Common Misunderstanding About Lower Back Pain

According to the literature, the incidence of lower back pain is quite high.

80% of the population will likely experience an episode of lower back pain in their lifetime. We have posted many blogs on back pain over the years, but it’s not realistic to cover every aspect of such a complex topic.

There are common misconceptions that come up in the clinic and many patients have the same questions for us. This blog post will address a few of the common misunderstandings about the more typical types of lower back pain that we see.

“I have degenerative disc disease…what now?”

Spinal degeneration, also known as degenerative disc disease, is a very normal process in the aging spine. It wears down as we go through life, like the tread on the sole of a shoe. Some authors use the comparison of wrinkles on our skin. Age-related changes in our bodies are normal and don’t always have to result in pain or dysfunction. Personally, I believe there’s a healthy middle ground on this matter, and we need to use some common sense when it comes to acknowledging the role that degeneration plays in our lower back pain. We can see degenerative arthritis on x-rays. Degeneration is normally classified as mild, moderate or severe on x-rays. It is normal for someone in their seventies to have moderate to severe arthritic degeneration. It would be rather surprising for someone in their thirties to have this amount of change.

Unfortunately, the term “degenerative disc disease” frightens many patients, and they arrive at our clinic under the belief that their spine is fragile and broken. This is not usually the case. Severe degeneration on x-rays might give us a clue as to why someone has repeated episodes of irritation and pain, but it doesn’t mean that the pain won’t go away. Although we cannot reverse the degeneration we see on the x-ray, we can find strategies and activity modifications that may allow that person to continue an active life without pain. Degenerative change can be compared to a glacier moving slowly over time. As it moves further down the arthritic spectrum, it is reasonable to expect that flare ups will occur a little easier than when someone is twenty. Yet just because there is severe arthritis visible on imaging, it does not mean you’re sentenced to a future of severe pain. Episodes of lower back pain in someone with severe arthritis normally doesn’t change or involve a change in the structure of the spine, but instead, it’s more of a temporary irritation of the area that is not a visible change on imaging.

“My pain is intense, it must be sciatica…”

Sciatica is a slang term used to describe irritation of the sciatic nerve.

The sciatic nerve is the large bundle of nerve fibres that stems from the lower back and travels down the back of the leg. When it gets irritated, it can be extremely painful. Not all cases of sciatic irritation are excruciating, though, and not all cases of excruciating back pain are sciatic irritation. True irritation of the sciatic nerve, also called radiculopathy, often extends past the knee to the calf and foot. Symptoms can range from intense pain to a dull ache, numbness, tingling, pins and needles and or burning. Weakness can also occur with severe cases of nerve irritation. A common misconception is that an MRI and surgery is required. This is not accurate. Most cases of nerve irritation that present in our clinic do not need an MRI. They respond well to conservative care, and a surgical consideration is usually not necessary. Most patients carry on with a very normal active lifestyle and come out of their clinical experience with a better understanding of their lower back, how to make it stronger and more resilient and how to reduce the chance of another lower back pain episode.

“My back pain is just the muscles”…

If you have an irritation of your lower back that lasts a week or two, perhaps most of the “problem” was muscular. We’ll never really know. Perhaps the best way to think of an episode of back pain that recurs and lasts more than a few weeks is like the chicken and the egg analogy. We don’t know if a muscle strain causes irritation of other spinal structures (like the joints) or whether a joint irritation leads to the inclusion of muscular spasm, but for most cases of back pain that last more than a few weeks, both areas are likely involved. As mentioned above, an important distinction is whether the nerve structures are entrapped or irritated. Nerve entrapment with lower back pain will change the typical course of uncomplicated lower back pain. If nerve irritation does not seem to be part of the picture, then most cases of mechanical back pain likely involve some irritation of joint structure and some irritation of muscular tissue in the area. Why is any of this important? For some reason, most likely the internet, people believe that stretching is always important for all types of lower back pain. To my knowledge, there isn’t any research supporting stretching for acute lower back pain, and in my experience, it often aggravates pain in the short term.

Although most stretches are benign and aren’t likely to cause new tissue damage, I would compare it to running on a swollen ankle. Although it’s not likely to cause any new damage, it’s also not likely to help alleviate symptoms faster. For most cases of uncomplicated, mechanical lower back pain, I normally recommend a short period of not stretching in rotation but to keep the spine moving in a relatively pain-free manner and engaging in activities that are comfortable and not too painful.

At Burlington Sports Therapy, we see many cases of back pain and no two cases are alike. Recovery from lower back pain usually involves temporarily modifying or removing the activities or habits that are perpetuating the tissue irritation, followed by advice on how to build up the tolerance of your lower back to help prevent future injury. None of this blog is direct advice to any reader. Lower back pain has many nuances and individual considerations, and no blog can perfectly summarize such a complex topic.

If you have lower back pain, give us a call. We can teach you about your condition, the various strategies to reduce the pain, and how to continue with an active life and prevent future episodes of pain.