Our knowledge of back pain has changed a lot in recent decades but unfortunately outdated knowledge still abounds.
Ken Niere, specialist musculoskeletal physiotherapist from the Australian Physiotherapy Association, explains the furphies he hears in practice, and what he wants everyone to know about back pain.
Back pain requires extended rest
While bed rest was once prescribed to people with a backache, in most cases Niere says you’d be far better off keeping up your daily activity.
“Many years ago, people would be in hospital for weeks because they had acute back pain,” he says.
“But they’d just become deconditioned – they would get better quicker if they were out moving around and exercising.”
Niere says that if you have a lot of pain, a day or two of bed rest is the maximum you’d want to take, otherwise you could jeopardise your recovery.
“You also don’t want to do too much too early – you’ve got to respect the pain, but it’s important to do normal activities of daily living as long as it doesn’t flare up,” he says.
“That takes a bit of guidance [from an expert].”
Back pain means your spine is damaged
Pain is a complex bodily function, and many patients are confused to learn that X-rays and scans often show little damage when they’d swear there would be a tear or fracture.
“There’s not a good correlation between lower back pain and the imaging results,” Neire says.
“People think, ‘If my pain is severe, then the damage must be severe as well’, but that’s often not the case. The level of pain that people feel is often disproportionate to the actual amount of tissue damage – some people have very little damage but a lot of pain, and a lot of people have a lot of damage but very little pain.”
Niere says this is important to know because sometimes people see a disc prolapse and think, “My back is stuffed!” when that doesn’t have to be the case — as someone else could have the same imaging result and experience little to no pain.
“[Physios use] the principles of cognitive behavioural therapy – you dispel the myths, create a plan, get the person involved, and follow through that plan,” he explains.
“That active involvement with the person is really important – [they need to] take responsibility for it themselves.”
Back pain always originates in the back
As much as your back might be aching, Niere says it’s often a result from tightness or damage to another part of the body.
“We’ve got to look at not just the source of the pain but the cause of the source,” Niere says.
“It might be tight hamstrings; or an arthritic hip that’s causing mechanical strain on the back, which then causes pain; or that their core muscle control is not good and that’s causing more strain on the joints and ligaments, which is causing the pain.”
Often identifying the source of back pain involves a physio examining habits and activities that have occurred in the lead-up to the pain event.
“It might be postural or inappropriate activity, or that someone spent three days in the garden and they’re not used to that amount of activity,” Niere says.
Once you have a bad back, you’re stuck with it forever
Back pain does have a high recurrence rate, but Niere says that’s often because it’s not managed well from the outset.
“There’s something like an 80 percent recurrence rate in 12 to 24 months [but] it goes back to them not looking at the underlying cause of the pain,” he says.
“They treat the symptoms with rest or mediation and their pain settles down, but if their sitting posture or their tight hamstrings keeps putting strain on the back and they don’t address the underlying cause, then of course it will come back.”
But if you have a good program and address the contributing factors to your back pain, then Niere says you can have a brilliant turn-around.
“Sometimes it’s not just the physical causes – it can be psychological causes [with] people convinced they have a ‘bad’ back but if you can convince them that that’s not necessarily the case [it stops it] being a self-fulfilling prophecy,” he adds.
Massage fixes back pain
If you’ve got an aching back, you’ll likely want to beeline to your local Thai or Chinese massage shop for $70 worth of relief.
But Niere says it’s worth noting that manual therapy can offer temporary relief – which is great – it’s still important to treat the underlying cause of why you got back pain in the first place.
“It can be a bit like taking Panadol, which will give you some short-term relief, but may not necessarily address the underlying causes,” he says.
“I would be careful about only having passive therapies, whether it’s heat or manual therapy – they address the symptoms, but not necessarily the underlying causes.”