Back Pain : Myth vs Fact

With thanks to our friends at Charted Society of Physiotherapy (UK), John Paul is sharing with you the 4 biggest myths when it comes to back pain.


Myth – Rest is Best

Despite experiencing some difficulty or discomfort with movement during episodes of back pain, research shows that returning to movement (and work) as soon as possible, is better for recovery than bed rest.



Myth – I should avoid exercise, especially weight training

Exercise is generally accepted amongst all respected practitioners to be the best modality for treating low back pain in both the acute and chronic phases. The research shows that no one type of exercise is superior, so it’s just a matter of moving!

Studies have shown great benefits and long-term safety of various types of exercises including high load resistance training.




Myth – A scan will tell me exactly what’s wrong

Pain is much more complex than something mechanically wrong in the body. Evidence has shown that even people without back pain will have changes on scans and x-rays. It is becoming quite clear that results from scans correlate poorly with symptoms of lower back pain.

This does not mean that all scans are irrelevant, but it does mean that they are not always necessary or helpful. In fact, research suggests that in some cases, having a scan can make situations worse.





Myth - Pain equals damage 

The level of pain experienced is very rarely proportional to the amount injury sustained to the back. Pain is far more complex than this, and can be influenced by our thoughts, beliefs, past experiences, sleep, psychological wellbeing, environment and more.



If you would like to read the research for yourself – please see the list of references below.



Balagu, F. et al., 2012. Non-specific low back pain. The Lancet, 379(9814), pp.482–491.
Darlow, B. et al., 2015. Easy to Harm, Hard to Heal. Spine, (August 2016), p.1.
Picavet, H.S.J., Vlaeyen, J.W.S. & Schouten, J.S.A.G., 2002. Pain catastrophizing and kinesiophobia: Predictors of chronic low back pain. American Journal of Epidemiology, 156(11), pp.1028–1034.
Pincus, T. et al., 2002. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine (Phila Pa 1976), 27(5), pp.E109–20. 
Swinkels-Meewisse, I.E.J. et al., 2006. Acute low back pain: Pain-related fear and pain catastrophizing influence physical performance and perceived disability. Pain, 120(1-2), pp.36–43.
Waddell, G., 1993.Simple low back pain: rest or active exercise? Annals of the rheumatic diseases, 52(5), p.317. 
Wynne-Jones, G. et al., 2014. Absence from work and return to work in people with back pain: a systematic review and meta-analysis. Occupational and environmental medicine, 71(6), pp.448–56. 
O’Sullivan and Lin (2014) Acute low back pain Beyond drug therapies; Pain Management Today, Volume 1, Number 1.
Steele et al (2015) A Review of the Clinical Value of Isolated Lumbar Extension Resistance Training for Chronic Low Back Pain; American Academy of Physical Medicine and Rehabilitation Volume 7, Issue 2, Pages 169–187.
Searle et al (2015) Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials; Clinical Rehabilitation 2015, Vol. 29(12) 1155 –1167.
Bjorn et al (2015) Individualized Low-Load Motor Control Exercises and Education Versus a High-Load Lifting Exercise and Education to Improve Activity, Pain Intensity, and Physical Performance in Patients With Low Back Pain: A Randomized Controlled Trial; Journal of Orthopaedic & Sports Physical Therapy, Volume:45 Issue:2 Pages:77-85.
Pieber et al (2014) Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain; Eur Spine J 23:779–785.
Vincent et al (2014) Resistance Exercise, Disability, and Pain Catastrophizing in Obese Adults with Back Pain; Med Sci Sports Exerc. 46(9): 1693–170.
Smith et al (2014) An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskeletal Disorders 15:416 DOI: 10.1186/1471-2474-15-416
Teraguchi et al, (2013) Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: the Wakayama Spine Study.
Videman et al, (2003) Associations Between Back Pain History and Lumbar MRI Findings
Cheung et al, (2009) Prevalence and Pattern of Lumbar Magnetic Resonance Imaging Changes in a Population Study of One Thousand Forty-Three Individuals.
Endcan et al, (2011) Potential of MRI findings to refine case definition for mechanical low back pain in epidemiological studies: a systematic review.
Brinjikji et al, (2015) MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis
Webster et al, (2010) Relationship of early magnetic resonance imaging for work-related acute low back pain with disability and medical utilization outcomes.
Shiri et al (2013) The role of obesity and physical activity in non-specific and radiating low back pain: The Young Finns study; Seminars In Arthritis and Rheumatism June 2013, vol.42(6):640-650
Taylor et al (2014) Incidence and risk factors for first-time incident low back pain: a systematic review and meta-analysis: The Spine Journal October 2014, Vol.14(10):2299-2319
Manchikanti et al (2014) Epidemiology of Low Back Pain In Adults. Neuromodulation: Technology at the Neural Interface, Vol.17: 3–10.
George et al. (2012) Predictors of Occurrence and Severity of First Time Low Back Pain Episodes: Findings from a Military Inception Cohort. PLoS ONE 7(2): e30597
Wilkens et al (2013) Prognostic Factors of Prolonged Disability in Patients with Low Back Pain and Lumbar Degeneration in Primary Care: A Cohort Study. Spine. Jan 1;38(1):65-74
Campbell et al (2013) Prognostic Indicators of Low Back Pain in Primary Care: Five-Year Prospective Study. The Journal of Pain. August 2013. Vol.14(8):873-883

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