10 common myths about back pain
In this article we will describe 10 common back pain myths.
Back pain is normal. In fact, 80% or more have at least one significant episode of back pain in their lives. So it is more unusual not to have it. Nonetheless, there are a lot of myths. We will go through 10 back pain myths.
1. Myth: Back pain leads to paralysis
Fact: The vast majority of people with back pain, do not end up with paralysis (or even partial paralysis). Both are very rare. The spinal structures are strong and resilient, and have excellent healing capabilities when treated appropriately. The common causes of back pain are often problems with bony tissues (like a spinal vertebral fracture), or damage to the soft tissues (such as muscles, ligaments, nerves, or spinal discs).
For paralysis to occur, the sensitive inner structures of the spine – such as the spinal cord or cauda equina (a group of spinal nerves that descend from the spinal cord) – must be affected. If this occurs, doctors call this ‘spinal cord compression’ or ‘cauda equina syndrome’.
But the spinal cord and cauda equina are well protected within the spinal canal by strong ligaments, bones, and muscular tissues. Even if the spinal cord and/or the cauda equina are affected, surgery within 24-48h of the diagnosis will decompress these tissues – preventing long-term complications, such as paralysis.
Cauda equina syndrome usually occurs due to compression from a prolapsed (‘slipped’) lumbar herniated disc. The discs are the softer pads between the bony vertebrae (blocks of the spine) that enable the spine to be moveable, so you can bend over.
2. Myth: Back pain is always caused by an injury
Fact: The vast majority of back problems develop over time and due to wear-and-tear of various tissues – and not due to injury. In contrast, a back injury is usually a ‘one-off’ event and may occur from a motor car accident, incorrect lifting technique, or a fall from the stairs.
Any new development of back pain after a trauma, such as a sports injury or a fall, should be assessed by a doctor or physiotherapist.
3. Myth: Severe back pain indicates a serious problem
Fact: Severe back pain does not mean severe disease. Symptoms may indicate a minor, treatable, and/or self-limiting problem, such as a pulled back muscle or an overstretched ligament, or a more debilitating condition that affects the spinal nerves and/or discs. Both usually get better with no treatment.
The nature and severity of symptoms usually differ from one person to another. Whilst a pulled muscle in the lower back can cause an intense flare-up of pain, causing people to end up in Accident and Emergency department; a severely herniated disc may be in close proximity to a spinal nerve, and yet produce no symptoms.
4. Myth: MRI scans are always needed to detect the cause of low back pain
Fact: Most people with low back pain do not need an MRI. Over 30 years of age, it will not be normal. There will be signs of wear and tear. So it can be hard to tell whether the ‘abnormalities’ are the cause of the pain.
Even if is caused by a prolapsed disc, most people get better in 2 weeks, and 90% by 6 weeks. So, it is often worth waiting at least 6 weeks before you even think about a scan – so long as there is no loss of power in the legs or disturbance to urine or bowel function (i.e. difficulty passing urine or poo). Loss of power, or bladder/bowel dysfunction are called ‘red flag symptoms’, i.e a sign of something potentially more serious.
5. Myth: Bed rest is good for easing back pain
Fact: no, no, no! Get up, and get moving. The need for bed rest is one of the biggest myths about pain experienced in the back, especially lower back pain or sciatica. In fact, laying down can increase back pain. For example, research has shown the intervertebral discs increase in size because they absorb fluids and swell. In addition, laying down changes the curvature of the spine by flattening it.
This is one reason people who normally have no back pain, will complain of back pain after staying in bed too long. Minimising physical activity to reduce back pain is also not a good strategy; and over the long term, will lead to even more issues, like weak muscles.
Regular swimming is a good way of controlling back pain.
6. Myth: Back pain is not inherited
Fact: It is, to a small extent. Just like the colour of hair or eyes, research suggests that specific changes in the lower back tissues – including alterations in the biochemistry, metabolism, and function of the spine – may be, in part, genetic. For example, back pain is partially inherited due to different generations having similar:
- Hydration state of discs
- Disc height
- Growth of osteophytes (arthritis) from the vertebrae and/or spinal facet joints.
These changes can contribute to lumbar disc disease or osteoarthritis of the spine; and may be inherited in up to 80% of people with these conditions.
This is a paper from the USA about the inherited nature of disc disease.
7. Myth: Stress does not affect back pain
Fact: It does, significantly. Stress, anxiety and depression can elevate the perception of lower back pain. And as back pain is unpleasant it can make anxiety and depression worse, leading to more pain – a vicious cycle.
Research suggests that certain life stressors such as lack of social support and demanding jobs are associated with musculoskeletal back pain. For treating back pain worsened by with stress, counselling can be very effective as part of the primary treatment; as well as medical treatment such as pain-killers, or antidepressants. An antidepressant called Duloxetine is especially useful, as it has a ‘side-effect’ that reduces long term pain.
8. Myth: A prolapsed disc will not heal without surgery
Fact: The vast majority of patients do not need surgery. The searing pain from a lumbar prolapsed disc can cause significant discomfort depending on the extent of herniation, and the type of nearby tissues that are affected (such as the sciatic nerve roots). The pain usually resolves without any lasting pain or complications, within 2 weeks (and 90% by 6 weeks).
Nonsurgical treatments – painkillers, physiotherapy etc – are effective in controlling prolapsed disc-related pain; and help reduce and eliminate pain.
Surgery for a herniated disc is rarely necessary unless a medical emergency is present (like spinal cord compression or cauda equina syndrome, see Myth 4 above). Surgery may also be considered as the last resort when neurological symptoms do not improve or worsen.
9. Myth: Back pain is constant and always gets worse
Fact: Back pain affects almost everyone at some point during their lifetime, and most people recover within a few days or weeks. For those who develop chronic back pain (pain lasting 3 months or longer), recurrences are possible, with periods of relief in between.
If back pain is constant, adequately treating the underlying cause and making lifestyle modifications will provide longer-term pain relief. Yes, over time, recurrences or flare-ups are possible. But seeking timely treatment can help decrease the severity of symptoms, and the frequency of recurrences – and/or significantly reduce the pain over time.
10. Myth. I have back pain so it must be my kidneys
Fact. Kidney disease rarely causes back pain. Pain in the back may occasionally come from kidney disease if you have infection or blockage in one or both kidneys. Other forms of kidney disease rarely cause pain in the back.
Site of kidney pain – a rare cause of back pain. It is usually on one side (where the affected kidney is) and higher up on the side of the back, under the ribs. Typically kidney pain can spreads from there around the side to cause pain down into the groin area.
Central low back pain is almost always a disease of the spine or back muscles, and not kidney disease. The kidney can only feel pain if the covering of the kidney (called the capsule) is stretched. This means swelling of the kidney from either infection or blockage of urine flow (such as due to a kidney stone) can result in pain.
Summary
We have described 10 common back pain myths. We hope it has helped you.
