With time comes research, with research (1) comes new information, yet old beliefs still remain strong. Let's look at a few of them, though many of them are likely still strong in your mind and beliefs.
1. Low back pain is usually a serious medical condition.
90-95% of all lower back pain has no indication of anything serious and will respond favourably to conservative treatments (education, exercise, physical therapy, pain management, etc).
2. Low back pain will become persistent and deteriorate in later life.
3. Persistent low back pain is always related to tissue damage.
4. Imaging scans are always needed to detect the cause of low back pain.
Contrary to common and popular belief and practice, you do not need to have a precise structural diagnosis to effectively treat low back pain. In fact, recent studies show that using imaging first to manage low back pain does prolong treatment and the persistence of the pain. Also, when you look at what the imaging finds, there is actually no conclusive evidence that those findings equal a pain sensation.
Think of this: In a systematic review of over 3000 asymptomatic people (people with no pain
sensations or physical disability) they found that by age 30, 52% of those had disc degeneration, at age 40, 50% showed disc bulges. That is a lot of people who don't have pain. So if you have pain and your scan shows one (or more) of these findings, does that really mean that those findings are THE cause of your pain? It leaves a big question.
5. Pain related to exercise and movement is always a warning that harm is being done and you should stop activity.
6. Low back pain is directly caused by poor posture when sitting, standing, and lifting.
7. Low back pain is directly caused by weak ‘core’ muscles.
These last two are big pet peeves of mine and I've written about them specifically before. Please know that having perfect posture is not going to cure your pain, neither will having a solid 6 pack.
8. Repeated spinal loading results in ‘wear and tear’ and tissue damage.
'Wear & Tear' needs to be retired. Our cartilage and joints need movement to stay healthy. We are not machines that wear out. Yes, as we age it is common to lose muscle mass and joint health. If we maintain a healthy movement practice we also maintain not only our joints & muscle mass, but our mental health as well.
9. Pain flare-ups are a sign of tissue damage and require rest.
10. Treatments such as strong medications, injections, and surgery are effective and necessary to treat low back pain.
Here it is also shown that movement and education around persistent pain give the best outcomes for 90% of persistent lower back pain. When looking at numbers, it is shown that 90% of LBP will recover in 3-4 months with no treatment (2).
So where does that leave us? With education and an expectation of continued learning with those who treat patients with back pain.
If your health care provider still falls back on these old beliefs do know that there are those of us out here that keep up with research. It isn't an easy thing to do and no fault of health care providers, there is a lot of info out there! No one can know everything.
If you would like to learn more, please message me or check out my membership platform that offers classes, courses, videos, personalized movement rehab, and more!
(1) O’Sullivan PB, Caneiro J, O’Sullivan K, et al. Back to basics: 10 facts every person should know about back pain. British Journal of Sports Medicine 2020;54:698-699.
(2) Gatchel RJ, Polatin PB, Mayer TG. The dominant role of psychosocial risk factors in the development of chronic low back pain disability. Spine (Phila Pa 1976). 1995 Dec 15;20(24):2702-9.