After 25 years as a physiotherapist I’ve seen the whole spectrum of back problems. One of the biggest problems however is a patients understanding or belief as to why they hurt their back in the first place. Anyone who has been following these blogs over the years will know that pain is not as simple as hurt equals harm and just because your pain started after doing this thing or that thing, it doesn’t mean this or that is responsible for your pain. My upcoming book, Pain: The Ultimate Mentor explores all this and more.
Your belief as to why you hurt your back matters, as it shapes the relationship with your back going forward and any other part of your body for that matter. If you believe you hurt your back for one of the reasons listed below, you will start living life through that filter and that may not be in your best interests. In fact it might just contribute to giving you lingering, persistent back pain.
So, here are the 5 biggest myths that influence peoples thinking when it comes to back pain. Patients will often say the following:
“I hurt my back because…….”
I was bending and twisting
Lets start with the most frequent one. It’s all too common a misconception that “bending and twisting” is bad for your back. That’s just not true. Think about it. If bending and twisting was bad for your back then the whole world would be constantly injured. Look around you, people are bending and twisting just fine all day long. You bend and twist dozens of times a day and you don’t hurt your back every day. It Is ok, in fact it is good for you to move your spine in all the variety of positions and angles that millions of years of evolution have allowed your spine to generate. Avoiding moving your spine is the problem. If you go around defending against the natural movement your body is capable of, you get stiffer, weaker and more sensitive to movements that you don’t do all that often because they come as a surprise to you when you do randomly do them. It’s not dangerous. If you don’t want those surprises then move more often and allow yourself to bend and twist. It’s ok.
My disc slipped
No it didn’t. Discs are not wet bars of soap. They don’t slip. They do change shape but they don’t move. Like cauliflower ear in rugby, The ear changes shape and gets a bit thicker in some rugby players but the ear itself doesn’t move around the face. Your discs will change shape over your lifetime and that’s ok. It’s part of living. Occasionally the disc changes enough that it hits a nerve and this can be very painful but it doesn’t do it suddenly in one dramatic movement. Not unless there is a major high speed collision. It’s usually compound changes that take place over a much longer period of time and those changes aren’t always painful. Most of the time they are painless. Disc do cause back problems but not as often as you think and they certainly don’t bolt out of your spine because you bent and twisted at the same time.
I pulled a muscle
Unlikely. When people say they’ve pulled a muscle they usually mean they’ve torn a muscle. When a soft tissue tears, it bleeds and you bruise. Just ask an athlete who’s torn a calf muscle or a hamstring. Their leg is black and blue. When this comes to your back you’ve more than likely sprained a joint in your back and the small muscles of the back are going into spasm around the sprain. Just like if you sprain your thumb the muscles at the base of your thumb will be solid and painful to move but you haven’t torn them. They are protecting an injured joint. It’s an easy label to give someone but it can result in people believing that they will tear muscles every time they do something challenging and therefore they avoid doing anything remotely challenging. That only means they will get stiffer and weaker which will lead to more back pain. To prevent sprains you want a mobile spine and strong muscles. They don’t tear all that easily so exercising them will help treat and prevent such sprains.
I slept wrong
Really? How many nights experience do you have with sleeping over your lifetime and do you really think you can get this wrong all of a sudden? Inflammation is greater at night-time as the body tries to repair and prepare. If you wake up stiff and sore one random morning it is more than likely the body is trying to deal with something that’s been brewing for a while and the pain isn’t due to the way you slept, it’s just a symptom of a bigger picture. You don’t need to rush out and buy a new mattress or half a dozen pillows until you find the right one if you’ve slept perfectly fine in that bed for months. Exactly why you went to bed feeling ok and woke up feeling sore can be for many reasons but sleeping wrong is not one of them. There is an exception of course. It isn’t unheard of for people who have been under the influence of drugs or alcohol to fell asleep half in or out of the bed or hanging over a chair or up against a radiator all night. Then you can sleep wrong but then you’ve got other problems to consider.
My Pelvis is out of line
This is such a dangerous mindset. To believe that you are so fragile and vulnerable that your spine and pelvis can go out of alignment all of a sudden. Unfortunately I hear this all the time as patients have often been told this in the past elsewhere. Worse still is when patients need someone to tell them if their spine is inline as they have some back ache and assume it can only be if their spine is “out of line”. I deal with jockeys and I’ve seen what a pelvis out of line looks like when a horse falls on top of them. You do not put your pelvis out of line by bending and twisting to tie your shoes. The bones of your spine are not a game of Jenga that shift all over the place. The muscles that extend the spine are big and strong and in some injuries the guarding response can be so powerful that it looks like the upper half of your spine is listing in a different direction from your lower half. Just like if you injured your elbow, you would bend your elbow to shorten the injured area. The bony bump at the back of your elbow is now more prominent but your bones are not out of line.
There are a lot of “Lazy Labels” out there when it comes to injury and back pain has no shortage of them. Words matter and if you believe you are going to “Pull a muscle”, “Slip a disc” and put your “Pelvis out of line” every time you bend and twist or go to bed everything will look like a threat and that’s no way to live.
All of this and more are explored in my up coming book “Pain: The ultimate mentor”.
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Thanks for reading.