3 Common Myths About Low Back Pain
Virtually all of us will experience low back pain (LBP) at some time in our lifetime. In fact LBP is the third leading reason for visits to the doctor. Not only is it common, but for some it can become disabling, robbing them of their quality of life. Despite the many advances in medicine in the last 100 years, there is still a lot of confusion around what causes LBP, and controversy about what the best treatments are. Some of this lack of clear understanding comes from the fact that there are several common myths about LBP which are widely believed not only by the public, but by many in the medical community. In this blog I will try to dispel 3 common myths about LBP, which will hopefully make it easier for you to know what you can do if you suffer from this condition.
Myth #1—“Most LBP is caused by degenerated or herniated discs in the lower (lumbar) spine.” Since the invention of MRI scanners, we have the ability to get amazing pictures of the structure of the spine. However what we have learned is that findings such as “degenerative disc disease” or disc bulges are extremely common, and there is a weak correlation between them and LBP. This means that there as many people without LBP as with LBP who have findings like bulging discs on their MRI. If we went to a supermarket and randomly selected the next 100 people we met and did an MRI of their lumbar spine, 30-50% of them would have bulging discs and other common findings, but only about 20% of them would be experiencing LBP.
So what’s going on? The fact is there are many reasons people have LBP, and in my experience there are usually several things going on which are causing the LBP. Commonly patients with LBP can have trouble sleeping, high stress levels, and tight low back muscles as well as weak core muscles. Some of the pain may also be coming from discs, or arthritis in the spine, but these structural issues are almost never the only cause. Successful treatment of LBP has to take into account all of these factors---to help people to get better sleep, get them involved in an exercise program (which could include physical therapy), as well other treatments which can include medications, spinal manipulation, acupuncture, spinal injections, and rarely surgery (I will get more into treatments in future blogs).
Myth # 2—“LBP is more common in people who do heavy physical labor, like construction workers or farmers.” Although people who do challenging physical work do experience LBP, it is not nearly as disabling for them as it is for those of us who work more sedentary jobs. The myth is that the spine is somehow a vulnerable structure which we need to treat gently. Actually the spine responds to physical demands just the way our biceps muscle does—the harder we work it, the stronger it will get. Of course using proper mechanics for lifting is still important, but as long as we do this our spine will be strengthened by physical work.
LBP is much more common in the western world than in so called developing countries, and one of the main reasons is that we sit more in this country. In my work with soldiers I have noted that many airmen come to me with LBP after they have been moved off the “flight line” where physical demands are high, to a desk job where they are sitting much of the day.
The bottom line is those with LBP do better when they remain active. What exercises are best for LBP would be the topic of a longer discussion. There are many good options but the best is to find something that you enjoy doing, since that is what you’ll have the easiest time sticking with. I will say that yoga is probably an ideal exercise for LBP. There are several places to go for classes including the Family YMCA, the base gym, and Yoga Connection a yoga studio in downtown Goldsboro.
Myth #3—“Surgery is a good treatment for LBP.” It is a bit of a paradox, but actually surgery is almost never the best choice for treatment of LBP. One would think that since we can treat knee arthritis with surgery (a knee replacement), we should be able to do the same if we have arthritis in our spine. Actually, medical research shows the opposite, and sometimes surgery can make things worse not better. However, if a patient has a disc herniation that is causing pain down their leg (sciatica) as well as LBP, research shows that surgery is an excellent, and perhaps even the best treatment. But most people with do not have sciatica associated with their LBP, and do need surgery.
So what should you do if you find yourself dealing with persistent LBP which is getting in the way of your quality of life? I can help in several ways: first I can find out what is causing your low back pain. As long as there is nothing too serious going on, we can then decide which conservative treatment(s) would be the best in your case. The options include medications, physical therapy, injections, acupuncture, and osteopathic manipulation (a gentle form of hands on treatment done in the office). I will write about some of these treatments in more detail in later blogs.
David Hogarty, DO