Back Pain Myth Busting Part 4

This series of blogs is to help bring some clarity with what to expect with back pain and what the evidence is telling us.

Next up are two biggies. How should I sit and can I lift with a spinal injury? Posture is an important factor with both positions but it’s understanding how it can be effective while recovering.

 

7 The perfect sitting posture may not exist

The body is designed to move. If we sustain a position for too long, we end up loading an area more than it’s designed for. This can either be in a slouched position or even sitting erect. It’s important to alternate our sitting positions to avoid pain and adaptations (1). This can be done with changing sitting positions, getting up regularly and doing tasks in standing that you would normally do sitting (i.e. taking phone calls). Try to change position every 20minutes.

Knowing that movement through range in sitting is necessary to gain confidence in your spine instead of being rigid/protective. (2)

 

8 Exercise and resistance training

Lower back pain can cause people to fear and avoid certain activities that involve bending, lifting and twisting (3). However, it is important that we encourage this within a safe environment, to gain confidence and reach better outcomes.

Initially it may be sore practising these movements, but as mentioned previously it’s about understanding the type of pain you feel. This will help strengthen the spine and supporting structures, getting you back to lifting, running and jumping.

Studies have shown great benefits and long-term safety of various types of exercises (4) including high load resistance training (5).

 

1.     Zemp et al, (2013) In vivo spinal posture during upright and reclined sitting in an office chair. BioMed Research International.

2.     Baumgartner et al, (2012) The spinal curvature of three different sitting positions analysed in an open MRI scanner. The Scientific World Journal.

3.     Thomas et al, (2008) The relationship between pain-related fear and lumbar flexion during natural recovery from low back pain. Eur Spine J.

4.     Steele et al (2015) A Review of the Clinical Value of Isolated Lumbar Extension Resistance Training for Chronic Low Back Pain; American Academy of Physical Medicine and Rehabilitation

5.     Pieber et al (2014) Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain; Eur Spine J

Back Pain Myth Busting Part 3

This series of blogs is to help bring some clarity with what to expect with back pain and what the evidence is telling us.

You may have heard of the phrase, Pain doesn’t hurt. In some cases, it doesn’t. Also, the urgency for having spinal surgery may want to be reconsidered based on the research.

 

5 More pain does not mean more damage

As mentioned previously the spine is a complexed structure with many different factors effecting it from a physical, mental and environmental perspective. You could have two individuals with the same injury, but can feel different sensitivities of pain (1).

Our nervous system has an influence on the pain we feel and can sometimes get stuck in a loop if the injury is poorly managed. So, even once it has healed we can still experience discomfort.

Our coping strategies vary depending on different types of pain. Once we understand that some pains are not causing damage, our quality of life can be drastically improved. (2,3)

 

6 Surgery is rarely needed

There are only a small proportion of people with back pain that need surgery. Following clear guidance from your physio or Dr by staying active with exercise, manual therapy when needed, positive reinforcement of movement, understanding your injury and good pain management we see excellent results.

The statistics for successful outcomes following surgery vary from one country to another and between surgeons. But there is evidence showing that the outcomes after having surgery are similar to non-surgical treatments over a span of 1-2 years (4,5).

 

1.   Vernon H, (2010) Historical review and update on subluxation theories. J Chiropr Humanit.

2.   Taylor et al (2014) Incidence and risk factors for first-time incident low back pain: a systematic review and meta-analysis: The Spine Journal October

3.   George et al, (2012) Predictors of Occurrence and Severity of First Time Low Back Pain Episodes: Findings from a Military Inception Cohort. PLoS ONE 7(2): e30597

4.   Brox et al, (2010) Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain Annals of the Rheumatic Diseases

5.   Wynne-Jones et al, (2014) Absence from work and return to work in people with back pain: a systematic review and meta-analysis. Occupational and environmental medicine

Back Pain Myth Busting Part 2

This series of blogs is to help bring some clarity with what to expect with back pain and what the evidence is telling us.

Moving on from part 1 are some misunderstandings of an old medical phrase and some advice that should only be left to the most severe of cases.

 

3 Back pain is not caused by something being “out of place”

There is literally no evidence of joint subluxations of the spine when under X-ray, MRI or any other type of imaging (1). Yet the phrase of the spine being “out of place” is still used and that it needs to be realigned like pieces of Lego.

As humans, we are not symmetrical and there are slight discrepancies, more so with scoliosis, Scheunemann’s etc. But we adapt to these changes throughout life.

It is worth noting a popular treatment for being “out of place” are joint manipulations. This is not relocating the joint, but causing cavitation (the formation of gas bubbles within the joint causing an audible sound). This is however effective in providing short term improvements to pain, muscle tone/tension and lowering fear.

 

4 Bed rest is not helpful

If we were to take a trip back to the 80’s you’d likely get told by the Dr to have a few weeks of bed rest and if you’re lucky be prescribed a corset.

We now know with strong evidence that gentle movement and trying to maintain normal activities as comfortably as possible will improve the rate of recovery (2,3).

 

  1. Vernon H, (2010) Historical review and update on subluxation theories. J Chiropr Humanit.
  2. Wynne-Jones, G. et al., 2014. Absence from work and return to work in people with back pain: a systematic review and meta-analysis. Occupational and environmental medicine
  3. Malmivaara et al, (1995) Treatment of acute low back pain: bed rest, exercises, or ordinary activity? N Engl J Med