Back pain is a common condition; an estimated 4 out of 5 Canadian adults experience back pain within their lifetime.1 The high prevalence of back pain also means that Canadians spend $6-12 billion each year on the treatment of back pain, and that doesn’t include other costs such as lost productivity and wages or disability payments.2 One thing that drives up these costs is a lack of awareness of what treatments are effective for back pain.
There’s plenty of misinformation out there regarding back pain. Help control the impact back pain has on your life and your wallet by making informed decisions.
Myth 1: I need bedrest.
FACT: For people with new onset low back pain, staying active helps to provide pain relief and function. There is also evidence that people with long term back pain do better when they participate in exercise than they do with rest.3
People who have back pain with referred pain down their leg (also known as sciatica) tend to have about the same level of pain and function whether they stay in bed or not.4 However, given that bed rest also comes with the risk of complications, staying active is the better option.
The best treatment plan? Modifying your activities and continuing to move will help you to recover more quickly.5
Myth 2: I need an X-ray, CT Scan and MRI to find out what is wrong.
FACT: These tests do not help you to feel better, expose you to potentially harmful radiation and may lead to unnecessary treatment.6 Findings on an MRI do not correlate well with back pain severity or the need for treatment.7 Many abnormal findings occur in healthy people with no history of back pain, meaning these tests are not very useful to identify the cause of back pain.8
These tests are only helpful if you are having back pain and other signs and symptoms such as unexplained weight loss, fever, loss of bowel or bladder control, changes in your reflexes, severe weakness or loss of feeling in your legs, or have a history of cancer. These findings, sometimes referred to as red flags, indicate that your back pain could be related to something else and warrants further investigation.6,7
If you are not having these symptoms, diagnostic imaging does not improve your care or outcomes and is not recommended.6
Myth 3: The more pain I have, the more damage there is to my back.
FACT: Pain is an individual experience that is effected by other factors such as stress and anxiety, work and family history, the meaning the person attaches to their experience of pain and their expectations of treatment (among other factors).7 In the words of one author, “there is little correlation between the findings on many imaging studies and a patient’s complaint” and, in fact, many abnormalities can be found on imaging studies of healthy asymptomatic individuals.8
Again, it’s the presence of red flags rather than the amount of pain experienced that correlates to a more serious injury or illness.
Myth 4: I need to see a surgeon to fix my back pain.
FACT: Most people with non-specific low back pain won’t benefit from surgery in the long term. The outcomes from back surgery vary by the specific type of surgery completed and the underlying cause of the back pain. The evidence suggests that back surgery for pain due to degenerative changes is no more effective than intensive rehabilitation. Surgery for back and leg pain related to a herniated disc may provide greater benefit than rehabilitation, but the benefit is not sustained in the long term. Surgery also comes with the risk of complications, such as infection, further injury caused by the surgery itself and the need for repeat surgery.9 For these reasons, surgery should not be used as a first resort for treatment of back pain.
Myth 5: Massage, spinal manipulation and dry needling feel good so they must be curing my back pain.
FACT: Passive techniques such as hot packs10 and massage11 may provide short-term pain relief, however an active approach that includes exercise further reduces pain and disability10 and is effective in the long term. Other techniques, such as spinal manipulation,12 have been shown to be no more effective than other treatment approaches.
While these techniques may provide temporary relief, if they are not accompanied by an active treatment approach they simply raise the costs of care without adding benefit (faster improvement, pain relief or improved function).
Myth 6: Lifting heavy things will give me back pain.
FACT: There’s nothing about weight lifting in and of itself that will cause you to have back pain, but like any exercise, if you try to suddenly increase the weight you are lifting without properly training and building up your strength, or if you do not use good form when lifting weights, you predispose yourself to an injury.
Recent studies have shown that supervised weight training using heavy weights may even be an effective treatment for some patients with low back pain, provided that the exercises are performed with good technique.13
Myth 7: Being told you have non-specific back pain means it’s all in your head.
FACT: The term non-specific back pain means that the symptoms cannot be “attributed to a recognizable, known, specific pathology.”12 Although a direct relationship can’t be made between your symptoms and findings and a specific illness or injury, such as cancer, a broken bone, infection or other disease, this does not mean that the pain you are experiencing is in your head.
If you currently have back pain, what can you do?
First off, keep moving! Make regular position changes and stay active within what you are able to tolerate. Pay attention to your body and take breaks, but don’t take to your bed.4,5
Pay attention to your posture, both at work and at leisure. Slouching too much or holding your back rigidly straight will both aggravate back pain. Maintaining a neutral posture that supports the normal curves of your back is recommended.
Consider your lifestyle factors. Are you overweight, inactive or weak? All of these factors contribute to poor posture and predispose you to injury. As this episode of back pain resolves, it’s time to get moving! Participation in exercise programs has been shown to prevent recurrences of back pain14,15 and is recommended.
There is evidence that people who seek physiotherapy services early after the onset of new back pain go on to use fewer medical services (surgery, injections, physician visits) than those who delay seeking a physiotherapist’s advice.16 Physiotherapists can design an exercise program to address your back strength and general fitness, can teach you about good posture and can help with short term pain relief. Click here to find a physiotherapist who can treat your back pain.
After all, you were born to move!
Statistics Canada. Back pain. 2006. Available at: http://www.statcan.gc.ca/pub/82-619-m/2006003/4053542-eng.htm. Accessed on December 18, 2015.
Bone and Joint Canada. Low back pain. 2014. Available at: http://boneandjointcanada.com/low-back-pain/. Accessed on December 18, 2015.
Jensen RK, Kent P, Hancock M. Do MRI findings identify patients with chronic low back pain and Modic changes who respond best to rest or exercise: A subgroup analysis of an randomized controlled trial. Chiropractic & Manual Therapies 2015; 23:26. Available at: Accessed on http://chiromt.biomedcentral.com/articles/10.1186/s12998-015-0071-x. December 21, 2015.
Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.: CD007612. DOI: 10.1002/14651858.CD007612.pub2.
Choosing Wisely Canada. Treating lower-back pain: How much bed rest is too much? Available at: http://www.choosingwiselycanada.org/materials/treating-lower-back-pain/. Accessed on December 18, 2015.
Choosing Wisely Canada. Imaging tests for lower back pain: When you need them-and when you don’t. 2014. Available at: http://www.choosingwiselycanada.org/materials/imaging-tests-for-lower-back-pain-when-you-need-them-and-when-you-dont/. Accessed on December 18, 2015.
Malanga GA, Dunn KR. Low back pain management: Making the diagnosis. The Journal of Musculoskeletal Medicine. 2010; July: 249-252.
Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology. 2015; 36(4): 811-816.
Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO & Loeser JD. Surgery for low back pain: A review of the evidence for an American pain society clinical practice guideline. Spine 2009; 34(10):1094-1109.
French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004750. DOI: 10.1002/14651858.CD004750.pub2.
Furlan AD, Giraldo M, Baskwill A, Irvin E, Imamura M. Massage for low-back pain. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD001929. DOI: 10.1002/14651858.CD001929.pub3.
Hayden JA, Cartwright J, van Tulder MW, Malmivaara A. Exercise therapy for chronic low back pain (Protocol).Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD009790. DOI:10.1002/14651858.CD009790.
Berglund L, Aasa B, Hellqvist J, Michaelson P, Aasa U. Which patients with low back pain benefit from deadlift training? Journal of Strength and Conditioning Research 2015; 29(7): 1803-1811.
Choi BKL, Verbeek JH, Tam WWS, Jiang JY. Exercises for prevention of recurrences of low-back pain.Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD006555. DOI:10.1002/14651858.CD006555.pub2.
Steffens D, Maher CG, Pereira LSM, Stevens ML, Oliveira VC, Chapple M, Teixeira-Salmela LF, Hancock MJ. Prevention of low back pain: A systematic review and meta-analysis. JAMA Internal Medicine 2016; doi:10.1001/jamainternmed.2015.7431
Gellhorn AC, Chan L, Martin B, Friedly J. Management patterns in acute low back pain: The role of Physical Therapy. Spine 2012; 39(9):775-782. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3062937/. Accessed on December 21, 2015.