Back pain is one of the leading causes of disability worldwide, supposedly affecting as many as one in ten people.
However, the exact causes of lower back pain are not always clear, and it’s not uncommon for osteopaths, physiotherapists, chiropractors and even GPs to come up with some pretty ‘out-there’ hypotheses as to why someone may be suffering.
Having said that, there are a few myths that floating around that really need to be busted. Here, our osteopath Anna Roberts takes a closer look…
Myth 1: It’s your posture
Bad posture has been drilled into society as being a terrible thing. Many modern interventions always seem to be focused on correcting posture such as desk-based assessments. But the link between posture and pain really isn’t clear-cut.
In fact, posture shouldn’t be about being straight or slumped. Instead, it should be more about our ability to change and move into a variety of positions easily. Lots of research has looked into the pressures through our spines and discs during particular positions, however the key is that these pressures will always change depending on how we move.
Furthermore, our skeleton is extremely robust. Your posture is not going to change overnight and be a sudden reason to cause pain; it requires a lot of force to do this.
Myth 2: Pilates will cure you
Pilates has been a gold-standard in treating low back pain… or so it seems. However, it is now debatable whether the science behind Pilates is actually benefiting the back.
Pilates teaches the principle of targeting core muscles to stabilise the spine in a neutral position during movement of limbs and the trunk. But this form of isolation may be the reason some individuals get more back pain following Pilates exercise.
It’s because pain is processed within our nervous system and the brain. Feeding more information through particular body parts that are already a bit grumpy can cause more sensitivity and actually increase your pain. The key is to keep the back moving during all exercise to avoid this. Whole body movement is a good distraction to the nervous system, so a Vinyasa flow yoga class might be a more comfortable option if Pilates isn’t helping.
Myth 3: You just need to strengthen your core
‘Core stability’ in the fitness and clinical worlds is a fashionable thing. It is believed that by strengthening your ‘core’ you can relieve your back pain.
But research has now questioned the suggestion of having ‘core muscles’. The idea that core muscles stabilise particular parts of the spine doesn’t seem to make sense if you’re moving, because muscle groups will change their activity according to any task the person is performing. ‘Stabilising’ muscles become ‘movement producing muscles’ as soon as you move, which we should be aiming to do as much as possible!
There is also debate about the meaning behind the word ‘core’ itself. It seems to mostly relate to the abdominals – and strengthening these will supposedly help support the back. It is based on the traditional thought of having muscles that directly work opposite one another.
Unfortunately, it just doesn’t exist like this. There are lots of people who don’t actively exercise to strengthen their abdominals and don’t have back pain. It would be more beneficial to focus on whole body strength in larger movements that like a variety of pushing, pulling, jumping, lunging and squatting (the back is in the centre of the body so it will respond to any movement led by the legs and arms anyway).
Myth 4: You need a scan
Some people think that having a scan (MRI, X-ray) will show the cause of their pain. Whilst it is important following a serious injury like bone fracture or ligament tearing, it might not always be necessary.
In fact, the problem with having a scan is that it most likely will always show something. A famous study in the clinical world was one in 2015, which took X-ray imaging of individuals from 20-80 years old. Results showed common findings of arthritis, disc problems and ‘pinching’ nerve roots among all ages.
The ‘ta-dah’ thing about this study was that the participants did not have back pain. It shows that injury doesn’t always have to be the cause of our pain. In fact, pain is so complex and is determined based upon a host of other factors, like situation/context, memory, level of stress and even general health. So don’t insist on getting under the scanner just yet, you might not ever need to.
Myth 5: Acupuncture is all you need
Passive treatment might include massage, manipulation and mobilisation or acupuncture. Basically, if you are lying on a couch and having someone do some treatment on you.
I often have patients who arrive expecting they are going to be getting only this; in truth this is a very small part of the consultation. While this may feel nice and help relieve your pain for a day or two, this type of management won’t sort out your problem for good. In fact, even if you have it every single day, it is unlikely to change anything structurally or physiologically on its own.
But active treatment (when you are doing something physically like exercise) isn’t necessarily better. The truth is that having a healthy mix between both of these types of treatment seems to be shown the most effective in research. It is also very subjective to the individual and a good therapist should tailor their treatment approach to the patient they have in front of them. I know some patients who hate manual therapy!
The NICE guidelines recently took acupuncture out of the list of effective management to low back pain; however I still have patients who swear by it. The key is the timing and the application of treatment. The more a patient is interested in their rehabilitation, the faster and the better their recovery!
