Low back pain (LBP) is a common injury that many of us will suffer at some stage of our lives and unfortunately for some, it can have a real impact on their quality of life.
There is lots of misconceptions and misleading information regarding back pain, what causes it, and how you treat it. Sometimes, even advice given with the best intentions can create a degree fear which can have harmful effects. An example is the video below:
This is a Worksafe ad that ran a few years ago. The message is obvious and valid… don’t try and lift stupidly heavy things otherwise you might hurt yourself.
Why is this harmful?
We need to appreciate that this video is an extreme example of what might occur if we did do serious damage to our back. The reality is that over 95% of lifting injuries are nothing like this, they are usually just minor strains that will settle quickly with appropriate management.
Let’s say someone did experience a minor lifting injury after watching that clip, do you think the image of their disc exploding would cross their mind? Of course it would! they would be worried that this minor injury is something far more serious, and they will experience more pain because of it.
Bulging Discs are as Normal as Grey Hair!
Very often people presenting with LBP will be referred for an MRI or a CT scan to investigate the ‘source’ of their back pain. Very often, the results will report a bulging disc or disc degeneration etc… the trouble is that bulging discs and disc degeneration are also very common in people who have never had back pain before. The graph below (figure 1.) shows the prevalence of ‘injuries’ in people who have never had back pain. To put that in to some context, I’m 30 years old, and have never had back pain, but there is still a 40% chance I have at least one disc bulge
So what does this mean?
It means that if you have a bulging disc, there is a fair chance that it was there long before there was any pain. It could be completely unrelated, and more importantly, you don’t need to change you behaviour because you think it might make it worse.
But a disc bulge must be related, How else could it occur?
Well the answer could be pretty straight-forward. The intervertebral discs are made up of 3 main materials:
- Collagen – this acts as the structural netting or scaffolding that holds everything together
- Proteoglycans – these are protein cells situated inside the disc that attract water
- Water – water molecules bind to the proteoglycans
Imagine the intervertebral disc is a mesh bag full of balls (figure 2).
The mesh bag represents the collagen, each ball represents a proteoglycan that has a molecule of water attached to it. when we are young, we have a lot more proteoglycans in our discs, so there a lot more water content – our discs are well hydrated which makes the collagen framework very taught – a bit like a swiss ball that is fully pumped up.
As we get older, our bodies lose some of these proteoglycans, which also means there is less water molecules to ‘pump’ up the collagen framework – bit like a swiss ball that is half deflated. Because the disc has less water content to keep the collagen taught, the edges of the disc bulge out the sides. And there you have it – a bulging disc that is completely harmless, and as normal as the wrinkles on your face.
Myth 2: You’re Back can go ‘Out of place’ or you can ‘Slip’ a Disc
Another common misconception is that the spine or spinal joints can go out of place. This misleading term often arises from people trying to explain why their back keeps getting sore.
If you closed your eyes and imagined a spine, there is a fair chance it will look like the picture below (Figure 4). These models are everywhere and although they have their uses, they are very oversimplified and can mislead people to thinking the spine is inherently unstable and can slip in and out.
The next picture is what an actual spine looks like (figure 5). You’ll notice that you can barely make out the intervertebral bodies from the discs because there are so many ligaments surrounding them. There is no way it can go out of place!
So if your back suddenly locks up, you can best assured that everything is still where it should be, acute back pain undergoes the same healing process as rolled ankle, it’s normal for it to be acutely sore for 2-3 days then it will gradually settle
Your Back is not Fragile
Leading on from the last point, if people believe that their back is fragile and unstable, they will change their behaviour to avoid something bad happening. It’s not unusual for people with long-standing LBP to believe that they are not allowed to bend or lift or sneeze or laugh because they genuinely believe that they will hurt themselves. The unfortunate thing is that these beliefs often cause them to give up their favourite sports or hobbies.
Bending is a normal movement, just like bending your elbow. What would happen if you actively avoided bending you elbow? It would get stiff and it would get sore. The same thing happens to your back if it doesn’t move the way it is designed to.
The spine is a remarkably strong and well-designed structure. They can cop a flogging! As kids and young adults, most have fallen out of trees, crashed motorbikes, played contact sports etc.
It would be a real shame if you gave up something you enjoy because of a misguided belief that it was harmful. Back pain doesn’t need to be feared. Movement is good, do the things you enjoy and who knows, your back might even feel better!
If you have questions or would some advice regarding back pain, feel free to contact Peak Sports Physiotherapy on 03 5721 4162!
Thanks for reading,
Belavy et.al (2015). Can exercise positively influence the intervertebral disc? Sports Medicine, DOI 10.1007/s40279-015-0444-2
Brinjikji et.al (2014). Systematic Literature review of imaging features of spinal degeneration in asymptomatic populations. American journal of neuroradiology, 36, 811-816
Raj (2008). Intervertebral disc: Anatomy-Physiology-Pathophysiology-Treatment. Pain Practice, 8(1), 18-44