People with low back pain often experience improvements in their symptoms regardless of the treatment they receive. Often there is no need to see a healthcare practitioner, as the pain will naturally fade as time passes. However, many people go on to have repeated bouts of low back pain that can impact everyday life (e.g., putting on socks). Less often, people experience constant low back pain. Here I provide some information and resources from leading experts to help guide people who are frustrated by low back pain that keeps coming back or won’t go away. Keep in mind that no single resource is perfect; however, these are a great start. Also, new research about low back pain comes out everyday – so stay tuned for future blogs with important updates.
Experiencing pain does not automatically mean your back is damaged
Many people, including healthcare practitioners, believe that having pain means they damaged their back. Many are also concerned that movement or exercise will create further damage. However, this is rarely the case. Pain is not a good indicator of damage or injury. Even very small amounts of irritation to the back can contribute to severe pain – where a person goes into ‘protection mode’ (tensed muscles, stiffness, and reduced or slower movement). Pain can even occur when there is no clear back irritation or damage/injury. Pain can also persist long after injuries to structures in the back have healed.
Pain is complex with many factors; don’t blame a single cause
Most (up to 99%) of low back pain does not have a serious underlying issue (e.g., broken bones requiring surgery, cancer, autoimmune disorder etc.). Even in cases where pain is severe and significantly impacts daily activities, there is usually no serious underlying disorder. Pain is complex and many factors come into play, such as emotions, beliefs, attention, and wide range of social factors. Signals from irritated tissues in the back are just one of many potential factors that can contribute to pain. Current research suggests that information that leads to threat, danger, and the need for protection can contribute to pain. In contrast, believable information that contributes to a sense of safety or reassurance can reduce pain. Professor Lorimer Moseley explains this further here: https://www.youtube.com/watch?v=gwd-wLdIHjs
Beliefs about back pain may be more important than what is actually going on in your back
As noted above, back pain is not just about the structures in the back – beliefs matter! Pain can be increased by negative or inaccurate beliefs about back pain. In fact, research is now finding that many factors outside of the back (e.g., stress, fear, and depression) are associated with ongoing pain. Often these factors are more important to address than physical factors (e.g., muscles, joints, or disks in the back). With that said, it is important to note that beliefs and physical factors are connected. For example, fear or worry can contribute to increased muscle tension and stiffness when picking something up off the ground. If the tissues in the back are already sensitive, increasing muscular tension and restricting movement is probably not very helpful in the long-term. The importance of beliefs is explored in this video by painHEALTH out of Australia: https://www.youtube.com/watch?v=xykL5iZ8LV4
Many myths and outdated views about back pain are still out there
Many people are told that their vertebrae, joints, or ribs easily go ‘out of place’ or that they are ‘misaligned’ which is causing pain. Further, many people are told that these things need to be corrected or fixed with hands-on therapy. There is no strong research to support these views. These beliefs may even facilitate “protection mode” as the back is viewed as fragile and prone to injury that requires fixing. This may contribute to the sense of having no control over back pain, the avoidance of movement or previously enjoyed activities, and more pain. It may also lead to dependency on healthcare providers. While hands-on techniques can reduce pain, there is no good research finding that it is because something is put back in place (even though it may feel like it). Only serious diseases or injuries (e.g., falling off a building) can result in spinal joint dislocation. This is extremely rare and requires an emergency room visit, not a chiropractor. In the following videos, Professor Peter O’Sullivan, Dr. Greg Lehman, and Dr. Shawn Thistle discuss back pain facts vs. fiction:
Movement is good for your back
Prolonged rest and the avoidance of activity can lead to more pain and loss of movement. In contrast, motion is lotion – it is good for the discs, muscles, and joints. However, it is important to note that when a person first starts moving, it can be painful. Yet, if continued and increased gradually, there is usually a reduction in pain along with an increase in function. The back is strong, sturdy, and adaptable – although it can feel quite sensitive, it is very difficult to damage. Along with movement and modifying beliefs about pain, many other factors can help de-sensitize the back. For further information and guidance, Dr. Greg Lehman provides a free recovery guidebook here:
X-rays and other tests are usually not needed
Most back pain does not require imaging (e.g., X-ray, CT, MRI), even if a person’s progress is slow. In fact, getting these tests when they are not medically indicated can do more harm than good. Dr. Bahram Jam describes this further here: https://www.youtube.com/watch?v=u3EK9h4JQlo
If you have concerns about your back, Dr. Peter Stilwell BKin, DC, MSc is now accepting new patients during limited hours. Click here for more information about Dr. Stilwell and his treatment approach.