Back pain equals further damage to the area
The international definition of pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (1). What this means is that we can have pain with tissue damage, i.e., a paper cut or without damage. Pain is more a protector of an actual or perceived threat, not of damage. There are many contributing factors that may flare-up pain. These factors are biopsychosocial such as past experiences, beliefs, injuries, fear/avoidance, stress, and social health may contribute to back pain. However, rarely does the pain mean further damage but more an over-protection response (2).
Scan results show that I have a damaged spine
Scans may show degenerative changes, disc bulges, protrusions and annular fissures. These can be quite scary for people to see as they believe they’re damaged and must be careful with movements. Recent evidence suggests that these scans showing changes mentioned above, are common with asymptomatic people (3). Degenerative changes, disc bulges, protrusions and annular fissures were all found in pain free people which increased percentages with age (3). What this means is that pain is multifactorial and more complex than just a scan result.
Weak core muscles are leading to my back hurting
A common belief is that it is important to have a strong “core”. Recent scientific studies have found that motor control or trunk muscle exercises are no better for reducing pain than any other form of exercise for chronic lower back pain (4). Many people with chronic lower back pain have been told they must tense their trunk muscles to “protect” the spine, with this is just leading to muscle fatigue and soreness. This over-protection can lead to an increase of threat with movements which is maladaptive.
Written by Harrison Brown (Accredited Exercise Physiologist)
References:
1. Merskey H, Bogduk N. Classification of Chronic Pain. IASP Task Force on Taxonomy, 2nd edn. Seattle, WA: IASP Press; 1994.
2. G. Lorimer Moseley, David S. Butler, Fifteen Years of Explaining Pain: The Past, Present, and Future, The Journal of Pain, Volume 16, Issue 9, 2015,Pages 807-813,ISSN 1526 5900, https://doi.org/10.1016/j.jpain.2015.05.005.
3. Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27. PMID: 25430861; PMCID: PMC4464797.
4. Saragiotto BT, Maher CG, Yamato TP, Costa LOP, Menezes Costa LC, Ostelo RWJG, Macedo LG. Motor control exercise for chronic non‐specific low‐back pain. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD012004. DOI: 10.1002/14651858.CD012004. Accessed 11 July 2022.
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