When we’re experiencing back pain is easy to feel that our spines are fragile and vulnerable to damage. It can really feel like any ‘wrong’ movement or position will be harmful to our backs. As a consequence, we often modify our behaviour and change how we move. For example, maybe you decide to skip a few weeks exercising or think it’s best not to bend the back when you need to put your shoes on? Patients frequently say to me… “It’s OK, I’m being really careful with my back”. They often think their spine and discs will break if they reach too far or move too quickly. Or that their ‘core’ is so weak and they’ll collapse in a heap of bones if they move an inch without tensing their abs (see here).
The truth is that the spine is one of the strongest parts of the body and it’s very hard to seriously damage- even though at times it’s doesn’t feel like it. Back pain can be a truly unpleasant, distressing and miserable experience. However, research now clearly shows a very weak relationship between ‘degeneration’ of spinal structures (e.g. the discs and joints) and how someone feels (i.e. pain)- see here. The findings of spinal ‘degeneration’ as seen on MRi only weakly predict future back pain- see here. Nonetheless, when you’re experiencing back pain, it’s easy to feel and imagine that your back must be damaged.
This perception is fuelled by myths around core stability, slipped discs, poor posture, scoliosis etc etc which are deeply engrained socially, culturally and eventually they find themselves engrained cognitively in our minds and drive our attitudes, behaviour and reaction to back pain. Add in a constant stream of poor advice on social media (eg ‘postural aids’) and the use of unhelpful (scary) words by healthcare professionals (see here)- and not wonder we become scared stiff to move when we have back pain, and we feel that our backs are easy to harm and hard to heal- see here.
For back pain treatment to be successful in the long term, it’s important that the healthcare professional addresses any beliefs and attitudes which can be an obstacle to you recovering from back pain. It’s important that you develop an understanding of why you’re experiencing back pain (termed pain education), while also emphasising that your spine and body is STRONG, RESILIENT and ADAPTABLE- and WILL recover. Appreciating these facts alone can real help recover from back pain (see here) and larger research ongoing (see here)
Through the use of the appropriate language, manual therapy techniques, exercise and self-management advice you can construct better ways of thinking about your back pain can enhance your CONFIDENCE to move freely with less fear, which means less muscle tension and normal loading of the spine- which results in less pain. See here for my top tips for back pain.
For some reliable evidence-based information on back pain, check out the Pan-Ed resources here.