Back pain is often misunderstood!
90+% of all back pain is not due to damage in your back. There are many external factors that contribute or drive the pain in your back.
One of the biggest factors that increases back pain is the beliefs you hold about your back pain. These beliefs are generally shaped by the people around you. It may be your parents, your friends or even other healthcare professionals. It may even be something that happened to somebody you know and how that was handled (good or bad) that is shaping your beliefs.
We hear in our clinic and get asked about on our social media all the time things that simply aren’t true. We even hear it day to day, well before COVID when you could meet new people, once they find out you’re a physio their back pain is usually the topic of conversation!
Our biggest gripe with back pain is how detrimental poor beliefs, misunderstandings, or myths around back pain are. Fear/anxiety are two things that make pain feel far worse than it should. Fear is often sold by bad healthcare practitioners to try and get you to come back through the doors more than you need to and to feel that you depend on them.
Your physiotherapist should empower you to be independent, not dependant!
Top five biggest back pain myths:
- A “weak core” is causing your back pain
- “bad” posture is the cause of your back pain
- Leg length discrepancy is causing your back pain
- Your office set up is the root cause of your pain
- The idea of a “slipped disc”
Does a weak core or a weak back cause back pain? No… A weak core is not causing your back pain!
Testing the core muscles is a go to test in the examination of many health care providers when they hear you have back pain. The first issue we have with this here is that the tests for your core aren’t really all that specific.
That aside though; the idea that, strong = pain free, and, weak = in pain, is far too simplistic.
Take for example top level athletes. They have just as much back pain if not more compared with the general population. So are we to believe that these highly conditioned athletes that have a teams dedicated to their training and recovery simply missed out on strengthening their cores and that’s why their back pain came on?
Conversely either you can think of a mother living in extremely famine in Africa, she is very skinny, has very little muscle mass but she still has the strength to carry her child miles to for clean water and then carry the water back home. Why doesn’t her back hurt to the point that she has to stop?
If it isn’t a weak core then it’s a “weak” back that needs to be minded that has been floated to the patient as an idea as to why their back is sore…..
This too is not true and it is also not beneficial in any way! By “minding” your back or “being careful” you are often making your back pain worse. If a “weak” back meant you automatically had back pain then everyone a year older than you would have worse pain than you. As we age we lose about 10% of our muscle mass each decade. That would mean the older you are the more likely you are to have back pain if weakness was the key issue. But, back pain is most prevalent in people around the age of 40 and is actually quite minimal in older age groups.
The back seems to be given special treatment when it comes to injury. The back consists of muscles and joints. If you hurt your ankle you wouldn’t expect for it to go back to normal by doing absolutely nothing for it and keeping it held in the same position all day. You would move the joints and strengthen the muscles and push the ankle to be able to move in all directions. You need to think of your back the same way. Your back needs to move in your rehab!
Your back is more robust than people give it credit for!
What is the best posture for back pain?
There is no perfect posture to sit/stand in. The only bad posture is one which you stay in for too long.
How many times did your mam tell you when you were younger to stand up straight because slouching was bad for your back? As we get older we discover our parents were right about a lot of things that made us roll our eyes as teenagers…. This time though, mam was wrong.
Just because you don’t stand up straight all the time doesn’t mean you will have back pain. In fact many people with “good” posture have back pain and many people with “bad” posture do not have back pain.
There are studies to back this up. In 2016, a study compared people with and without back pain. it found there was no correlation between posture type or range of motion and low back pain.
Another study where a group of researchers took pictures of women that had back pain for up to 16 years and a group of women with no back pain found that using posture alone physios could not identify the patients in pain. They then showed these photos to hundreds of physios. A similar thing was done in multiple countries where physios had to pick out who had the best sitting posture/desk set up out of various photos of patients with and without pain.
There was no agreement between the physios as to what was best.
If us physios (“the experts”) can’t agree on a best posture, don’t let one of us tell you what they best way to stand is and that bad posture will mean pain! This is just not the case and it is often not helpful at all.
Many people we see spend all day and night standing and sitting with “perfect” posture because mammy told them to do so or the doctor told them to do so or a physio told them to do so…. BUT, these people often have back pain as they have been so tense through their lower back all day that when they go to move their lower back in any direction it’s sore and stiff! In fact, studies have found that people who “stand up straight” are more likely to have back pain than those of us who slouch.
Is leg length discrepancy causing my back pain?
We often get asked this at pain and performance clinic. Patients come to us having been told a leg length discrepancy is the cause of their back pain. They are usually looking for a second opinion because this couldn’t be right, could it?
The answer is, no! It is very, very unlikely that a leg length discrepancy is causing your back pain. Physios, chiropractors, doctors… they all like to be able to give you one simple reason for your back pain. But, pain and back pain in particular, is often more complex than one simple cause.
Why is your leg length discrepancy not the cause of your back pain?
For starters, 90% of people in the world have two different length legs. Do you think 90% of the world have back pain? No they do not….
Secondly, if leg length discrepancy was the cause of your back pain why did your back pain only start now? One leg hasn’t decided a couple of years after you’ve finished growing to just grow on its own…
On a similar note, your back pain often comes and goes, but your leg stays the same length. This would indicate to me that the leg length discrepancy is not the cause of your pain.
My final issue with the idea of a leg length discrepancy being the cause of your back pain is that the tests to check for length discrepancy are often full of mistakes. What does your doctor do to check for leg length discrepancy? They pull, poke and prod at your hips, they look at your knees, they use a tape measure, BUT, like I said these tests aren’t always accurate. The only way to accurately determine a leg length discrepancy is to use a scan.
Now if you do use a scan for this and you have a leg length discrepancy for most people this won’t be the cause of their back pain even if a leg length discrepancy is found. Leg length discrepancy’s need to be more than a 2cm difference between legs in order to be “clinically significant” as the doctor would say.
If you’ve been told that leg length discrepancy is the cause of your back pain it may be time for a second opinion, back pain is very treatable. The length of your leg can’t be magically changed, instead we need to find the actual cause of your pain and address that to get you back doing the things you love pain free.
Does my chair or desk set up cause my back pain?
There is a lot of misinformation out there about orthopaedic chairs and standing desks etc. Over the last year we’ve seen countless “proper” chairs brought into homes, we’ve seen numerous standing desks be assembled in a house instead of an office and we’ve seen people still have back pain.
The truth is that there is no evidence to suggest that orthopaedic chairs or the correct desk set up will prevent or reduce back pain. In fact, if this was the case then we would have been able to almost eradicate back pain. Back pain is far more complicated than the chair you are using or the desk you sit at.
Of course sitting habits can be part of what is going on in your back but it is far from the root of all evil when it comes to back pain. Other things that may affect your back pain are fear, stress, anxiety, lack of sleep, your previous experiences with back pain or other injuries, your beliefs of back pain, beliefs/misinformation you’ve heard from other healthcare professionals or friends, your basic strength/fitness levels, a change in exercise habits (either way more or way less).
As you can see there is a lot that can contribute directly to your back pain so if you have acute back pain at the moment it is best to seek the opinion of a physio you trust. If though you are just looking for some tips to stave off back pain and to ensure that bit of stiffness you feel at work doesn’t become a big problem we believe the best solution is to include movement breaks in your day.
Movement breaks mean moving for as little as 30-60 seconds to reset and ensure you don’t get some movement into your back muscles and joints. Movement breaks can be simple stretching exercises or even as simple as getting up and taking 10-15 steps away from your desk and then walking back. This is something that was more naturally built into your day when you went into the office.
Have you been told you had a “slipped disc” or have a friend that’s been told the same?
This is such a common thing people are told to justify their back pain.
Physios/Doctor’s keep telling patients this
Discs. Don’t. Slip.
The idea that one of your discs can just slip out of place is simply not true. Your discs are the tough cartilage between each of your vertebrae (spinal bones). Your discs are very tightly secured between the bones of your back.
When studying to be a physio we study human anatomy in labs with cadavers. In one of our first lessons here I vividly remember my lecturer discussing the idea of slipped discs. He showed us a human spine and showed us how no matter how much he pushed or pulled he would not be able to simply make a disc slip out from between vertebrae.
There are of course injury’s to discs. But, 90% of back pain/back injury’s aren’t caused by actual damage to the back. It is very unlikely one of your discs have “slipped out”.
Over the last few weeks we’ve been addressing some myths around back pain. This week we want to discuss the idea of “leg length discrepancy” with you.
What are physio’s or doctor’s trying to say when they say “you’ve a slipped disc”. Well it may be that you have a disc injury but their explanation is not clear enough.
Discs like any body parts can get injured. When they get injured they can swell. Much like an ankle would if you sprained it. This swelling in your disc may mean the disc pushing outside it’s normal boundary and pushes on a nerve and that can cause some of your pain or symptoms. This does not mean however that the disc has moved.
If you do have a disc injury, just resting is not going to change things. You may need some time to rest when you first hurt your back but this rest is not your rehab. Generally we don’t say rest instead we say “activity modification”. The difference is with rest, people often stop doing everything if their back is sore. You may need to stop doing some things that aggravate your pain but you need to keep moving as much as you can to prevent stiffness. When your symptoms ease and exercise becomes more do-able for you we then try to work with you to introduce exercises that will strengthen your back and help you get back to doing the things you love.
If you would like more information or need help for you own back pain please don’t hesitate to get in touch https://www.painandperformanceclinic.ie/contactus