Back and back pain: myths and misunderstandings

There are many stories about the back and back pain: the back is weak, there is wear and tear, rest is rusting, it is in my genes, if a therapy helps my neighbors it also helps me .... I would like to briefly discuss a number of common misunderstandings. Why? If an idea is embedded in the ideas of a patient, then he/she will behave accordingly. And that can have a counterproductive effect on the recovery.

 

I have to learn to live with the back pain

Especially people with back problems who have already visited many doctors and therapists without success are often left on the principle of learning-to-live-with-it. That will indeed be the case for a certain group. Then it becomes important to find a way to deal with the complaints and limitations. That can be adjustments in private and work. In another group of people with back pain, improvement seems to be feasible, even after many years of complaints. I do not write that to give false hope: it is my experience. Those are the people who say: I had come much earlier. I can not say in advance who can and can not be helped. Only good examination can give more clarity.

 

It's between your ears

Yes, the joke is that it is always between the ears. Somehow it is our brain that makes us aware of the symptoms. And even if something that is 'broken' is repaired in the body, the brain can still think that something is wrong and generate symptoms. Or the nervous system may have developed an extra sensitivity for complaints that have caused problems in the past: sensitization. I think it is important to realize that if someone with a complaint, such as back pain, goes to a counselor that always something is going on. The trick is to find out what that is. Take every complaint seriously.

 

The cause of my back pain can be traced on an X-ray or MRI scan

This is quite a difficult subject. With imaging research such as a photo or a scan, everything can be seen. The problem is that it is often hard to see whether that also causes the complaints. It is namely an anatomical plate and not a pain plate. The chance that something 'abnormal' is seen with imaging examination is already quite large in people without symptoms. So how do you make the distinction with people with complaints? In medicine, this is done by making a prediction about the problem the patient has and finding the most reliable test (and not the other way around!). Maybe it is a photo or a scan. There is a second requirement that must be met before the test is allowed to be carried out: the result must be decisive for the therapy. So if someone got acute low back pain two days ago and comes to the doctor with the question of whether a scan should be made, the answer will probably be: no. Because the chance that your complaint will soon spontaneously getting better is very high. Making a scan does not change this. Come back if there is no clear improvement within a few weeks.

 

The exercise that helped me so well is also good for my neighbor

That would be nice. Then we place that exercise on my site and that's how everyone is helped. The problem is that no 2 people are equal. And that the cause of the back complaints can also be different. And that determines the policy. Often enough, people with the same back pain are offered different therapy paths because the most effective form is sought for that person. Can it be bad to do that exercise anyway? Usually not. Sometimes the exercise strengthens the cause of the complaint or disturbs the recovery. How do I find out? Well, by trying it and paying attention to the development of the complaints, or by consulting a doctor specialized in complaints of the musculoskeletal system.

 

I have back pain, so I have to rest

Yes and no. In the first days of back pain it can make sense to take leave some activity and even lie down. And we also know that people who stay active in daily life as much as possible usually get rid of their complaints faster. That differs per person. If you rest for longer period, remember the following: a- the physical condition decreases by 15% in the first 10 days, b- 1% of the total muscle mass per day of rest is lost, c - the bones lose calcium. To get that in good condition can only by ... physical activities. Especially when complaints are chronic, and it is clear that the back can be loaded despite the complaints, it is important to become/stay active.

 

Tiger balm, massage, a warm lamp etc is good for low back pain

These measures locally stimulate the nervous system of the skin or underlying tissues. This can in a smart way slow down the stimuli that ultimately give the pain. As a result, it is only a short-term effect: as long as the stimulation lasts till a short time afterwards. Then the original complaints come back unfortunately. It may be useful to try to find relaxation (pain gives tension). Sometimes there will be a definite decrease of the complaints.

 

If nothing really helps anymore, then I let myself operate

With a good surgical indication this can be an option. This always involves abnormalities of the anatomy: hernia, sheared vertebra, fracture, tumor. Not always is operating wise. A careful consideration of the advantages and disadvantages is necessary: ​​chance of success, chance of extra problems. The neurosurgeon or orthopedist can tell you more about that.

 

But if no abnormalities are found in the anatomy, such as in non-specific back complaints, the chance of success by operating is as good as zero. In the Netherlands you probably will not find an operator for this.

 

The low back is a weak spot

Not true! The low back is a very ingenious construction with top materials. It is super stable and allows movement. How is it that so many people have low back pain (1 in 4)? That is because we do not treat our back wisely. Look around how people walk, stand, sit, hang, be passive, little exercise. It is not kept in good condition by not respecting what it needs. It is built to carry a certain load in a certain posture. Is there too much loading? Is there too little? Is the load too one-sided or too long-term? Then in time he will beep and crunch. Like a regular car that is used on the race track, or a race car that stands still for years.

 

You may, of course, feel that the back is a weak spot. I think of 2 things: 1- the above: the back is indeed weakened; 2- the back is sensitive. A misunderstanding is that a sensitive back is the same as a weak back.

 

My bad posture is in my genes, so I can not help it

It is known that problems with the posture can have a relationship with back complaints. There are a few fairly rare syndromes in which the posture may suffer. The chance that you have something like is very small, because these are not that difficult to recognize. And even if you have one, you can do something about it. It is effort for a longer period of time. Moreover no genes are known that provide a certain type of posture.

 

But my parents have/had this too, then is it genetic? Possible. Usually it is simpler: a child copies the behavior of the parents. This also applies to postural behavior.

 

My back pain comes from wear and tear

It is quite difficult to substantiate or reject this statement. There will certainly be people who have back problems due to wear and tear. Summary of an article on wear and tear in the back: what is meant by these signs of wear are usually certain 'deviations' that are seen on an X-ray which are in fact normal aging processes. They do not give back pain and they can make movement limitation and stiffness.

 

With musculoskeletal medicine all back complaints can be cured

That might be true .... Many people can be helped but not everyone. There are limits to the possibilities. It all depends on what is found in examination and whether it can be solved with musculoskeletal medicine. There are also back complaints that a musculoskeletal doctor must refer because, for example, an operation is the appropriate solution or because there is an infection. On the other side of the spectrum of back complaints are the symptoms that improve spontaneously. Then you should also stay away from therapy unless the recovery process can be accelerated and that is the patient's wish.

  

References
Nielens H, et al. Chronische lage rugpijn. KCE reports vol. 48A. Federaal Kenniscentrum voor de Gezondheidszorg, 2006.
Jarvik GJ, et al. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med 2002; 137: 586-597.
Borenstein DG, et al. The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects: a seven-year follow-up study. The Journal of bone and joint surgery 2001; 83-A (9): 1306–11.
Bousema EJ, et al. Disuse and physical deconditioning in the first year after the onset of back pain. Pain 130 (2007) 279-286.
Ihlebaek C, et al. The 'myths' of low back pain: status quo in Norwegian general practitioners and physiotherapists. Spine 2004 Vol 29;16:1818-1822.