10 Myths and 10 Facts about Low Back Pain

Posted by Nicholas Dang on August 03, 2023

Low back pain (LBP) is the leading cause of disability globally and tends to be associated with costly, ineffective and sometimes harmful healthcare. Unhelpful beliefs about LBP are likely a strong driver in this disability and ineffective care. Such beliefs are widespread in people with and without LBP, as well as the media and well-intentioned clinicians.¹

Here are 10 myths and 10 facts—based on current research—that you should know about low back pain:

	Myth	Fact
1	LBP is usually a serious medical condition.	LBP is not a serious life-threatening medical condition.
2	LBP will become persistent and deteriorate in later life.	Most episodes of LBP improve and LBP does not get worse as we age.
3	Persistent LBP is always related to tissue damage.	A negative mindset, fear-avoidance behaviour, negative recovery expectations, and poor pain coping behaviours are more strongly associated with persistent pain than is tissue damage.
4	Scans are always needed to detect the cause of LBP.	Scans do not determine prognosis of the current episode of LBP, the likelihood of future LBP disability, and do not improve LBP clinical outcomes.
5	Pain related to exercise and movement is always a warning that harm is being done to the spine and a signal to stop or modify activity.	Graduated exercise and movement in all directions is safe and healthy for the spine.
6	LBP is caused by poor posture when sitting, standing and lifting.	Spine posture during sitting, standing and lifting does not predict LBP or its persistence.
7	LBP is caused by weak ‘core’ muscles and having a strong core protects against future LBP.	A weak core does not cause LBP, and some people with LBP tend to overtense their ‘core’ muscles. While it is good to keep the trunk muscles strong, it is also helpful to relax them when they aren’t needed.
8	Repeated spinal loading results in ‘wear and tear’ and tissue damage.	Spine movement and loading is safe and builds structural resilience when it is graded.
9	Pain flare-ups are a sign of tissue damage and require rest.	Pain flare-ups are more related to changes in activity, stress and mood rather than structural damage.
10	Treatments such as strong medications, injections and surgery are effective, and necessary, to treat LBP.	Effective care for LBP is relatively cheap and safe. This includes: education that is patient-centred and fosters a positive mindset, and coaching people to optimise their physical and mental health (such as engaging in physical activity and exercise, social activities, healthy sleep habits and body weight, and remaining in employment).¹

While these myths and facts apply to most cases of LBP, there are some cases that may require different assessment and management. If you are uncertain, you should consult with a trusted healthcare practitioner.

References:

O’Sullivan et al. (2020) (PMID: 31892534)

Tags: back pain, Injury, Pain, posture, research

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