Back pain is arguably the most misunderstood of all the different aches and pains that humans succumb to. Back pain is certainly one of, if not the most common pain complaint in western societies and it causes huge amounts of financial, physical and mental problems (1). Unfortunately, the health profession doesn’t have a great track record in dealing successfully with back pain. This has understandably encouraged those suffering with the problem to search out alternative treatment and management options. Unfortunately this has only confused the situation for most back pain sufferers, with a broad range of “alternative therapists” chipping in with their own ideas about the causes of back pain and how best to deal with it. Many of these ideas have no scientific grounding and are in fact myths, which can result in poor treatment decisions and in some situations can make back pain worse. These ideas range from the barely plausible to the outright whacky and I don’t intend to mention any of them hear. Instead I would like to focus on the growing amount of good medical science that we now have to call upon, when dealing with back pain. One way to do this is to look at some common beliefs about back pain and see if they stand up to scientific scrutiny.

Myth 1: Pain = Damage

Many people who experience back pain, believing that there is a direct link to the amount of damage they have in their back. This however isn’t the case for the vast majority of back pain sufferers, even those who experience severe levels of pain. Our understanding of how pain works has improved massively over the past decade and we now know that it is common for very high levels of pain to be experienced and for there to be relatively little damage to the back. (9)

Myth 2: A scan will tell me what’s wrong

Sometimes it will, but much more often it won’t. It is also very common for people without any back pain to have scans which show abnormalities. In fact these “abnormalities” are just normal changes and highlighting them with a scan often causes unnecessary worry and can make pain worse. (2, 3)

Myth 3: Reducing back movements will reduce pain

Good quality back movement actually reduces most back pain. Many people who have long standing and recurrent back pain develop bad movement habits and they adopt ways of moving that they feel protect their back, but which actually perpetuate and provoke their pain.

Myth 4: Exercises such as weight training should be avoided

The opposite is true. Regular exercise reduces pain and physical work outs, including those that feature weight training, which have been shown to be protective against back pain (10, 12).

Myth 5: Core training and Pilates can prevent back pain

Developing and improving “core strength” to reduce and to prevent back pain has become something of a mantra amongst many Doctors, Physios and Personal Trainers despite there being no sound scientific evidence to support this. In fact there is a growing amount of scientific evidence that shows core strengthening exercises to be no better than general exercise in resolving back pain. So if your back muscles feel tense & sore, it might not be helpful to do exercise like core stability work that puts even more sustained tension on them. As far as Pilates is concerned, the picture is the same as for core stabilising exercises. Doing Pilates work outs is no more effective at reducing or preventing back pain than any other form of exercise & in some people may make things worse. (6, 7, 11)

In summary, there is not a one size fits all solution to the complex problem of back pain. Treatments that have traditionally targeted specific back structures such as joints, discs, nerves & muscles have consistently given poor clinical outcomes (4, 5). In contrast, when we implement treatments that address, beliefs about pain together with lifestyle factors and movement behaviours, then we witness significant improvements. (8)

References

1 Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010
study. Ann Rheum Dis. 2014;73:968-974.

2 Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in
asymptomatic populations. AJNR Am J Neuroradiol. 2015;36:811-816.

3 Jarvik JG, Hollingworth W, Heagerty PJ, Haynor DR, Boyko EJ, Deyo RA. Three-year incidence of low back pain in an
initially asymptomatic cohort: clinical and imaging risk factors. Spine (Phila Pa 1976). 2005;30:1541-1548; discussion
1549.

4 Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain. Cochrane
Database Syst Rev. 2004:CD000447. http://dx.doi.org/10.1002/14651858.CD000447.pub

5 Menke JM. Do manual therapies help low back pain? A comparative effectiveness meta-analysis. Spine (Phila Pa 1976).
2014;39:E463-E472. http://dx.doi.org/10.1097/BRS.0000000000000230

6 Smith BE, Littlewood C, May S. An update of stabilisation exercises for low back pain: a systematic review with
meta-analysis. BMC Musculoskelet Disord. 2014;15:416.

7 Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain.
Cochrane Database Syst Rev. 2005;3:CD000335. http://dx.doi.org/10.1002/14651858.CD000335.pub2

8 O’Sullivan P et al, Unraveling the Complexity of Low Back Pain J Orthop Sports Phys Ther 2016;46(11):932-937.
doi:10.2519/jospt.2016.0609

9 Hasenbring MI, Verbunt JA. Fear-avoidance and endurance-related responses to pain: new models of behavior and their
consequences for clinical practice. Clin J Pain. 2010;26:747-753.

10 Ciolac E, Rodrigues-da-Silva JM. Resistance Training as a Tool for Preventing and Treating Musculoskeletal Disorders. Sports
Med. 2016 Sep;46(9):1239-48.

11 Yamato TP et al Pilates for low back pain. Cochrane Database Syst Rev. 2015 Jul 2;(7):CD010265. Doi: 10.1002/14651858.
CD010265.pub2.

12 Steffens D et al Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med. 2016 Feb;176(2):
199-208. doi: 10.1001/jamainternmed.2015.7431.