Low Back Pain: 10 Facts, 10 Myths

Low Back Pain Information For Medical Legal Professionals

For those of us who deal with back injuries in the medical and legal arena, this list of myths and truths about back pain is informative and to some extent counter-intuitive. Unfortunately, many practitioners treating patients with pending litigation perpetuate the myths, thus leading to an adoption of an illness mentality that inhibits their recovery and return to work and normal activities. This illness mentality frequently leads to excessive and prolonged unnecessary care and prolonged perceived disability. 

My job as an orthopedic surgeon is to educate patients regarding these myths. My job as a medical expert witness is to clarify what is appropriate treatment in litigated cases. 

Hopefully, this information will be useful in understanding what is appropriate treatment in individuals with back injuries. 

I encourage you to read the entire article but below is a recap of the myths and truths about lower back pain. 

10 false ideas:

1. LBP is usually a serious medical condition.
2. LBP will become persistent and deteriorate later in life.
3. Persistent LBP is always related to tissue damage.
4. Scans are always needed to detect the cause of LBP.
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.
6. LBP is caused by poor posture when sitting, standing and lifting.
7. LBP is caused by weak ‘core’ muscles and having a strong core protects against future LBP.
8. Repeated spinal loading results in ‘wear and tear’ and tissue damage.
9. Pain flare-ups are a sign of tissue damage and require rest.
10. Treatments such as strong medications, injections and surgery are effective, and necessary, to treat LBP.

10 helpful ideas:

1. LBP is not a serious life-threatening medical condition.
2. Most episodes of LBP improve and LBP does not get worse as we age.
3. A negative mindset, fear-avoidance [behavior], negative recovery expectations, and poor pain coping [behaviors] are more strongly associated with persistent pain than is tissue damage.
4. 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. Graduated exercise and movement in all directions is safe and healthy for the spine.
6. Spine posture during sitting, standing and lifting does not predict LBP or its persistence.
7. 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. Spine movement and loading is safe and builds structural resilience when it is graded.
9. Pain flare-ups are more related to changes in activity, stress and mood rather than structural damage.
10. Effective care for LBP is relatively cheap and safe. This includes: education that is patient-centered and fosters a positive mindset, and coaching people to [optimize] 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).