- Rest
Long gone are the days of bed rest for low back pain! Prolonged rest is associated with higher levels of disability due to the disuse of our joints and muscles. Movement is encouraged, even when in pain – even if this means just pottering around the house at the beginning. Often we fear moving when we are in pain and wait until the pain is gone before commencing movement again. Unfortunately this is not beneficial in the short term or long term. Movement is what aids the recovery of low back pain. Injuring the lower back is just like injuring any other joint – we may need to avoid aggravating activities for a few days after injury (like you would if you hurt your knee) however we need to gradually return to these activities.
Take home message: keep moving!
2. Scans (x-ray, MRI etc)
Another common myth, probably the most common one that I hear, is that all back pain needs to be scanned. This is not the case at all at all! Scans are only indicated when serious pathology is suspected like infection, cancer or a bone break, which thankfully only accounts for 1-4% of all cases of low back pain! Scans will almost always show “something”, even in those who don’t have pain, for example:
- 30% of 20 year olds;
- 40% of 30 year olds;
- 50% of 40 year olds; and
- Up to 84% of 80 year olds have disc bulges
In addition:
- 37% of 20 year olds;
- 52% of 30 year olds;
- 68% of 40 year olds; and
- 96% of 80 year olds have disc degeneration
3. Medication
It is a common assumption that strong medication is needed for low back pain. Research done to date shows that taking strong prescription pain medication has no further effects than over the counter pain medication and can in fact have more side effects. It is important to liaise with your pharmacist and/or doctor regarding which medication to take, how to take it, how long to take it for and how to stop taking it.
4. Surgery
There are a few cases of low back pain where surgery is indicated, however for the most part conservative management is adequate. In fact research to date shows that the outcome from surgery has no greater effect than non-surgical or conservative treatment in the medium to long term.
5. “Don’t bend”
Our spines are robust structures designed to move in different ways just like other joints in the body. If we perform an unaccustomed activity like lifting a heavy object or lifting in an awkward way we can be sore after. This would be the case with any joint after doing something we aren’t used to doing. If we completely avoid doing a certain movement like bending our bodies will never become accustomed to it.
6. Pain
There are lots of factors which influence our experience of pain. We now know that pain is not always a warning sign for damage. Our central nervous system, including the brain and spinal cord, have a strong influence over the pain we feel. For some the pain may start after an injury however our nervous system may then become overly sensitive and can increase the pain we feel, from activities which we may not previously have found painful.
Factors that can affect how sensitive our nervous system is include:
- Social factors – home life & work life
- Psychological factors – mental state, mood & emotion
- Physical factors – how we view movement, are we fearful or exercise? Are we avoiding certain movements because we believe them to be “bad”?
- Lifestyle factors – sleep, diet etc
7. Posture
One of the most common questions I get asked is “what’s the best posture for sleeping / sitting / standing?”. The answer to this question is: your best posture is your next posture.
There is no evidence to support low back pain being caused by particular postures. We do however know that movement is key. The best thing you can do is avoid being in one position for too long.
