These days, it can be really hard to know what to believe when it comes to back pain. Is it my age? Is something out of place? Do I need an MRI? Should I stretch it? Should I strengthen it? Is it my core????? The sad truth is that many of the things we once thought about back pain and sciatica have gone the way of bigfoot, myths that are hard to shake. Heck, even AI will tell you to stretch your hamstrings and strengthen your core to get rid of back pain… but in today's post, we’ll cover what the science says about these myths and more importantly, what they mean to you and what to do about back pain instead.
Myth: You need an MRI or X-ray to “see what’s going on
Have you been told that you have changes on your x-ray or MRI? These usually go by the names of Degenerative Disc Disease, Lumbar Stenosis, bulging discs, herniated discs, loss of lordosis, or too much of a curve in your spine. Often these words are tossed around pretty casually and usually not explained in any great detail...which then leads people to ask Professor Google what those words mean and guess what is top of the search rankings? A picture that looks like this. So, let’s break down some of the real meanings of these terms and what they tell us about our backs.
Degenerative Disc Disease...sounds bad, right? Makes you think that it is only going to get worse and that if it is a disease and it is in my back...maybe it is the cause of the back pain? What if I told you that it is neither degenerative or a disease? When we first started using MRIs, doctors coined this phrase to talk about changes that they saw in the spine, especially as somebody got older. What they didn’t know at the time was that those changes were also in people without any back pain at all. In fact, some of those changes, in people who are pain free, can be found in people in their 20s. What’s more, when we target these discs with medical treatments, they often have no effect. I’ve even heard of doctors telling their patients that, because of what they saw on an MRI, that they have the spine of an 80 year old and that often stops their patient in their tracks because...if it is degenerative...and their spine is already that of an 80 year old...they better play it safe and make sure they rest as much as possible and do only “safe” things because when they wanted to lift or run, their back would hurt. When they did this, they created a self-fulfilling prophecy because now their support system for their spine got weaker and weaker until doing basic things would set off their back pain. Unfortunately, this group is often shunted off to “pain management” and a lifetime of shots, dependency on medications, and ultimately surgeries...some of which the surgeons wouldn’t even have on themselves.
What about stenosis? This one often comes along with Degenerative Disc Disease. Did you know that the spine has a lot of space? And if the doctor sees some narrowing, more often than not, you still have enough free space in your spine to do just about anything(even if you may feel a bit stiffer when you start moving). In fact, for your nerves to move freely, you only need about ⅓ of the space available. What’s more, is that the older you are, the more likely you are to have this happening and not know it(because you didn’t have pain).
How about bulging discs? Did you know that they heal? Think of a bulging disc as the spine’s version of a rolled ankle. When you first roll it, it is red, swollen, and it hurts to move. But it heals, right? The spine is the same way. In fact, after about 3 months, the disc bulge is about 50% smaller than it was, at 6 months about 75% and finally at a year, it is fully reabsorbed as the body gets rid of the excess fluid. Some feel better long before full healing and many have chronic pain long after the spine has healed. What’s more, due to the way your back is wired(nerves), your pain may actually be coming from a level above or below where you have your disc bulge.
Your insurance company is aware of this myth too because they see that an MRI is usually the pathway into more and more invasive procedures, shots, or dangerous painkillers. That is why they are having people go to the more effective and less expensive(how often to you see those together) of seeing a Physiotherapist first before going to do more invasive procedures.
Don’t get me wrong, MRI’s do have a role, especially if your Physician suspects something serious going on but as a Physio, I treat the person, not their picture.
Myth: You hurt because something’s out of place
Did you know that it takes over 2000 pounds of force to stretch fascia(or the glue that holds you together) by 1%. Or that it takes over an hour with a hammer and chisel to separate an SI joint with 2 people on a cadaver(that’s not fighting back)? But yet, when we’re dealing with back pain or sciatica, it can feel like something is out of place, like 1 hip is higher, or that if we could just pop it, things would get better. What we've understood for about the last 20 years about pain is that it has very little to do with positioning of the joints. So what is really happening when you hear all those pain relieving pops when you get an adjustment??? Or how about when those knots disappear after a massage? Or how about if you've been "shown" an X-ray with the "answers" as to why you hurt. Maybe you've "lost the curve in your neck". The simple truth is that when we get an adjustment or a massage, we give our joints, muscles, and especially nerves the three things they need to thrive. We give them movement, blood, and space. I don't mean that the adjustment somehow "opened" up anything or that you've now made your muscles longer or even "broken up scar tissue" unless you or your massage therapist or chiropractor is superhuman and can move a ton with their bare hands. What they've really done is move your muscles, joints, or nerves in a certain way that "resets" your body's living alarm system i.e. your nerves. Unfortunately, without you doing the right kind of movement to reinforce this, your alarm system will often "trip" requiring another trip to the massage therapist or chiropractor and the cycle begins again.
This "reset" to your alarm system is why you feel more aligned, with better posture, and feel looser and with less pain after an adjustment or massage. This is a good thing in that it means that you are a rapid responder to the right kind of movement and that you have the ability to heal yourself and get back to running, lifting, and enjoying life. You just have to make sure for a short period of time to minimize the movements that provoke and feed your system the right movements. Have questions? Speak with a back pain specialist for free.
Myth: Rest is Best when it comes to pain
When it comes to back pain, motion is lotion. Yes, the first day or 2(tops) after a back injury, resting seems to help but if you’ve been resting greater than a couple of days, often this makes back pain and sciatica worse and makes it last far longer than it should. Now the question comes, what movement should I do to deal with back pain especially if everything hurts(especially bending over to do dishes, laundry, or getting up from a chair). This is highly dependent on what causes it to spasm, ache, or have pain shooting down your leg. Often the best place to start is by laying on your stomach on your bed, often with a pillow under your stomach and doing several gentle, slow breathing exercises. If you notice your pain goes down, remove the pillow and repeat. If you notice no change-don’t worry, it could be that your spine wasn’t ready for that just yet(but checking in with a pain specialist like a physio wouldn’t be a bad idea to find out what would help). You can pick a time that works to get the help you deserve here.
Myth: You hurt because you’re getting older
Does this story sound familiar? I just recently was working with a 31 year old who had low back pain and was told by her doctor “You know, you’re getting older and back pain is part of that”? The doctor didn’t stop there. This person is a runner and a mom who wanted to be active and be able to play with her kids and also get the stress relief that she got from running. But her back pain made it so that she was not even able to bend over and lace up her shoes let alone make it out the door. But her doctor told her to “rest 6 weeks, take some anti-inflammatories, and maybe think about giving up running”. And this person wasn’t alone. I’ve heard this way too many times from 20 and 30 year olds. And if this wasn’t bad enough, once you reach your 40s and 50s, you’ll often be told you have the back of an 80 year old. Often this is because they see on the MRI more “wrinkles” than they might have expected. But when we study when people actually report back pain the most, it happens to be around 40 years old and the trend of back pain actually goes down from there even though our spines keep showing more wrinkles on the inside the older we get.
Myth: You hurt because you have a weak core
For about 20 years, from the late 90s there was a focus on the core as being the source of back pain or better put, a weak core. Hence a focus on things like planks, sit ups, back exercises, and more. Yet, even with a focus on strengthening, back pain did not get better. Often the weakness was a result, not the cause of the back pain. Often the body would limit how much power the core could produce because your alarm system wasn’t sure it was safe for you to tighten your abs because it compressed the back.
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What is the underlying cause of your pain? (hopefully nothing too serious!)
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What other, natural, drug free methods are there to speed up recovery alongside treatment?
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About the Author
Dr. Brandon is the owner and a Physio at Body Mechanix Physiotherapy and Fitness. Four of his favorite people call him daddy while he's been married to his other favorite person for 21 years. He enjoys teaching martial arts and is a Mestrando in Capoeira while in the mornings, he can be found working out with the guys in F3 around town. He's the author of 4 pain relief guides for sciatica, low back, shoulder, and knees and the lead contributor to the Active Tallahassee Blog.
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