Myth # 1: Once I have back pain, I will always have back pain.
Initially LBP may be very painful, but the majority of people have a good and quick recovery. Others have short periods of back pain/discomfort throughout their lives. Few persons develop long-standing and disabling problems. Risk factors include distress, anxiety and fear of movement (for example being told you cannot bend or lift anything). When identified earlier, clinically assessed and given sound advice as a means of guiding them on self-management, such persons tend to have a better prognosis.
Myth # 2: Stay in bed and rest.
If your back hurts a few days after an injury, avoiding aggravating activities is important. However, keeping active and gradually returning to normal activities aids in recovery. Doing some common tasks at home or work may be painful initially, but an earlier and gradual return to these activities (even better with the guidance of a physiotherapist) does better for the back than prolonged bed rest which is associated with higher pain levels, greater disability, poorer recovery and frequent absenteeism.
Myth # 3: More back pain = more damage
More pain does not always mean more damage. Factors affecting the extent of pain felt, includes previous pain experiences, coping mechanisms, mood, fears, fitness and stress levels. Hence, the intensity of pain felt by two persons with the same injury may differ.
The brain regulates pain and has the ability to alter its intensity. The nervous system and brain may be more active in persons experiencing LBP. This might explain why when a person engages in more activities, they feel more pain and they may not be damaging the spine.
Strategies to decrease pain and disability experienced include: a gradual return to activities, exercise, education, and cognitive-behavioural techniques. Dispelling concerns about ‘harm’ being done to the back makes it easier for persons with LBP to participate in physiotherapy.
Myth # 4: My back pain is due to something being ‘out of place’.
X-rays and scans of the majority of persons with back pain do not show any evidence of bones or joints being ‘out of place’. Some persons have their spine manipulated thinking they are putting things back in place, but nothing was “out of place” or “slipped out” (Discs cannot slip). Yes, the discs are potential sources of LBP, but not always. Disc bulges seem to be more apparent as we age and there are persons with bulges who have no pain. Many people actually have these bulges resolved and shrink over time without requiring surgery.
Decreased pain after manipulations (or cracking the back) can be as a result of neurophysiological effects, improved range of motion and not necessarily anything “popping into place”. Health care practitioners have to be careful to not suggest that structures have moved out of place. This is potentially frightening, leads to greater disability and may result in increased levels of fear, stress and anxiety (these are related to poorer outcomes in LBP).
Myth # 5: I need a scan or X-ray.
Many times, X-rays or scans are not needed, sometimes a good, clinical assessment will suffice. These tests are generally reserved for a few persons with signs of more serious problems. Findings such as ‘disc degeneration’, ‘disc bulge’ and other anatomical changes seen on scans can be incidental and are found in people of the same age without LBP. Additionally, a lot of persons with chronic LBP have no significant findings on these scans and their pain is described as “non-specific LBP”.
The results of these scans can cause a poorly perceived prognosis by patients, if not explained correctly. A US study showed that patients who were sent for an early MRI had more functional decline and underwent more surgeries than those who had no MRI scan done. Sometimes scans are done by patients’ requests, but this can be improved when patients are properly educated.
Myth # 6: I need surgery to fix my back pain.
There are very few people who actually require surgery for back pain. Many people manage their back pain by better understanding it and staying active. Surgery is not considered until physiotherapy and exercise have failed. Sometimes spinal surgery results are no better than other interventions such as physiotherapy/exercise and medication.
Myth # 7: I need “special/fancy” treatment.
There are many popular treatment techniques with limited effectiveness when used by themselves to treat LBP. Some of these techniques include spinal manipulation, traction, massage, acupuncture, injections, antidepressants, NSAIDs, opioids and muscle relaxant. Many persons have managed their LBP effectively without these treatments, after their understanding of pain improved and they became more physically active.