Ben Verling, Osteopath at Osteo and Physio, explores some of the myths around treatment for bad backs.
1) Bed rest is bad.
Most people are aware that you need to keep as mobile as possible to help back pain get better. This can simply mean hobbling around your bedroom before lying back down again, any movement, no matter how small is better than none when in pain. But, if you are suffering from an acute episode of back pain, rest is vital and yes bed rest is an essential part of that.
Sitting will often aggravate a bad episode of low back pain so is not an option in the early phase of the injury. Walking is important when possible, but other than that giving the body a chance to rest and recover is an essential part of the repair process in the early stages.
2) Getting a scan is helpful.
In a small percentage of patients this is true, but for the vast majority it is not. It is understandable that a person might want to get either an X-ray or MRI scan of their back when they have been in a lot of pain as they might assume it will show what the cause of the problem is. Research shows that this is almost always not the case, you will just get a false positive result.
A false positive means that you incorrectly associate what shows up on the scan as the cause of the pain – more often than not this is a ‘disc bulge’. But we know from research that the majority of adults that are not experiencing any back pain at all are also likely to have ‘disc bulges’ present. So you can be pain free and have these structural changes in your disc. It is not always the cause of the pain.
The conclusion is that the causes of back pain are complex and multi-factorial. It is rarely just due to a structural problem with the back. Sometimes the knowledge that you have a ‘disc bulge’, as discovered on a scan can actually hinder your recovery because it makes you more fearful of what you can’t do in case you further injure your back. Fortunately, conservative treatment, corrective exercises and the right advice will see that most acute back pain resolves fully in time, without any ongoing problems.
3) Surgery is necessary to resolve back pain.
This is rarely the case. An acute episode of back pain can be very painful and disruptive to normal life for a period of time. Fortunately, the pain will normally always go. Due to the nature of acute back pain, people understandably fear that there may be some permanent damage done.
The pain and restricted movement from the injury, as unpleasant as they are, are actually part of the body’s natural repair processes making you rest so as to not cause yourself further injury. It is worth bearing in mind that the amount of pain you are in is not always equivalent to the amount of damage done from the injury. This does not mean you should not pay attention to the pain, get medical advice if you are worried. But with treatment and the right exercises acute pain will eventually subside, enabling life to return to normal life once again.
4) You need time off work.
Obviously this depends on the extent of the injury to the back, sometimes a few days off are necessary. But research shows that the more time you take off, the longer the problem will take to get better. We need to rest and build up our strength again after an episode of back pain, but the closer you can stay to your normal routine whilst taking appropriate measures to resolve the injury, the more quickly the pain will resolve.
The inevitable worry about the lasting effects of acute back pain can help to maintain the problem and being off work means you will potentially have more time to focus on the pain and how much it is affecting your life. This worry can manifest as tension, potentially prolonging the episode.
5) Exercises or certain movements will further hurt my back.
Avoiding certain movements after an episode of back pain for fear of aggravating the injury again is common. A specific movement might have caused a lot of pain, it is natural to be cautious about repeating it. A typical example is the fear of bending forward to put socks on or to pick something up from the floor.
The problem with being fearful of these movements is that you may take longer to return to normal movement patterns than is ideal. Weakness can develop in the part of the back that has been sore through lack of proper use, or a compensatory pattern of tension can develop elsewhere because of slightly altered posture. This can actually increase the likelihood of a problem returning or tension developing elsewhere in the back.
The return to normal movements may take time (and should not be rushed) but the ultimate goal of effective treatment is to facilitate this recovery. Unguarded movement free from worry about the consequences of that movement is key. You must end up confident that you can go about your daily life without fear of an episode of back pain returning. The best thing we hear in the practice is when we ask a patient how their back is feeling, they report that they haven’t even thought about it recently – it has slipped from their consciousness, a sure sign that they are feeling truly better.
