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Help Me Make This Pain Go Away!

I know that statistics are the last thing you want to hear about right now -- your aching back is pretty much all you can think about at this time. And while I will discuss the "what you should do" suggestions quite soon, first I want to explain what's meaningful and what isn't when it comes to back pain.

My favorite myths about back pain vividly illustrate why your confusion is so understandable -- you've been hearing a lot of misinformation, ranging from medical misconceptions (imaging studies are helpful for making a diagnosis) to old wives' tales (if you are middle-aged, it's normal to have back pain).

Realizing that the following popular myths aren't always true will put you on the path toward better understanding.

Ten Myths About Back Pain

Myth 1: If you bend down to lift something up and your back goes out, it is because you bent wrong.

Very rarely will your back go out after you've made a simple movement, such as bending. If you suffer sudden back pain as a result of bending, it is more likely that you have been doing something that has damaged your back little by little. Bending was simply the final indignity, and your back responded with, "No more!"

Myth 2: The location of the back pain determines the problem.

The fact is, you may be experiencing pain in one part of the body but the problem often does not originate from the same spot. For example, an imbalance in your feet can cause your lower back to hurt.

Myth 3: Extra weight can be the primary cause of back pain.

While extra weight is not good for your body overall, your spine is not going to give out because of a few extra pounds. Being overweight is only one piece of the back pain puzzle -- it is by no means the determining factor.

The question I always ask is, "Was the patient overweight before he or she had the back problem?" Extra weight is generally not the root problem; the unhealthy habits that caused the patient to be overweight in the first place are usually the primary reason for their back pain.

Myth 4: If you have back pain more than once, you will probably need to have surgery at some point.

Surgery is not inevitable; nothing could be further from the truth. It is always best to start with the least invasive solution. Back surgery is not a cure-all. The common model that the surgeon may present to you -- that a disc sitting on a nerve needs to be corrected -- is oversimplified and at best only partially true. As a rule of thumb, don't even consider surgery initially. It is not recommended during the first 6 weeks of pain onset; half of patients with radiating lower back pain recover spontaneously with pain management, minimal bed rest, and a return to appropriate physical activity.

According to the National Committee for Quality Assurance, patients often undergo aggressive treatments when less costly and less complicated therapy may yield similar or better results. Unfortunately, some patients who have back surgery find themselves suffering from failed back surgery syndrome (FBSS). The fact that there is actually a term to describe this situation says it all.

For a select few, back surgery can be the best course of action, but explore the less invasive solutions first.

Myth 5: MRIs are helpful for diagnosing back pain.

Magnetic resonance imaging (MRI) is actually ineffective when it comes to the diagnosis of back pain. Based on studies conducted between 1998 and 2000, doctors at the University of Washington in Seattle concluded that using MRIs leads to a higher rate of specialist consultations and more surgeries for patients, but results in fewer beneficial outcomes. In the Journal of the American Medical Association, Nortin M. Hadler, professor of medicine at the University of North Carolina at Chapel Hill, noted that MRIs are not effective for patients with back pain because the imagery is insufficient to diagnose the root cause.

Myth 6: The best way to predict future occurrences of back pain is with an X ray and/or blood work.

In one study, 3,000 Boeing employees were followed over a period of 4 years. The investigators found that psychological stress was a far more accurate predictor of future back pain problems than any physical measure.

Myth 7: By age 60, it is normal to have some back pain in the morning.

It is not normal, but it is very common for middle-aged adults to experience back pain. However, back pain does not have to be a life sentence that worsens as you age.

Myth 8: If you have a disc herniation, there is nothing that you can do; you just have to learn to live with pain.

There are thousands of people who have a disc herniation who have absolutely no symptoms. In a landmark study published in the New England Journal of Medicine, researchers found that 28 percent of the people whose MRI results revealed a disc herniation have actually never suffered back pain.

Myth 9: To have a strong back, you need strong abdominals and a strong core; the best way to achieve this is through sit-ups and crunches.

Sit-ups and crunches actually cause more back pain than they prevent. I've treated so many patients who have hurt themselves by doing these exercises that I am perfectly willing to tell you that these are the worst exercises you can do. I firmly believe that they should never be done.

Yes, you want to strengthen your back by having a well-functioning core and abdominals, but the abdominal exercises (like sit-ups) that doctors have been recommending for years have nothing to do with stabilizing your back because they work the wrong abdominal muscles. The ideal exercise for back strengthening is an exercise called "The Skinnies", which works a small internal abdominal muscle called the transverse abdominus.

Myth 10: Diet has nothing to do with back pain.

"You are what you eat" happens to be true about back pain. When people digest food, they have a viscerosomatic reaction. This means that as the digestive system processes the food, it can affect the muscles. Just as every joint and muscle seems to ache if you have an alcohol-induced hangover, the same type of viscerosomatic reaction occurs when you eat foods that disagree with you in some way.