Lower back pain is common, can be acute or chronic, and will often be treated by a number of allied health professionals. When pain continues despite best efforts, specialist referral is often the next step. This brief article in the British Journal of Sports Medicine gives some really handy myths and truths about lower back pain. It helps explain why I do not necessarily MRI all people with lower back pain, and how this can sometimes negatively affect the persons outcome -something we should all try to avoid. Check out the article here:
Ten unhelpful LBP beliefs
Unhelpful LBP beliefs are common, culturally endorsed and not supported by evidence.
Myth 1: LBP is usually a serious medical condition.
Myth 2: LBP will become persistent and deteriorate in later life.
Myth 3: Persistent LBP is always related to tissue damage.
Myth 4: Scans are always needed to detect the cause of LBP.
Myth 5: Pain related to exercise and movement is always a warning that harm is being done to the spine and a signal to stop or modify activity.
Myth 6: LBP is caused by poor posture when sitting, standing and lifting.
Myth 7: LBP is caused by weak 'core' muscles and and having a strong core protects against future LBP.
Myth 8: Repeated spinal loading results in ‘wear and tear’ and tissue damage.
Myth 9: Pain flare-ups are a sign of tissue damage and require rest.
Myth 10: Treatments such as strong medications, injections and surgery are effective, and necessary, to treat LBP.
Ten helpful facts about LBP
A positive mindset regarding LBP is associated with lower levels of pain, disability and healthcare seeking. Once red flags and serious pathology are excluded, evidence supports that:
Fact 1: LBP is not a serious life-threatening medical condition.
Fact 2: Most episodes of LBP improve and LBP does not get worse as we age.
Fact 3: A negative mindset, fear-avoidance behaviour, negative recovery expectations, and poor pain coping behaviours are more strongly associated with persistent pain than is tissue damage.
Fact 4: Scans do not determine prognosis of the current episode of LBP, the likelihood of future LBP disability, and do not improve LBP clinical outcomes.
Fact 5: Graduated exercise and movement in all directions is safe and healthy for the spine.
Fact 6: Spine posture during sitting, standing and lifting does not predict LBP or its persistence.
Fact 7: A weak core does not cause LBP, and some people with LBP tend to overtense their ‘core’ muscles. While it is good to keep the trunk muscles strong, it is also helpful to relax them when they aren’t needed.
Fact 8: Spine movement and loading is safe and builds structural resilience when it is graded.
Fact 9: Pain flare-ups are more related to changes in activity, stress and mood rather than structural damage.
Fact 10: Effective care for LBP is relatively cheap and safe. This includes: education that is patient-centred and fosters a positive mindset, and coaching people to optimise their physical and mental health (such as engaging in physical activity and exercise, social activities, healthy sleep habits and body weight, and remaining in employment).