Low back pain is a big deal, and a big problem. Recently low back pain was ranked as causing the highest “chronic disease burden” throughout the world.
Also, joint and muscle problems are considered the most expensive health problem in the U.S. today, especially when lost time is factored in.
In my experience after 30 years of treating low back pain, the biggest stumbling block in treatment is not physical — it’s the beliefs (some partly true, most not) that surround this very common condition. I’ll cover some of the more common beliefs, and show how they stand up to reality. Like all health myths, they cause a lot of problems, both by patients trying inappropriate treatments and delaying the proper treatment.
Myth: Low back pain usually goes away on its own. Just wait it out.
This first belief is probably the most widely held, and causes so many patients to delay care, sometimes for years. It’s half truth.
Most acute low back injuries do improve with time. However, one study shows that 75 percent of the patients who went to a family medical center for acute low back pain were still complaining of pain one year later, and half were still having to limit their daily activities. The doctors thought most had recovered, because only 10 percent returned for follow-up treatment. However, when the patients were contacted by phone, they said they did not bother to return to the doctor, but they were not recovered. In half of the patients, the pain was still bad enough to limit their daily activities a year later.
We often see these people years later, when the problem has progressed to the point that painkillers no longer work, or the patient can’t do their normal activities any more. They often say, “I was waiting for it to go away.”
Myth: Most back pain is caused by tight or weak muscles, so the best treatment is exercise.
Another half truth. Almost every patient I have treated for back pain has had joint problems along with the muscle spasm. Exercise can actually worsen joint irritation; I don’t give many exercises to patients in pain until they have started to respond to treatment, and can handle them. The best treatment for joint problems is manipulation, and we always start that treatment from the first visit. Sometimes the manipulation has to be modified, if the patient has had back surgery or has osteoporosis, but there are many different ways to manipulate a spine, some of them very gentle.
Myth: If you had a back problem, you would know it.
This barely rates as even a half truth; let’s call it a quarter truth. Back pain is like a lot of chronic health problems, it often builds up without any signs or symptoms, and then seemingly comes out of nowhere. I have heard so many patients say, “All I did was roll over in bed (or bend over to pet the cat, or pick up a book from the floor…) and my back let go.” This means the problem has been dormant for a while, sometimes several years.
A common history is for a patient to have a back strain that seemed to completely heal, only to have it flare up again years later. I have even had patients tell me their back problems seemed to begin with a sports injury in their teens, or that they recall “growing pains” in their legs and back that either never completely healed or resurfaced when they were in their 30s.
Myth: Anti-inflammatory drugs are a good treatment for back pain.
Again, half true. These drugs, including Motrin, Aleve, Vioxx, aspirin, and Toradol, are great at easing the pain of back problems but do nothing for the underlying causes. Long-term use can actually interfere with healing because inflammation is a part of the healing process, and stopping it chemically may not allow the process to complete.
Myth: X-rays, CAT scans and MRIs are useful tests to find the cause of low back pain.
This is false. Most spinal pain is caused by mechanical problems in the joints and muscles of the spine. These types of problems simply do not show well on imaging tests. (Mechanical problems are immediately obvious to chiropractors; I spent an entire semester training to feel for normal function in the joints of the spine.) Imaging tests are useful to see if there are any diseases in the back, but the typical findings of some disc degeneration or arthritis often leads the doctor down the wrong path of treating these, rather than the true cause of the pain.
I addressed this issue in more detail in my May 23 column.
One of the most common comments we hear from our patients is, “Why did I wait so long to get treated?” The answer is because we hold these beliefs about back pain that are simply not true. I have treated so many people whose lives are made miserable by back pain who could have been successfully treated years earlier.
The better you understand your spine, the healthier — and more pain free — you can be. Do not let these myths interfere with your spinal health.
Dr. Michael Noonan practices chiropractic, acupuncture and other wellness therapies in Old Town.