Myth #1: Bed Rest is good for Low Back Pain
Lying in bed for excessive periods can actually cause low back pain. Ever wonder why it is harder to put your socks on in morning but at night you whip them off with ease? This is due to the discs being packed with concentrated protein chains that love water. When we sleep, gravity is eliminated so these protein chains cause the discs to fill with fluid and gradually lengthen the spine. This is why first thing in the morning getting out of bed we are actually taller. It’s also why first thing in the morning it’s harder to put on your socks and your back feels stiffer. In the morning when the discs are full of fluid is also the time discs are most susceptible to injury. However, as we go about our daily activities the pressure of our bodyweight causes the fluid to seep out, and after about an hour, we are back to our natural height. This whole process is healthy and how the discs get nutrients. However, while about eight hours in bed is healthy, anything much longer than that is not and allows the disc to continue to swell and can increase low back pain.
Myth #2: Stretching will fix your Low Back Pain
Unfortunately, for many back pain sufferers, stretching is only a temporary fix that could be contributing to your back pain. In order to stretch the low back the spine tends to get a lot of flexion (bending), which puts increased stress on the discs and low back. When we do stretches such as pulling your knees to your chest we trigger a “stretch reflex”. This is a neurological phenomenon that reduces pain sensitivity for about 15-20 minutes, but the pain returns and is often worse than before. However, not all stretching is bad, in fact some people respond best from stretching and getting more flexion in their low back. This is where seeking advice from a qualified professional will help guide you with your personal needs and what stretches/movements are best for you.
Myth #3: Stronger Back Muscles will cure my Low Back Pain
When doing rehab for the low back we often skip endurance training and jump straight to strength training. Dr. Stuart McGill explains it as “imagine if you put a souped-up 500 horsepower engine inside a dinky, broken down car and then raced around town at top speed, it’s only a matter of time before the mega-engine rips the frail frame and suspension to pieces.” Similarly, if you suffer from back pain and you have developed a disproportionate amount of strength in relation to their current level of endurance, one can only expect further injury. The classic example is: “I just bent over to pick up a piece of paper and my back gave out.” This isn’t due to a lack of strength, because the piece of paper is insignificant in terms of weight. Maintaining proper movement patterns requires adequate endurance, so bending over to pick up a piece of paper doesn’t throw your back out. Once endurance and core stabilization has been established then more aggressive strength training can be added.
Myth #4: My MRI will provide me with all the answers I need
MRI’s are a good tool to use when used as a piece of the puzzle and not the sole determining factor. MRI’s must be combined with clinical exam findings, and the ordering physician should have an idea of what they think would be seen on the MRI. It is common for disc pathology to be seen on MRI but the individual is asymptomatic (no symptoms). One study found that 64% of the subjects had disc pathology present but were asymptomatic. They can also lead to false labeling of patients, and could lead to patients not getting the proper care they need. Dr. McGill states the source for low back pain usually stems from something functional, such as flawed movement patterns and repetitive activities that over time sensitize your back tissues and drive them to a painful response even under low load. Dr. James Andrews a widely known Orthopedic Surgeon who performs many surgery’s on professional athletes stated "If you want an excuse to operate on a pitcher's throwing shoulder, just get an M.R.I.". MRI’s should never be the sole determinant in the direction of your treatment.
Myth #5: Getting injections and pain medication will give me the best long-term solution.
Pain Management is exactly what it sounds like: management. It focuses on the symptoms instead of addressing and fixing the original cause, and in some cases leaves patients feeling that the pain is all in their head. Once you stop taking the pain medication or the injection wears off two things happen:
- The pain is still present
- The pain is gone but the underlying cause wasn’t fixed, so you are at an 88%-90% chance of low back pain re-occurrence in 18 months.
Injections and pain medication are not bad and are necessary in some cases, but it is not the answer to the problem. It is like the MRI, it is useful when used as a piece of the puzzle. On top of the underlying causes not being addressed, pain killers can be highly addictive and repeated injections can lead to weakening of tendons, ligaments, and bones.
1. McGill, S. (2015). Back mechanic: The step by step McGill method to fix back pain. Waterloo, Ont.: Backfitpro.
2. Liebenson, C. (2007). Rehabilitation of the spine: A practitioner's manual. Philadelphia: Lippincott Williams & Wilkins.
3. Etal, J. M. (1994). Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain. The Nurse Practitioner, 19(9).