You tried to hop out of bed this morning, but instead, had to slowly roll to one side, and push yourself up with your arms.
Just standing up straight feels nearly impossible.
It’s hard to find a comfortable way to sit without feeling a sharp pain in your low back.
It feels like you will never work out the same again.
Hopefully this doesn’t describe your morning, but if it does, just know that you're not alone.
In fact up to 84% of the population will experience non-specific low back pain at some point in their lifetime. (1)
Telling you that plenty of people experience this doesn’t get you out of pain, but I do hope this article can help shed some light on what’s actually going on in your body, and what you should do (and not do) about it.
Low back pain is the fifth most common reason for physician visits. (2) That’s pretty high!
Like we already said 84% of the population will have low back pain in their lifetime (1), and less than 1 percent were due to some type of traumatic or emergent problem (3) (tumor, cauda equina, fracture, etc…). In other words it's statistically unlikely that an acute episode of low back pain is caused by something extremely serious.
Lastly, it has been estimated that over $50 billion annually is spent on low back pain in the United States alone. 50 BILLION!
Ok, enough with the stats. You get the point. It’s common, it’s real, and it’s expensive.
So let’s address everyone’s first thought when their low back starts hurting.
When your back hurts, and you feel like you can’t move, it seems logical that a picture of your insides will help determine the problem.
It will show you the structural damage that's causing your pain, right?
Unfortunately, the link between X-rays/MRI’s and your pain is very weak. In other words, just because an image finds something “off” doesn't mean that finding is the cause of your pain.
An overwhelming amount of studies have shown that abnormal findings are extremely common in healthy, asymptomatic people. For example: one study on sciatica found that 32% of their non-symptomatic participants had evidence of degenerative discs, and disc bulges on an MRI. (4)
This graphic from Tony Comella displays this point really well:
It goes back to the causation vs correlation idea. Just because two things can be correlated, does not mean that one caused the other.
I know this is sounding like I am anti-imaging, but thats not completely true. There is a time and place for imaging, but overall I think we rush into it prematurely.
Physical Therapists are trained in differential diagnosis. This means that we are extremely capable of determining if your injury falls into the musculoskeletal domain, or if you should be referred out to a physician for further testing.
Since we have already established that the vast majority of low back pain is not due to trauma, and that imaging correlates very poorly to the cause of your pain, why are we rushing to a specialist to have imaging done?
It unnecessarily costs you time and money, when you could start with PT where you will likely end up regardless. If things were presenting abnormally, I would absolutely tell you if a specialist and imaging were needed.
What most people don't tell you is that herniated discs can heal, disc degeneration is poorly correlated to back pain onset, and that a well designed rehab program has strong evidence supporting it's efficacy in treating low back pain.
Ok, enough with numbers and hypotheticals.
The first step is understanding that movement is not bad. It’s easy to start avoiding certain things because they have been painful.
The best approach is to start easing into lower level exercises to improve your currently limited mobility. This will also start to desensitize your body to certain movements, telling your brain that these positions are now safe to move into.
Here are some exercises to start with, and then progress through as your pain begins to decrease.
Lower back pain is an unfortunately widespread problem, and there are a million and one people telling you that they have the missing piece to ridding you of this pain.
It’s just not that simple.
Humans are amazingly complex and, as research has shown, so is pain. There are situational, environmental, and psychological factors that all play a role.
What I hope you take from this article is a sense of reassurance and confidence. Low back pain doesn't have to be the end of doing things you love, no matter what an X-Ray or MRI tells you.
Your body is amazingly resilient. Knowing and believing this is a critical first step to getting back to doing the things you love!
I truly hope this article was helpful for you.
If it was, would you consider sharing it with someone else who could benefit? Thanks a ton!
1. Balagué, Federico, et al. "Non-specific low back pain." The Lancet 379.9814 (2012): 482-491.
2. Anthony Delitto, et al. "Low Back Pain: Clinical Practice Guidelines" Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic and Sports Physical Therapy, 2012, 42(4).
3. Gatchel RJ, Polatin PB, Mayer TG. "The dominant role of psychosocial risk factors in the development of chronic low back pain disability." Spine (Phila Pa 1976). 1995 Dec 15;20(24):2702-9.
4. Savage, R.A., G.H. Whitehouse, and N. Roberts, The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males. Eur Spine J, 1997. 6(106-114).
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