5 things you should know about your back pain


You don’t realise how much you use your back throughout the day until it starts hurting! Yesterday everything moved well but today rolling over in bed, getting up out of a chair or even just sneezing hurts. It’s not as if you lifted something heavy or spent all day pulling weeds in the garden – but you’ve just woken up with pain.

Sound familiar? It can be a frustrating experience when you develop an acute episode of back pain for what seems like no apparent reason. As confusing and debilitating acute back pain can be – there are some key simple truths that can be helpful to have in the front of your mind.

Here’s 5 things to know about your acute episode of low back pain:

1.Your spine is not fragile

It may feel fragile, it may even feel like your back is about to crumble underneath you. But how your back feels and what’s actually the case are often two very different things.

Your spine is made up of vertebral bones stacked on top of each other with discs in between. The joints are firmly supported via some facet joints at the sides of the spine, strong ligaments that wrap around the spine and multiple layers of muscle.

Your discs don’t slip in and out of place and even if there’s a bulge in those discs the stability of the spine remains unaffected. You can’t damage your spine by sitting too much or “sleeping wrong” or even running around. It’s just too strong and stable.

Yes it’s true that you can damage your spine but you need a great deal of force – think car crash, or repetitive high forces like an elite fast bowler. But for the most common (>95% of the cases) pain does not equal damage.

2. Pain does not equal damage

Back pain that comes on out of the blue is the most common presentation of back pain. It can be very painful and debilitating but doesn’t mean that damage has occurred.

Much more commonly the back gets a little stiff, it’s not moving as well as normal and the stiffness is what’s causing the pain. It’s a movement problem that needs to be fixed not a structural problem that needs a surgery.

3. An MRI on your spine is almost always not needed

MRIs are a type of imaging that provides a highly detailed picture of the anatomy when lying flat. It shows what’s going on with the tissues and structures of the spine. It doesn’t give any information about how your back moves or functions: how mobile you are, how strong you are, how good your endurance is, how fast you can react, how good you are at controlling balance or posture etc…

So MRIs show what’s there not how things function. They show the anatomy but not the physiology.

So why aren’t they helpful for the majority of back pain?

They’re not helpful because the majority of back pain can’t be attributed to a specific anatomical structure. In other words we diagnose back pain based on how it responds to movement rather than a particular tissue/joint/disc etc. So if an MRI tells us what the state of the tissues are but not how they move or function then they aren’t going to give us much useful information in how to treat the problem and get better – for that we need to test the effects of different movements.

Early MRIs have actually shown to have negative effects on recovery of back pain. The reason for is thought to be due to the fact that MRIs often show “problems” that are actually normal and benign. This like small disc bulges or facet joint changes etc. Reading those words often causes us to be more concerned and fearful. And when we’re more fearful we tend to move less which unfortunately makes our recovery slower too.

4. Your spine is adaptable

The good news about our bodies is that our spines are adaptable. They can get stronger and more flexible if we move them and exercise.

Strength training Plantar fasciitis

Even our discs can get healthier with movement! A study showed that runners who run regularly have thicker healthier discs than their non-running control groups. Bones, discs, muscles even ligaments all get stronger when loaded. It’s actually somewhat counter-intuitive – but when your back is sore movement is the best way to settle pain down but also the best way to improve the structure and health of your spine.

Resting too much, avoiding exercise and being fearful of movement all correlate with slower recovery and higher frequency of low back pain episodes

5. For most back pain – “motion is lotion”

The vast majority of back pain will improve with movement. Sometimes general movement is enough to settle things down, sometimes it requires a more specific type of movement matched to the presentation is needed. But motion is lotion – slowly and progressively move your way out of pain and back to normal again.

If you’re unsure about what type of movement is best – then go see your physiotherapist to find what’s the what’s right for you to move well again.

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