Updated: Jul 29, 2020
In 2014, lower back pain was highlighted as the leading cause of disability in the world with 1 in 10 people suffering from back pain in their lifetime. The more you understand about what causes back pain and how to effectively treat it, the more likely you are to stay healthy, active, and pain free. To help you on your journey toward a pain free future we have compiled a list of the most common myths surrounding back pain and how you can start today to reduce your risk of future back pain episodes.
Myth 1: Back pain is cured by stretching/yoga/Pilates.
While some stretches may provide temporary relief from back pain they will not cure the origin of your back pain. In fact, some stretches may even increase your pain sensitivity and increase the frequency of pain experienced. For example, the yoga poses knees to chest (aka apanasana), single-leg knee to chest (aka pavanamuktasana), and reclined twist (aka jathara parivaratanasana), often give temporary pain relief but ultimately increase lumbar spine instability and aggrevation of the vertebral discs. Another example of an unhelpful stretch is touching your toes with your legs straight. This stretch will often stress the lumbar spine into extreme flexion and place stress on the sciatic nerve. Therefore, when reaching down to pick something up, try hinging at you hips and/or lifting one leg off the floor to maintain a healthy curve in your lower back. A good exercise from yoga is the cat/camel pose which involves cycling between rounding and arching your back while on all fours. This is a very stable position to help losen up any stiffness without placing undue stress on your spine. Nerve flossing (aka kicking your chin) can also be a useful exercise to help ease sciatic nerve irritation. Research shows that stretching alone does not affect your range of motion in the long-term and healthy mobility/flexibility comes more from moving well and moving often in your daily activities.
Myth 2: Good desk ergonomics and good posture will prevent back pain.
Every office has an occupational health department that likes to sell the benefits of good desk ergonomics. For those who are new to this term, desk ergonomics is the act of setting up with your desk and chair in such a way that places the least amount of stress on your body when working for long periods of time. However, here in lies the problem. Any position, whether it is slouched in your chair or perfectly upright can be detrimental to your spinal health and lead to back pain. This is because you are not built to stay inactive for hours at a time in any one position. A better idea is to move between a variety of working positions throughout the day and include regular breaks from your desk to walk a little. For example, alternate between sitting and standing, alternate between slouching and sitting upright, and walking away from your desk (to maybe fill up a water bottle or touch base with a colleague etc.) every 30 - 60 minutes. There are two phrases that I like which summarises this concept the best, they are your best working position is your next one and motion is lotion.
Myth 3: The cause of your back pain can be seen on an x-ray or MRI.
Medical imaging are very limited on what they are able to detect and the source of your back pain can often be missed/misdiagnosed. These images of your back will show changes to your spine that may or may not relate to the cause of your back pain and so making assumptions based on them alone is problematic. For example, your vetebral discs can often show signs of bulging or loss in height that naturally occur over time. Therefore, saying a bulging disc from a medical image is the source of your pain is guess work at best. The source of your back pain can more accurately be determined by screening set movement patterns to determine which do and do not trigger pain. It is continually repeating flawed movement patterns that leads to back pain issues and why addressing these movements are more effective that diagnosing pain from medical imaging and prescribing rest.
Myth 4: Your 6-pack muscles are your core and they protect your spine.
Your ‘core’ muscles are all of the muscle between your nipples and knees and they all need to work together to help stabilise your spine as you move. The most notable of these muscles are:
Rectus Abdominus (aka the ‘6-Pack’)
Inner & Outer Obliques
Transverse Abdominus (aka ‘Nature’s Weight Belt’)
If you train just your 6-pack muscles then you are missing the majority of muscles involved in stabilising your spine. Therefore, it is essential that when training your core muscles you include movements that build strength and endurance in all of the core muscles.
Myth 5: Back pain is inevitable as you get older/back pain is hereditary.
Genetics and lifestyle choices may increase the likelihood of you expereincing back pain, however, you are not predetermined to experience back pain nor is it a life sentence if you do. In fact, the older you get the lower your risk of experiencing back pain with most people’s back pain issues peaking in their 30’s and 40’s. This is in part due to your body learning to reduce micro-movements that can place stress upon the spine. A key factors that does increase you likelihood of experiencing back pain as you age is physical inactivity, specifically a lack of weight-bearing exercise and core conditioning. Some restrictive diets may also increase your risk by lowering your intake of essential nutrients that keep your muscles, bones, and joints in tip-top condition.
Myth 6: You should bed rest and avoid exercise with back pain.
If you’ve experienced back pain before you probably just wanted to ‘take it easy’ and ‘rest up’ for a few days until the pain eases off or your doctor gave you medication to make the pain better. The problem with this approach is it can often lead you to feeling stiffer and prolonging the pain episode. The reason you feel stiffer after lying for long periods of time is because the discs between your vertebrae have been filled to the brim with fluid. When you stand up and start moving this excess fluid drains from the discs and you start to feel looser. This is also why you are tallest first thing in the morning, as the full discs push your vertebrae further apart. This variation in the fluid in your discs is natural and essential for delivering nutrients to the discs and issues only arrise when you spend too long in horizontal positions. 7-9 hours of sleep is enough for the majority of adults so try to limit any time spent lying down when not sleeping. The smarter approach to managing back pain is to identify which movements are triggering your pain and improve the way you perform them to reduce the stress placed upon your spine. Stopping all movements will not fix the problem, at best it’ll just put it on the back burner to come back worse because you neglected to tackle the cause and not the symptoms.
Myth 7: The only things that will help your back is medication or surgery.
Medication can help mask your symptoms but does not address the underlying cause of your pain. As a result, medication is a poor long-term strategy for the management and treatment of back pain. The use of medication should be seen as a means to get you moving again so you can work on the issues that have caused your pain. For example, taking medication in the first few days may help you to do some therapeutic walking or some core stabilisation/mobility exercises that will address the cause of your pain. Surgery should be the absolute last resort and often does not resolve pain issues. Unless you have a serious underlying condition that is causing your back pain (this is very rare by the way), then you are better off talking to an experienced strength and conditioning coach or personal trainer to help you improve your spine hygiene, find ways to move pain free, and take effective action to reduce and eliminate your back pain. If your doctor, chiropractor, physiotherapist, osteopath, or trainer have told you surgery is the only cure for your back pain, then you may want to get a second opinion from a more knowledgable health professional.
Myth 8: Exercise causes my back pain.
This can be a little inflammatory so let me be clear. Performing certain exercises can often be a trigger for many peoples back pain. However, the key here is not to avoid all exercise, but instead find the activities which aggravate your back and temporarily work around these limitations while you improve these movement patterns and build better core muscle stability and endurance. For example, if you find loaded back squats trigger your back pain you may benefit from performing bodyweight, hex-bar, or dumbbell squat to lessen the compressive forces from performing heavy back squats. Another example is if walking causes pain, you may want to address your walking mechanics (aka gait) to ensure you are moving in a more healthy, spine sparing way.
Myth 9: I need regular chiropractic adjustments to keep my back healthy/pain free.
Whether you see a chiropractor, physiotherapist, or osteopath the objective should be same. That is, reduce your pain symptoms and give you the tools to prevent the pain from reoccurring. Therefore, the practice of ‘regular adjustments’ to maintain your spinal health is aimed more at reliving you of your money than relieving you of your pain. While some chiropractors will give you exercises and guidance to manage your pain, most will not or do not know how. Personally I would never recommend someone to a chiropractor as the techniques they employ to adjust/crack your spine offer minimal to no long-term benefits. If you are in need of rehabilitation advice/treatment then working with a good physiotherapist and strength & conditioning coach will be a more effective strategy and money well spent.
Myth 10: A strong back will prevent back pain.
Most therapists are keen to increase your strength in the early stages of rehabilitation as a weakness to the muscles that stabilise your spine are often the root of your back pain. However, before you can build strength you must first build endurance as the muscles that stabilise your spine do not produce single high force actions, rather they perform repeated small bouts of movement that continually stabilise and protect your spine from injury. Therefore, starting with short bursts of isometric exercises and increasing duration and volume will build the endurance of these stabilising structures and ensure you have the right tools to build your strength upon. If you build strength before endurance you increase the risk of performing compensations that may compromise your spinal health.
Bulletproof Your Spine
With so much information out there and the information you’ve learned here its hard to know what you should and should not be doing to reduce your risk of back pain. Well we’re not going to leave you high and dry, below is a simplified daily back pain relief strategy based upon the work of Dr. Stuart McGill, the foremost expert in back pain and spine hygiene.
Walking - build a pain free walking style. Start by standing upright in a pain free posture. Experiment with slightly tipping your pelvis forward and backward until you find a ’sweet spot’ that does not cause pain. Lightly stiffen your abs then try a few marching steps in place to test. Then begin walking, swinging your arms at the shoulder, not the elbow and walk at a brisk pace with large, quick steps. Work your way to walking at least 30 minutes in the morning, 20 minutes at lunch, and 30 minutes in the evening.
Cat/Camel - start by kneeling on you hands and knees with your hands directly under your shoulders and knees directly under your hips. This is called the tabletop position. While keeping your arms straight, gently cycle between arching your back and then rounding your back. Do not hold in the end range of motion, the idea is to keep moving through the poses to help mobilise your spine in a safe and stable way.
Bird Dog - start in the tabletop position. Then slowly raise you right arm and left leg simultaneously while keeping your back in a neutral position. Raise your arm and leg until they are straight, but do not raise them above your shoulder/hips (see picture above). Tip: do not point your toes, instead try pushing your heal away. Clenching your fist may also help with keeping proper alignment. Hold this raised position for 10 seconds then lower your limbs gazing the floor gently then raising up again for another 10 second hold. Start with 4 reps each side, repeat with your left arm and right leg and then take a 30 second rest. Then perform 3 reps each side, rest, 2 reps, rest, and finally 1 rep. This pyramid format is best and when you want to progress do not exceed 10 second holds, instead increase the armount of reps e.g. 8, 6, 4, 2 or similar.
Side-Bridge - Begin by laying on your side with your weight supported by your elbow and the side of your leg below the knee. Maintain a straight line from your shoulders to your knees without any sagging or tenting at your hips. From the side your body should form a triangle with the ground. Rest the hand of your top arm on your bottom shoulder for added support and hold this position for 10 seconds for 3 - 4 reps. Add reps as you progress and do not start with more than 6. Follow the same pyramid of sets and reps as before and perform on both sides. To increase the challenge, you can straighten your legs so your weight is supported by your elbow and feet, or progress even further by straightening your arms and legs, supporting your weight by your hands and feet.
Curl-Up - This is not a sit-up so follow carefully. Begin by laying on your back with one leg bent and your foot on the floor and the other leg out straight. If you find this position painful, try alternating which leg is bent to see which is less painful. Stiffen your abs like you are going to take a punch and maintain a small arch in your low back so you can see daylight underneath you from the side. Place your hands under the small of your back to help here and lift your elbow so they float just off the ground. While maintaining a neutral spine slightly lift only your head and shoulders off the ground count to 10 then lower. This will only be a couple inches of movement so be sure to not reach forward with your neck as you do it. Start with 5 reps of 8-10 seconds, rest 30 seconds and then 3 reps of 8-10 and continue with the same pyramid format we used before.
Overhead Stretch - When ever you stand up from your chair make it a habit to stand up, reach up overhead and hold for 10 seconds, then reach even further and hold for another 10 seconds. Remember to breathe deeply helping your tight muscles to relax. Drop your arms by your side and carry on as normal keeping good posture and movement patterns.
For a more detailed look at how you can learn to identify the cause of your back pain and cure it, check out “The Back Mechanic” - by Dr. Stuart McGill (link below)