Back Pain Myths and Why You Shouldn’t be Scared
I often see patients that are in heavy distress due to their low back pain. Whether it is acute or chronic, low back pain is often felt by patients as being a very scary thing. My goal today is to try to give some evidence-based answers about how back pain should be understood and treated.
Spinal Pain Usually Isn’t Serious
The truth is that around 80% of people will have at least one episode of low back pain in their lives. It’s okay. In fact, around 90% of acute low back pain will slowly get better on its own.
Quit it With the Lumbar Belts
Too many people are walking around with lumbar belt supports. These are for cases of extreme back pain that need stabilization.
Strengthening your body is the smarter way to protect yourself.
In fact, according to a study in Spine Journal in 2009: “Of the four trials comparing the prevalence of back pain in people wearing and not wearing a back belt it conclusively showed that there was no benefit. In fact, the only preventative measure that came out positively was exercise.”
You Probably Don’t Need an MRI or Xray
This topic is one of my biggest pet peeves. It seems that every new patient that comes to me brings stack of Xrays, MRIs, and laboratory tests.
The vast majority of spinal pain is mechanical. This means that movement is the important factor for recovery. Your doctor should be performing a combination of a neurologic examination and a movement-based examination in order to properly diagnose and treat your spinal complaint.
Unless there is a significant neurological deficit or the complaint truly doesn’t respond to therapeutic interventions then an MRI is unwarranted. These imaging tests are to rule out scary things, not to find common problems.
And beyond this, MRI studies are shown to be inaccurate:
Herzog R, Elgort DR, Flanders AE, Moley PJ. Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period. Spine J. 2016 Nov. PubMed #27867079.
People mostly assume that MRI is a reliable technology, but if you send the same patient to get ten different MRIs, interpreted by ten different radiologists from different facilities, apparently you get ten markedly different explanations for her symptoms. A 63-year-old volunteer with sciatica allowed herself to be scanned again and again and again for science. The radiologists — who did not know they were being tested — cooked up forty-nine distinct “findings.” Sixteen were unique; not one was found in all ten reports, and only one was found in nine of the ten. On average, each radiologist made about a dozen errors, seeing one or two things that weren’t there about missing about ten things that were. That’s a lot of errors, and not a lot of reliability. The authors clearly believe that some MRI providers are better than others, and that’s probably true, but we also need to ask the question: is any MRI reliable?
Get Out of Bed
Laying around does not get rid of low back pain- this note is taken from a Cochrane Database Review:
Eleven trials (1963 patients) were included in this updated version. There is high quality evidence that people with acute LBP who are advised to rest in bed have a little more pain [Standardised Mean Difference (SMD) 0.22 (95% Confidence Interval (CI): 0.02, 0.41)] and a little less functional recovery [SMD 0.29 (95% CI: 0.05, 0.45)] than those advised to stay active.
In other words, exercise for low back pain will either have the patient better or the same, but bed rest for low back pain may actually increase the pain complaint.
Unless your pain is extremely acute, you should be doing some type of movement.
Don’t Rush for Surgery
Of patients with low back pain and sciatica, the large majority of them do not need to have operations. Previous studies have shown that in the long-term there is no significant difference between the outcomes of patients who have early surgery, postponed surgery, or in those who avoid surgery altogether. See the following information from WebMD concerning sciatic pain surgical intervention:
“The most important result is that what we did not expect — that in the conservative-treatment group, most of them also had a quick recovery,” Peul tells WebMD. “It was slower than the early-surgery group. And 39% had longer-lasting leg pain and needed surgery. But at one year, the results for the two groups are nearly equal. Even at three and six months, the outcomes were not that much different.”
Patients whose surgery was delayed got just as good results as those who had surgery right away.
“So for leg pain, if you cannot cope with the pain, there is a quite good reason to have surgery early,” Peul says. “But if you can stand the leg pain and have enough medication and cortisone shots, you can postpone and even evade surgery. And patients have to be informed that whether surgery is done now or later, they will have the same outcomes.”
Current recommendations are for patients to wait six weeks to see whether their sciatica gets better.
“I think we should wait at least two extra months to see if the patient is recovering. If not, or if the pain is worsening, surgery should be done early if the patient is asking for it,” Peul says. “If the patient can sustain the pain, waiting is the best strategy. But if the patient very badly wants to do it, early surgery is a good choice.”
Surgery does not always work. Peul says that one in 20 patients with severe sciatica has continued pain even after back surgery.
What Do I Do When I Have Back Pain?
If the pain is a new pain and is related to a movement, first try to find some type of exercise or position that relieves your pain. Many people find relief from going for a walk or a swim. As long as your legs don’t feel weak or that you may fall, it’s a good idea to keep moving.
These positions are also known to be helpful for many cases of low back pain, especially if it’s related to a disc injury:
If there is a lot of pain at first, anti-inflammatory medicine such as Ibuprofen can help in the short term. Putting some ice or heating/cooling creams on the area can also be relieving.
If the problem persists even with some of these techniques, it might be a good time to seek a professional opinion.
When you first have a pain complaint, I would urge you to schedule an appointment with a Primary Care Physician (PCP).
PCPs generally fall into the category of general doctors who are able to see patients without any special recommendation. These are generalists and chiropractors.
Generalists hold the MD degree. They are well-trained in the diagnosis, treatment of disease and dysfunction of the many internal body systems. In other words, a generalist is the best entry point if you think your problem is related to cardiovascular or organ dysfunction.
Chiropractors hold the DC degree. They are well-trained in the diagnosis, treatment of neuromusculoskeletal disease and dysfunction. In other words, a chiropractor is the best entry point if you think your problem is related to nerve, muscle, or skeletal dysfunction.
Both generalists and chiropractors will perform a thorough examination and give you a diagnosis and treatment based upon that diagnosis.
Putting It All Together
First, try to do some exercise at home and try some anti-inflammatory medications if the pain is bearable and movement-related.
Next, if you or someone you know is having a pain complaint that doesn’t seem to be getting better on its own, it’s probably time to get a professional examination and diagnosis.
If the diagnosis is a mechanical problem, then your chiropractor will give you a variety of treatment options and explain the injury to you.
Make sure that your doctor has you doing exercise alongside other types of treatment.
Finally, get back to regular sport and exercise as you feel better and better in order to minimize a problem coming back.
But the most important thing to remember is that in most cases back pain isn’t scary.
Wishing you a safe and happy week,
Stephen Shinault DC