Before I went to school to become a physical therapist, I think my experience was probably similar to a lot of other people. My personal experience with back pain was fairly limited but I knew two or three people who had "serious back problems." I remember in talking to these friends about their issues, their back pain seemed to possess a mysterious aura, almost a mythical existence. Many of them had undergone major surgeries or years of pain meds, but their unfortunate reality was that their back pain was there to stay, likely to never go away.
My name is Dr. Allan Buccola and I am a physical therapist and owner of Impetus Physical Therapy is Greensboro, NC. In this post, I aim to discuss some of the most common myths about low back pain, and how they actually keep people in pain longer. Physical therapists are human movement specialists, treating movement related dysfunction through a number of noninvasive methods, with a strong emphasis on promoting patient independence through client education.
My practice champions patient independence and education probably more than most, because it leads to better and faster outcomes. This is something I can do because of the unique way my practice is set up. Throughout most of the 20th century, treatment for low back pain has been sadly deficient in these two things, leaving patients frustrated and without options.
Myth #1: Once you have back pain, you'll always have back pain
I continue to hear this from many people, typically those who are not patients interestingly enough. I think this idea extends from the frustration and helplessness patients experience after one or two failed treatment attempts. It's an unfortunately common story that's heartbreaking to me. When you have pain, you might go to the chiropractor for several weeks and if things don't get better immediately, you look at your bank account balance and decide that nothing worked and it's just something you'll have to live with.
As someone who works within the medical community, I have to point out that there are several disciplines and specialties that are able to provide help with back pain. I think it's important to not spend too much time with one practitioner if you feel you are not making progress, but to try an alternative. Ultimately it's you who will know what's working, because eventually you will feel better and stop thinking about your pain.
The majority of first time episodes of back pain have been shown to resolve on their own, without any medical treatment, but it's important to not delay care when pain persists. And don't give up! Keep seeking treatment until someone is able to help you. Even in severe cases where long standing pain is a problem, physical therapy can still do a lot to decrease pain, improve quality of life, and give the patient more pain management strategies.
Myth #2: My back hurts because I'm getting older
This my least favorite myth of all, mostly because it takes a person's pain and blames it on something completely out of their control. In the world of back pain, patients have to be able to understand how they can take control of their well being and improve their pain. There is no medical reason that 'getting older' is causing someones back pain.
As someone who works frequently with people in their 70's, 80's and 90's, the most frequent episodes of back pain I encounter are related to a lack of physical activity, a degradation in posture, or chronic obesity. All these things may be more common as we age, but they are not inevitable. These back pain triggers are environmental at best, and can largely be controlled by lifestyle choices.
When I hear a patient tell me that their physician has told them that they have back pain because they are getting older, I get the impression that the physician is out of ideas. This is a myth that stops people from looking for solutions to back pain that is often simple to explain and easy to fix, at least in my own clinical experience.
Myth #3: Movement is bad for people with back pain
Not too long ago, when a person went to their doctor with back pain, they were often given a bottle of pills and told to stay in the bed for 2 weeks. This proved to be about as successful a treatment as blood letting. We quickly learned that this almost always resulted in pain being worse rather than better.
The human body is designed for movement. Blood circulation is mediated by the active contraction of muscles in the legs. Joints lubricate themselves as they moved through their range. Short bursts of intense physical activity trigger thousands of metabolic adaptations at the cellular level in order to create rapid improvements in performance.
For many people with low back pain, a quick or gradual return to as close to normal amounts of physical activity is often the best option. Minimizing physical activity or maintaining a rigid posture for a long period of time will eventually lead to another long list of ways your body feels awful, whether the original back pain goes away or not.
In cases of arthritis in the spine, movement helps lubricate those joints, and loosen them up, whereas prolonged sitting or lying will actually make them more stiff. In cases of muscle tightness or spasm, tolerable sustained movement can help retrain the nervous system surrounding tight muscles, gradually providing a reset to the system. In general, physical activity produces endorphins which have an overall helpful effect by decreasing the body's sensitivity to painful stimuli. If you have back pain, listen to your body, but maintain a normal and active lifestyle.
Myth #4: Injections and pills will fix my back pain
Pain pills and injections are often the first line of defense from medical doctors treating back pain. This is almost exclusively because of how the healthcare system is set up to work. Physicians are the entry point to the medical system, and injections/medications are the tools of the modern physician. For about half of cases, these options will provide some immediate short term relief, and for a select minority, they will offer complete, long-term resolution of symptoms.
Medications are an important part of pain management for many patients, but their main job is relieve symptoms, rather than address the actual problem. It's important to realize that in the absence of addressing the causes for your back pain, management of the symptoms will only work to a small degree, especially if the problematic cause of the pain continues to get worse.
One of the reasons that I have so much success with my back pain clients is that I am able to take the time to educate them on how their job, hobbies, or lifestyle choices may be contributing to their pain in the first place. I take time to provide solutions for ergonomics in the workplace, better sleeping positions at night, and modifications to daily activity that become part of the solution. This is a level of education that not only helps the patient quickly improve their pain, but more importantly, allows them to prevent a future incidence from occurring.
Myth #5: Yoga will help with my back pain
This is a question that I get very frequently from my patients. The answer is very complicated for a number of reasons. Whereas the yoga sessions that I have personally taken part in struck me as something that could be beneficial to almost everyone with an uncomplicated medical history, the presence of back pain complicates things.
Firstly, there are many, many different types of yoga offered, even in a medium sized city like Greensboro, making it difficult to recommend yoga as a generally beneficial activity for someone with pain. Secondly, the setting and instructor make all the difference. Are you asking about the benefits of yoga videos you follow along with at home? Are you referring to the large yoga classes offered at the local YMCA? Is your focus more on a meditative traditional yoga?
These things will make a difference, and the expertise of the instructor in their ability to customize the yoga session to all individuals in the group is critical. A good yoga instructor will be able to offer multiple variations for each pose based on the medically oriented mobility restrictions that each person might have. They should also have a good idea of which poses have the greatest potential to be provocative to those with preexisting low back pain. There are other factors to consider when trying to decide if yoga will be beneficial for your particular back problem, but I'll touch on that in a future yoga dedicated post.
Don't put it off
As I mentioned previously, the majority of first episodes of back pain are likely to resolve on their own without medical intervention, however there are some other things you should consider before you delay treatment.
1. There is good evidence to support that the longer a person lives with low back pain, the lower the chance a full resolution will take. Something I often tell my patients is that they didn't come to have this much pain over night, and they certainly won't get rid of it over night.
2. If you find that your pain is episodic, but with each episode, the pain is worse and sticks around for longer, that's a good sign that it might be time to see a physical therapist to address the causes of your back pain.
3. Most instances of low back pain are relatively benign, but there a couple of instances where I would recommend you get checked out immediately by a medical professional. If you have pain that does not seem to change with physical activity or rest, pain that can be characterized as a strong pulsating pain, pain associated with a traumatic event such as a fall, or sudden shooting, 'lightning-bolt' type pain from the back down into the lower leg or foot, these are all instances where immediate investigation is warranted.
So that's a wrap! Hopefully, I've shed some light on a commonly confusing problem. Additionally I would recommend that if you need to see someone, please don't allow yourself to wait a ridiculous amount of time to see someone. I hear all too often how patients wait two weeks to see their primary physician, and then wait another 2-6 weeks to see a specialist. That is simply unacceptable and unnecessary.
Some specialties are excellent at addressing muscle related pain, such as massage therapists. Chiropractors are excellent at addressing spine mobility problems, but the ability to address soft tissue problems varies between practitioners. Specialty orthopedics and neurologists are excellent for solutions that warrant pharmacological or surgical solutions, but I find that they can be over reliant on findings from medical imaging, and easily distracted by the findings.
Physical therapists are uniquely qualified to diagnose and treat acute back pain, due to their extensive education in both neurological and musculoskeletal areas. We are also educated to identify and rule out more complex medical causes of back pain that are more appropriately treated by a physician. Most amazingly, we are able to do all of this without x-ray imaging or expensive MRIs. This allows us to be excellent at addressing soft tissue impairments, muscle pain, spinal mobility problems, as well as screen for other problems that are more serious.
Most PT practices will require a referral from a physician solely because insurance companies require this, but because my practice does not contract with insurance, I can see patients directly and quickly, without having to waste precious time or money on a doctors visit.
Please contact me if you have any additional questions or concerns. I offer free 15-minute telephone screenings for those who are unsure if their problem is appropriate for physical therapy.
Thanks for reading. Learn more about our practice here. You can call for a free consult or book an appointment on our site. Find out more here about what makes Impetus unique among PT practices in Greensboro, NC.
Until next time, don't stop moving!