Have you heard that if you eat Pop Rocks and then drink a can of Coke your stomach will explode?
You have probably heard this myth before, and you probably know it is not true. I was reminded of this common myth this weekend. We were at a friend’s house for a cookout and he began to tell me about some recent problems he has had with back pain.
“I threw my back out last year and I have had pain on and off ever since. I think I have a slipped disc or something. I work out all the time so I don’t know why it happened because I think I’m in pretty good shape. I just feel like I need to take some pressure off of that nerve or have my back popped back into place. Anyway, I’m trying to be careful, I squat down and lift with my legs, and I try not to bend my back so I don’t hurt myself worse.”
The above statement includes nearly every back pain myth that exists. I am going to attempt to break each one down, in what will be the first of many posts on low back pain. First let me say that back pain is one of the most common conditions that we see as PT’s, and it is certainly one of the most prevalent conditions in the United States. Although medical technology continues to progress, treatment for back pain continues to struggle. A cost analysis study by the American Medical Association found that in 2005 spine problems cost approximately $85.9 billion, while cancer was estimated to cost $89 billion. These numbers tell us one of two things:
- We are doing a great job treating cancer
- We are doing a poor job of treating back pain
Which one do you think is most likely true?
The next question is, why are we doing such a poor job at treating back pain. While there are many facets to this issue (and I certainly wouldn’t be able to address them all here), I think a big part of the problem is all of the myths that surround the condition. These false beliefs confound treatment and limit patients’ ability to seek the best possible care.
So let’s try to tackle the myths in my friend’s statement above:
- “I threw my back out.”– I think this is an odd statement because it suggests that you can dislocate your vertebrae. It would be extremely frightening if this was possible because there would be a lot more spinal cord injuries. Your spinal column is designed to be a strong center of movement for your body, and additionally is the protection for one of the most vital pieces of your anatomy: the spinal cord. If you just “threw your back out” there would likely be much more serious implications than some pain. In part this is a myth that has been perpetuated by one specific branch of practitioners (not named here), but it is not based on science. Studies using x-ray have conclusively proven that in 99% of cases your back is not “thrown out.”
- “I have a slipped disc”– This is similar to the above statement in that if your discs truly slipped off of the vertebrae, then they would defeat their own purpose. They are a part of structure that is designed to move fluidly and freely, and protect vital parts of our anatomy. While imaging often shows bulging or herniated discs, these are not likely a source of pain for most people. One study found that 90% of people age 60 or older had degenerative disc disease, pinched nerves, or bone on bone disc herniation. The interesting thing is only 30-50% of them have back pain. This may indicate that our “slipped discs” may not play as big a role as previously thought.
- “I work out all the time, I’m in good shape, so I shouldn’t have back pain”– Even if you are the most avid exerciser, you are still at risk for back pain. I find this myth the easiest to explain. Think of your average week and how often you exercise. If you are like many people it is likely 2 hours or less per day. While that is a great accomplishment, and wonderful for your health, you are still a sedentary person. Don’t believe me? Log the number of hours you spend sitting, lying, or sleeping every day. This includes transit time in the car, time eating, time at work (if you sit at work) and your everyday R&R. You may be surprised at how much time you actually spend not moving in a day.
- “I need to take pressure off of my pinched nerve”– This one is somewhat more controversial. While you clearly do not want to spend your day compressing nerves or applying unnecessary stresses, pinched nerves do not necessarily have to hurt. Again, 90% of people age 60 or older, who have never had back pain, will likely have a pinched nerve. The important thing here I think is that nerves are tissue in your body just like any other. They need blood to bring them oxygen and nutrition, and space to perform their normal functions. Every time you apply pressure to your skin you are compressing nerves. In fact there are likely many nerves which you compress by sitting (sciatic) or moving (median, spinal nerves, etc.). These don’t typically hurt, so why in the case of back pain do your “pinched” nerves have to be the culprit.
- “I need my back popped back into place”– Let me preface this by saying I am a big advocate of spinal manipulation. If done by a properly trained Physical Therapist it is very safe and effective at treating some types of back pain. However, the idea that your back can be adjusted, or popped back into place is not correct. See #1 here. Being able to put the back into place assumes that it was “thrown out”, and multiple studies have shown that this is clearly not possible. Besides that fact, manipulation is not appropriate for every type of back pain. Some people may respond better to traction, or stabilization exercises, so just because you have back pain does not mean you need a manipulation.
- “To avoid hurting my back I squat and lift with my legs”– This is possibly the most common misconception about back pain. While it is true you want to lift with your legs, you don’t do this by squatting, you do it by dead lifting. Squatting is a very important pattern for our function. It allows us to be mobile, and move to and from the sitting position. However, the squat is not meant to be strong. The dead lift, however, is very strong. In this position many people will think the back is at risk for injury, but in reality there is less compressive force on the spine, the lower extremity muscles are in better position to exert force, and the core muscles are more active in stabilizing the spine. Win, win, win.
- “If I bend or move my back I might hurt myself”– There are 76 different joints in the entire spine (over 170 if you include the articulations to the ribs). With so many joints, so much flexibility and so much freedom to move why would we think that motion at the spine is a bad thing? Your spine is designed to be mobile. You can bend your back forward because it serves a purpose for your survival. We are wonderfully and fearfully made, and this design must serve some purpose. So why spend so much time trying to immobilize the spine. Rather, we should be finding ways to move safely. This includes having a full and free range of motion, as well as being able to stabilize and immobilize the spine under heavy load or threat. The real trick is learning when you should be mobile and when you should be stable.
Once we debunk the common myths that surround back pain, we can start to focus on more effective treatment. This in turn will help to reduce the costs related to low back pain. This is very important as every day we hear about health care legislation, or the health care crisis. All political agendas aside, we do in fact have a health care crisis in this country. This is caused by a myriad of myths that make treatment difficult and expensive. While back pain is certainly not the only condition that suffers from this state, it is certainly one of the most common. Changing ideas and perceptions is the first step to truly eliminating our health care crisis.
This will certainly not be the last time we talk about back pain, but we hope this information may help to change a few ideas, and improve our treatment of low back pain. Be sure check out the cost analysis study below, which I have attached the link for.
Brook et al.-2008- Expenditures and Health Status Among Adults with Back and Neck Problems.