Low Back Pain: Myths and Facts

Low back pain is the leading cause of disability worldwide according to the World Health Organization, with the National Institutes of Health reporting that approximately 8 out of 10 people will experience low back pain at some point in their lives (1, 2).  Moreover, with more Americans working from home than ever - from big companies like Amazon, Apple, and Google, all the way to small, locally-owned businesses (3) - more people may be experiencing low back pain in the next few months.  Whether it’s due to changes in work patterns, increased sedentary behavior, or less-than-ideal ergonomic setups, many factors could make low back pain a common complaint among those who are working from home.  But despite how common low back pain is, there are a lot of popularly-believed myths surrounding it - and these myths can encourage people to do things that may once have been believed to be helpful, but are now understood to be actually counterproductive.  

Kate LaValley, PT, MsPT, MDT of Pearl Physical Therapy is here to set the facts straight regarding low back pain.  In addition to earning her Master’s degree in Physical Therapy from Thomas Jefferson University in 2001, she has also earned her certification in Mechanical Diagnosis and Treatment (MDT) under the McKenzie System.  The McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT) is an internationally acclaimed method of assessment and treatment for spinal and extremity pain.  MDT-certified physical therapists are specialists in the evaluation and treatment of low back pain, which includes restoring the ability to function to people with low back pain - even to individuals with severe and/or chronic low back pain.  Kate is no exception; she’s one of the leading physical therapists on the treatment of low back pain in the North Country of New York, is often consulted on low back pain, and has helped countless patients with low back pain improve their function and quality of life.

MYTH:  Bed rest is the safest thing for me to do and will help me recover from my back pain.

FACT:  Though the urge to lay down in bed and rest may feel strong, it may be entirely misplaced.  “Bed rest has not been shown to help the majority of people with back pain recover more quickly,” says Kate.  In fact, the opposite is true.  “Bed rest has been shown to prolong and complicate recovery.”  This has been found in multiple studies, including a form of research called a meta-analysis, which looks at multiple studies on a topic to try to determine if they all come to a common conclusion.  In this case, the meta-analysis agrees that the research is clear: bed rest leads to poorer outcomes and a slower recovery.  So if you or a loved one have had a recent back injury, try to fight the urge to spend a day or two in bed (4, 5).

MYTH:  If I could just be better about my posture, I wouldn’t have such bad back pain.

FACT:  As it turns out, posture isn’t everything.  “While posture is one very important component to help resolve a percentage of back pain, it does not help with all back pain,” Kate says.  Posture should be considered only a piece of the puzzle.  Research shows that some people, including people with specific forms of recurrent or chronic low back pain, do have changes in their posture that contribute to their pain (6).  But for many other types of low back pain, posture is a much less important component (7, 8, 9).  Moreover, Kate adds, “in the population where addressing posture is an important factor in resolving low back pain, it is necessary to perform very specific movements and exercises in addition to posture correction to achieve quicker and more complete resolution.”  Because these movements and exercises depend so much on the individual person, it’s best to get a full evaluation from a physical therapist to identify which ones will work best for you.

MYTH:  Lifting is dangerous because it’ll make my back pain worse.

FACT:  This is sometimes, but not always, true.  “Some low back pain is best served by avoiding lifting for a short period of time,” Kate agrees.  “However, not all back pain means that you should stop all lifting.”  This may be relieving to hear, especially for those of us who find that it’s hard to stop all lifting entirely.  “Even for the population that is best served by avoiding lifting early on in their recovery, it is imperative that they regain the ability to lift again for full healing,” Kate explains.  And when you do return to lifting, Kate says, “proper body positioning when lifting heavier objects is always important to protect your back and prevent injury.”  This means holding an object close to your body and lifting with the legs instead of with the back, like below:

MYTH:  If I get an MRI, my doctor will be able to see what’s wrong.

FACT:  “An MRI can often detect a pathological process when it's present, but that does not mean that an MRI will detect the reason for your specific low back pain,” Kate says.  “Research studies have looked at asymptomatic people (people having no symptoms of low back pain), and when given an MRI, a significant number of them showed pathological processes such as degenerative disc disease, herniated discs, stenosis, arthritis, and nerve root impingement.  Therefore, an MRI does not tell the whole story.”  That’s a lot to unpack, and maybe surprising - how can people with no back pain have such serious-sounding problems as herniated discs or arthritis?  It turns out that just because you have these findings on MRI does not mean you will absolutely have pain - and the fact that these findings don’t correlate with pain is something that we’ve known since the early 90’s (10, 11).  Moreover, this isn’t a rare finding: between 30 - 40% of people in their 20s with no back pain have some form of disc disease, herniation, or other degenerative spine problems, and this increases to 80 - 90% of people in their 80s with no back pain (12).  So if the things an MRI shows are pretty common and don’t always cause pain, what does?  Kate explains, “Many low back pain sufferers have mechanical pain, meaning their pain is affected by positions and movements.  Mechanical pain often does not show up on an MRI.  A great example of mechanical pain is when you bend your finger back to where it hurts.  If you took an MRI of your finger it would most likely show a normal finger…but you still have pain and the reason for your pain is the mechanical force of bending it backward.  There is no damage there, just mechanical pain.”  With mechanical pain being impossible to see on an MRI, Kate continues, “A physical therapist can evaluate your back and specific problems without an MRI to get the whole story that an MRI can’t tell us.  Most people do not require an MRI to find out the reason they have pain and what will be the most helpful to resolve it.  And PTs, especially PTs who are Mechanical Diagnosis and Therapy (MDT) certified under the McKenzie system, are specially trained to be able to tell you within a few visits whether you may benefit from further testing or another form of treatment.”

MYTH:  I have really severe back pain, so a lot of structures are damaged.  I have to be careful not to damage my back more.

FACT:  This is another thing that just sort of feels right, the way that getting in bed feels like a good idea when you back hurts - but just as with bed rest, the answer to this isn’t so intuitive, either.  “Pain does not always equal damage, just like we covered with the mechanical pain example above,” Kate explains.  “When we know tissue damage is present from an injury, there may be a very brief period of time when movement is modified or rest is called for.  However, it is crucial to optimal recovery to start movement as early as the body tolerates.”  This makes sense and aligns with what we now know about bed rest - but going back to the MRI, what if there is some damage shown on the imaging?  “When damage is documented on MRI or through other diagnostic imaging tools and is diagnosed as a degenerative processes, this is considered normal wear and tear of our hard working bodies,” Kate reiterates.  And, though it can be hard not to worry about what you see on an MRI, remember that many people with no back pain have those same findings, proving, as Kate says, that “not all degenerative processes are painful or limiting.”  The good news, she adds, is “most pain that is due to degenerative processes resolves faster with specific movement and exercise.  By far we see more pain and problems due to fear of damage and not enough of the right movement.”

MYTH: If I want an evaluation with a physical therapist for my low back pain, I have to see a doctor first and have them send me to a PT.

FACT: “In New York State, you have direct access to physical therapists,” Kate explains.  “That means that you do not have to see your doctor first, and you do not need a doctor's referral or order before you see a PT.  The exceptions to this rule are if you have Medicare, no fault insurance, or worker’s compensation insurance.  Under direct access, you will need a doctors order after 30 days or 10 visits being treated by your PT. ” This is true whether you see a physical therapist in person or through telehealth, where you meet with your PT through electronic video conferencing.  Telehealth has become especially popular in the setting of COVID-19, as people are increasingly meeting with their providers from the safety of their home to comply with quarantine orders.  

If you’re interested in a telehealth evaluation of your low back pain with Kate to determine what is causing your pain and how to most effectively address it, or have any questions for her not addressed here, click here to fill out a form with your name and contact information, or call Pearl Physical Therapy at (518) 563 - 7777.