09 May Mythbusters: Low Back Pain Edition
We are all familiar with back pain in some aspect or another whether it happens to us after a long gaming session, bending over to pick up something heavy wrong, or even just hearing about it from others. Back pain can be a serious and debilitating problem, and it’s pretty widespread–approximately 60-80% of individuals report experiencing LBP once in their lifetime according to Ihlebaek and colleagues. But is it inevitable? And what do we know about what causes it? Let’s bust a few myths around back pain and stick with the facts.
Myth #1: Sitting in a slumped position/non-ergonomic chair causes back pain
This is likely one of the most common misconceptions about the cause of back pain and for good reason. Nearly all education talking about position/ergonomics in school/university discusses having a perfect 90-90-90 seating position and while this has some merit, it does not take into account one of the most important aspects: duration, or how long a position is sustained. Sure, this position puts our head, neck, back, elbows, wrists, and legs in a good position, but what if we sat in that “perfect position” all day? These areas would still become more and more strained trying to maintain this position.
In an article by Davis and Kotowski, researchers determined that postural variability and dynamic sitting significantly reduces short-term discomfort in the low-back, upper-back, and shoulders.
Another article by Waongenngarm and colleagues discusses the differences between slumped sitting, forward sitting, and upright sitting. They found that all sitting postures created some amount of discomfort after only 1 hour of sitting. Forward leaning posture resulted in the most discomfort, followed by the upright, and slumped sitting postures.
“The slumped sitting posture is the most comfortable sitting posture for the low back after 1 hour of sitting. However, the slumped sitting posture reduces muscle activation of the trunk whereas upright sitting posture seems to be a healthy sitting posture for the low back because it leads to activation of stabilizing muscles in the back.”
- Be sure to move and shift your body frequently
- Don’t get caught up on trying to maintain a “perfect posture”
- Give yourself a movement break–get up and walk around
- Find a chair/station that allows you to move when you need to, but also offers support when you need over long stretches of sitting
Myth #2: Most pain comes from disc herniations. If you have a disc herniation, it’s a serious problem that will need surgery down the line
Disc herniations do happen fairly commonly, but to say that most low back pain is a result of a disc herniation is egregiously wrong. According to Dydyk et al., between 0.5-2% of individuals experience a herniated disc every year and less than 5% of low back pain is a result of a disc disease. A disc herniation is most likely to occur with a combination of lifting and twisting, either with heavy objects or repeatedly over time. That’s not a motion that’s particularly common in gamers.
So what can be done if a herniated disc is suspected? Currently researchers note that over 85% of patients with symptoms associated with an acute herniated disc will resolve within 8 to 12 weeks without ANY treatment. Though surgery is an option, it should almost always be seen as a last resort. Physical therapy, NSAIDs, and epidural injections should be attempted first as they are cheaper, less invasive forms of treatment while also demonstrating a high degree of success.
- Disk herniations are rare as a source of pain, especially in gamers
- Surgery is rarely required for people who do have a herniated disk; recovery can be as simple as giving your body some time to heal and in some instances conservative treatment of physical therapy, NSAIDs, or epidural injections may be necessary
Myth #3: Imaging for low back pain will help you most accurately figure out what the problem is.
Imaging can be useful for identifying what structures are involved in an injury–but it’s not the be-all, end-all. Especially for back pain, imaging often doesn’t provide a clear picture of what the actual source of the pain is.
In a 2014 study, researchers looked at 1250 individuals who had low back pain and a disc herniation visible on MRI. Participants went through a series of tests to determine the causes of their low back pain. Interestingly, lumbar disc herniations ranked 9th as the cause for the individuals low back pain. Even though all 1250 had a proven lumbar disc herniation, it only caused low back pain for 13.4% of the participants. Persistent heavy lifting (40.2%), osteoporosis (35.6%), and sacroiliac joint diseases (34.6%) accounted for a much greater percentage. When specifically looking at those under 30 years old (which is a large majority of gamers), the largest cause of low back pain was a muscle sprain/strain (48.8%).
These results show that it is critical to have a thorough examination in determining the root cause of low back pain in each individual. Even if imaging shows us that a herniation is present, it might not be the actual problem! Imaging results always have to be confirmed with physical examination and clinical tests.
- Imaging can actually be unhelpful in determining the cause of pain if we just stop there.
- Back pain should always receive a physical examination to determine the underlying cause and how to best address it.
Myth #4: Wearing an SI belt helps back pain
If you’ve ever watched strongmen competitions, you’ve probably seen people wearing lifting belts. These athletes wear a belt when lifting these heavy weights as there is a higher risk of injury, but also because it helps to keep a tight or supported core. When it comes to lifting and carrying, everything we do stems from our core. So if these top level lifters are wearing a belt to help prevent injury, then why isn’t everyone?
The simple answer is there really doesn’t seem to be much benefit. In a 2008 review of seven preventive studies (14,437 people) and eight treatment studies (1361 people), researchers identified that there is limited evidence that lumbar supports have any effect on preventing or reducing low back pain (Duijvenbode, 2008).
Not only is there minimal benefit with regards to managing pain, but we also know that by wearing a brace/belt we begin to lose strength due to our muscles not doing the work. If you wear a support at all times, your muscles do less work and become weaker.
There are still times when a belt can be useful or appropriate. If you’re lifting very heavy weights, a belt to assist with core engagement is appropriate. If you’re pregnant, and the hormone relaxin has caused a decrease in ligamentous support, an SI belt can help compensate for that. And if you have a history of SI joint injuries, research shows an SI belt can help reduce pain or future injury in conjunction with a core stabilization program.
- A belt may help back pain in the moment, but it will weaken the back over time
- Start strengthening the muscles in and around the core. Don’t let a belt do what the muscles of your body should already be doing for you.
- A SI belt does help pregnant women and people with a history of SI joint injuries.
- Lifting belts are great if you are lifting enough weight that you might have issues with maintaining form and risk injury.
Myth #5: Back pain is always best treated by a chiropractor — or, if it’s severe enough, by surgery.
Sure, getting your back cracked by a chiropractor can decrease symptoms in the short term, but if we’re focused on resolving back pain then this may just be one step of the process.
Chiropractors and physical therapists can perform a technique to improve joint mobility and decrease pain. Chiropractors call this technique “adjustments”, while physical therapists generally call it a “joint mobilization” or a “joint manipulation”. This technique does NOT realign bones or joints; it doesn’t “reset” bones into a proper position (generally–although certain manipulation techniques can be used to reduce a subluxed or dislocated joint, this requires traction as well as manipulation). It stimulates joint mechanoreceptors, helps muscles to relax, and promotes correct joint movement and range of motion.
None of those things, however, fix an underlying problem. They just treat a symptom of the problem, like pain or stiffness. If effort is not taken to strengthen the underused muscles and stretch the overused muscles, then we will just fall into the same cycle all over again.
While chiropractors can help to treat low back pain, there are other options within the healthcare field that can address the issue as well such as primary care physicians, physical therapists, occupational therapists, surgeons, neurologists, acupuncturists, and clinical psychologists. In a study by Blanchette and colleagues, there was no significant change in cost or outcomes when using chiropractic care for back pain compared to exercise therapy, physical therapy, or medical care for the treatment of low back pain.
What does this mean? It means that chiropractors aren’t your only or even necessarily your first choice when it comes to diagnosing and treating back pain. Recovering from back pain requires you to treat the causes, not just the symptoms.
If your healthcare professional isn’t providing exercises to address underlying issues as part of your treatment regimen for non-traumatic low back pain, they’re not providing you with what you need to fully recover.
While surgeons can potentially be part of the treatment team for low back pain, chronic back pain, or back pain not caused by a traumatic incident, is unlikely to improve more with surgery than it will with conservative interventions like physical therapy. Surgery is a BIG deal and is not a “quick and easy fix”. Surgery still requires a long period of recovery afterwards, during which time you will…you guessed it…need to do physical therapy to develop the appropriate strength and stability with these new movement patterns.
Our bodies are adaptive and resilient. Most injuries that you may experience while going about your normal day (picking something up wrong, bending/twisting wrong, aching pain from sitting all day, etc) will improve over time and with conservative interventions. The earlier you identify and intervene with back pain, the easier and faster your recovery will be.
- Chiropractors can help with back pain, but so can many other healthcare professionals, including physical therapists
- Treatment for non-traumatic low back pain must be ACTIVE and involve exercise and potentially ergonomic changes
- Do not neglect the back once it is recovered. Work on core stability so that you’re less susceptible to injury.
- The body is resilient in recovery. Be patient and consistent with treatment.
Bonus Myth: If I hurt my back, the best thing for it is rest.
Don’t be like snorlax and only rest!
Sure, there’s a time and a place for rest. But not everything is best treated by resting. We used to use “RICE”–rest, ice, compression, elevation—as our acronym of choice to remember how to treat injuries. Newer research, though, shows that “MEAT”–movement, exercise, analgesics, treatment–is a better way to go. The body was made to move. We’re not suggesting you start lifting heavy weights while you’re still having pain; what we know is that gentle, consistent movement is far better for muscle, ligament, and tendon injuries than strict rest is.
If you’re already dealing with back pain, check out some of our guides!
Blanchette, M. A., Stochkendahl, M. J., Borges Da Silva, R., Boruff, J., Harrison, P., & Bussières, A. (2016). Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies. PloS one, 11(8), e0160037.
Davis, K. G., & Kotowski, S. E. (2014). Postural Variability: An Effective Way to Reduce Musculoskeletal Discomfort in Office Work. Human Factors, 56(7), 1249–1261. https://doi.org/10.1177/0018720814528003
Ihlebaek C, Hansson TH, Laerum E, et al.: Prevalence of low back pain and sickness absence: a “borderline” study in Norway and Sweden. Scand J Public Health, 2006, 34: 555–558. DOI: 10.1080/14034940600552051
P. Waongenngarm, B.S. Rajaratnam, P. Janwantanakul. Perceived body discomfort and trunk muscle activity in three prolonged sitting postures. J. Phys. Ther. Sci., 27 (2015), pp. 2183-2187. https://doi.org/10.1589/jpts.27.2183
Samini, F., Gharedaghi, M., Khajavi, M., & Samini, M. (2014). The etiologies of low back pain in patients with lumbar disk herniation. Iranian Red Crescent medical journal, 16(10), e15670. https://doi.org/10.5812/ircmj.15670
van Duijvenbode, I. C., Jellema, P., van Poppel, M. N., & van Tulder, M. W. (2008). Lumbar supports for prevention and treatment of low back pain. The Cochrane database of systematic reviews, 2008(2), CD001823. https://doi.org/10.1002/14651858.CD001823.pub3
Wilke HJ, Neef P, Caimi M, Hoogland T, Claes LE. New in vivo measurements of pressures in the intervertebral disc in daily life. Spine (Phila Pa 1976). 1999 Apr 15;24(8):755-62. doi: 10.1097/00007632-199904150-00005. PMID: 10222525.