active, developing a better understanding of what pain means, and identifying the factors involved in their pain.
This can help them continue their normal daily tasks without having to resort to surgery.
On average, results for back surgery are no better in the medium and long term than non-surgical interventions, such as exercise.
8 School bags are safe – worrying about school bags may not be
Many people believe that children carrying heavy school bags can lead to back disorders. However, research has not found any difference in whether the schoolbag is heavy or light among the children who later develop back problems or not. However, if a child – or their parent – believes that the school bag is too heavy, the child is more likely to develop an issue and this highlights the importance of fear in the development of back pain.
Given the concerns about inactivity and obesity in children, carrying a school bag can actually be an easy and healthy way for children to get some exercise.
9 The perfect sitting position may not exist
Should we all be sitting right? Contrary to popular belief, no particular static sitting position has been shown to prevent or reduce back pain. Different sitting positions suit different people. Some people report more pain from sitting straight or “straight”, others from a slouched position. So while slouching is seen as a negative, there is no scientific evidence to support this. In fact, many people with back pain can sit in rigid sitting positions (e.g. sitting extremely upright) with little variation.
The ability to vary posture, rather than maintaining the same position, along with learning to move in a safe, relaxed and varied manner is important for people with back pain.
10 Lifting and bending is safe
People with back pain often believe that activities such as lifting, bending and twisting are dangerous and should be avoided. However, contrary to common thinking, the research to date has not supported a link between any of these factors and back pain.
Of course, a person can strain their back if they lift something difficult or lift something heavier than they would normally lift. Similarly, if a person has back pain these activities may be more painful than usual. However, this does not mean that the activity is dangerous or should be avoided.
While a lifting or bending movement can initially cause pain in the back, bending and lifting is normal and should be practiced to help strengthen the back. It will be similar to returning to running and sports after spraining an ankle.
11 Avoiding activities and moving cautiously does not help in the long term
It is common, especially during the first few days, for your movement to change significantly. This is similar to limping after spraining the ankle, in that the movement normalizes when the pain subsides. Although initially difficult, it is important to return to meaningful activities that are painful or feared. After an episode of back pain, many people may begin to move differently due to fear of pain or belief that the activity is dangerous. Such altered movements can be unhealthy in the long term and can actually increase the strain on the back.
12 Poor sleep can contribute to back pain
When someone is in pain, it can be difficult to get a good night’s sleep. However, it works both ways in that sleep problems can also contribute to back pain. In the same way that poor sleep can make us more stressed, give us headaches, make us tired or feel down, it can also cause or prolong back pain. So improving sleep routines and habits can be very helpful in reducing pain.
13 Stress, bad mood and worry
How we feel can affect pain experiences. Pain in the back can be triggered by changes in stress level, mood or different levels of anxiety.
In the same way that these factors are linked to other health conditions such as sore throat, irritable bowel syndrome and fatigue, they have a very large effect on back pain. Managing stress, mood and anxiety levels through doing things we enjoy and reducing tension can be very beneficial in reducing pain.
14 Exercise is good and safe for back pain
Many people with pain are afraid of exercise and avoid it because they think it could cause more problems. But this is not true! We now know that regular exercise helps keep you and your body fit and healthy, and actually reduces pain and discomfort. It reduces muscle tension, helps your mood and strengthens your immune system as soon as you get started.
All types of exercise are good without there being big differences in effectiveness between them – so choose something you like, can afford and which is practical for you.
Walking, using stairs, cycling, jogging, running and stretching are all good activities and help to relax all the tense muscles in your body.
When you are in pain, it can be very difficult to start training. We feel it more in little-used muscles than in active muscles. Therefore, if you feel sore after exercise, this does not indicate injury or damage to the body.
15 Persistent back pain can get better
Since pain is associated with many factors that vary between individuals, treatments that address the relevant factors for each individual can be effective. It can be very frustrating not to get the desired pain relief after many different treatments. This causes many to lose hope.
However, this is common as most treatments address only one factor. A good example is when someone gets a massage for their sore muscles but does nothing about sleep, fitness or stress levels.
By identifying the different contributing factors for each person and trying to address them, pain can be significantly reduced and people can live happier and healthier lives.
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The article is inspired by an article in Independent.ie and was written by Mary O’Keeffe (University of Limerick), Dr Kieran O’Sullivan (University of Limerick), Dr Derek Griffin (Tralee Physiotherapy Clinic).