Back pain is a bigger health problem in Australia than in any other country in the world and will affect at least 80 per cent of us during our lifetimes.
With almost $5 billion spent each year on managing the condition — much of it on unnecessary tests and entirely ineffective treatments — three leading back pain specialists separate the facts from the fiction with this very common but debilitating condition.
1. Bed rest is not helpful for back pain
In the first few days after the initial injury, avoiding aggravating activities may help to relieve pain. However, there is very strong evidence that keeping active and gradually returning to all usual activities (including work) is important in aiding recovery.
In contrast, prolonged bed rest is unhelpful, and is associated with higher levels of pain, greater disability, poorer recovery and longer absence from work.
2. Back pain is common and normal
Experiencing back pain is like getting tired or becoming sad; we don't necessarily like it, but it occurs to almost everybody at some point. What isn't common, however, is not recovering from back pain.
Most acute back pain is the result of simple strains or sprains and the prognosis is excellent. Within the first two weeks of an acute episode of pain, most people will report a significant improvement in their symptoms with almost 85% of people fully recovered by three months.
3. Scans are rarely needed
Both healthcare professionals and members of the public often consider getting a scan "just in case" there is something serious involved in their pain. However, all the evidence suggests scans only show something truly important in a tiny minority of people with back pain.
4. Back pain is not caused by something being out of place
There is no evidence that back pain is caused by a bone or joint in the back being out of place, or your pelvis being out of alignment. For most people with back pain, scans do not show any evidence of discs, bones or joints being 'out of place'.
Of course, it is worth noting that many people feel better after undergoing treatments like manipulation. However, this improvement is due to short-term reductions in pain, muscle tone/tension and fear, NOT due to realigning of body structures.
5. Surgery is rarely needed
Only a tiny proportion of people with back pain require surgery. Most people with back pain can manage it by staying active, developing a better understanding about what pain means, and identifying the factors which are involved in their pain.
This should help them continue their usual daily tasks, without having to resort to surgery. On average, the results for spinal surgery are no better in the medium and long-term than non-surgical interventions, such as exercise.
6. Schoolbags are safe
Many people believe that children carrying a heavy schoolbag might cause back pain. However, research studies have not found this link, revealing no differences in schoolbag weight between those children who do and do not go on to develop back pain.
However, if a child — or their parent — believes that their schoolbag is too heavy, the child IS more likely to develop back pain, highlighting the importance of fear in the development of back pain.
7. The perfect sitting posture may not exist
Should we all sit up straight? Contrary to popular belief, no specific static sitting posture has been shown to prevent or reduce back pain. Different sitting postures suit different people, with some people reporting more pain from sitting straight, others from slouching.
So, while slouching gets bad press, there is no scientific evidence to support this. The ability to vary our posture, instead of maintaining the same posture, together with learning to move in a confident, relaxed and variable manner is important for people with back pain.
8. Lifting nd bending are safe
People with back pain often believe that activities such as lifting, bending and twisting are dangerous and should be avoided. However, research to date has not supported a consistent association between any of these factors and back pain. Of course, a person can strain their back if they lift something awkwardly or lifting something that is heavier than they would usually lift. Similarly, if a person has back pain, these activities might be more sore than usual. This, however, does not mean the activity is dangerous or should be avoided.
While a lifting or bending incident could initially give a person back pain, bending and lifting is normal and should be practiced to help strengthen the back, similar to returning to running and sport after spraining an ankle.
9. Stay at work
Think of back pain as a sports injury. In general, sports people don't rest in bed when they are injured and neither should people with back pain. If you follow the sports person example you might reduce your training load for a week or two but remain active.
For workers that may mean altering your work routine, and gradually resuming full duties over a week or two guided by your GP or physio. In general it is a bad option to take time off work if you have an episode of back pain. It will usually delay your recovery.
10. Poor sleep influences back pain
When someone has pain, a good night's sleep can be hard to get. However, it works both ways as sleep problems can lead to back pain in the future. In the same way that poor sleep can make us more stressed, give us a headache, make us tired or feel down, it can also cause or prolong back pain. Therefore, improving sleeping routine and habits can be very helpful in reducing pain.
11. Stress, low mood and worry influence back pain
How we feel can influence the amount of pain we feel. Back pain can be triggered following changes in life stress, mood or anxiety levels. In the same way that these factors are linked to other health conditions like coldsores, irritable bowel syndrome and tiredness, they have a very large effect on back pain.
As a result, managing our stress, mood and anxiety levels through doing things we enjoy, and engaging in relaxation can be really beneficial in helping back pain.
12. Exercise is good and safe for back pain
Many people with pain are afraid of exercise and avoid it as they think it may cause them more problems. However, this is not true. We now know that regular exercise helps to keep you and your body fit and healthy, and actually reduces pain and discomfort. It relaxes muscle tension, helps mood and strengthens the immune system once started gradually.
13. Don't pay more for 'back pain' medicines
Some pain medicines have been promoted as specifically targeting back pain but that is not how they work. If you take a pain tablet your body has no way to just send the medicine to your back; or just to your knee if you have knee pain. As well, if you look at the medicine packaging you will see that the back pain formulation is the same as the osteoarthritis version and the period pain version and the headache version. You don't have to pay more for the back pain version.
14. Strong painkillers aren't the answer
Many people think strong pain needs a strong painkiller. That is wrong. If you have a new episode of back pain you should start with a simple painkiller. Strong pain killers such as those containing an opioid do provide a little more pain relief, but not a lot more, and they have greater potential for side effects.
Ongoing or persistent back pain is different. Long term use of strong painkillers is rarely a good management option, particularly if that is the sole treatment. There are now some newer pain management programs that can help people with persistent back pain come off strong painkillers without making their pain worse.
Chris Maher is a professor of physiotherapy at Sydney Medical School and Director, Musculoskeletal Division at The George Institute for Global Health. Mary O'Keeffe and Dr Kieran O'Sullivan are teaching physiotherapists from the University of Limerick.