Low back pain is one of the most common musculoskeletal issues people face and has a lifetime prevalance of 85%. However, it’s also one of the most misunderstood. Back pain is multifactorial, meaning it can be influenced by a combination of factors, including:
- Biophysical factors – muscle strength, mechanical loading, mobility
- Genetic factors – predisposition to certain conditions
- Psychological factors – stress, anxiety, and fear of movement
- Social factors – work environment, lifestyle, and daily habits
- Associated comorbidities – conditions like obesity, diabetes, or depression
Given this complexity, making sweeping generalisations about back pain is usually inaccurate. However, several common myths continue to shape how people think about and manage their pain:
1. Pain = Damage
Many people believe that if you feel pain, it must mean there is tissue damage in the spine. However, this is not always the case. It is possible to:
- Have tissue damage but no pain
- Have pain with no tissue damage
Pain is influenced by various factors, including nervous system sensitivity, inflammation, and even psychological stress. Instead of assuming pain always signals damage, it’s better to assess how your body responds to movement and loading over time.
2. You Need a Scan to Diagnose the Injury
Many people with back pain think, “I just want to see what’s wrong with my back.” While this seems logical, imaging (like X-rays or MRIs) is not recommended for most cases of low back pain unless there are red flag symptoms (e.g., severe trauma, unexplained weight loss, or loss of bladder/bowel control).
Studies have shown that many people without pain have “abnormal” findings on scans, such as disc bulges or degenerative changes. A scan alone cannot accurately diagnose the cause of pain and can sometimes lead to unnecessary worry or treatment.
3. A Weak Core Causes Back Pain
The idea that a weak core leads to back pain is one of the most persistent myths. While having a strong core is beneficial, it is not a magic fix for back pain. In fact:
- Many people with strong cores still experience back pain
- Focusing only on core strength ignores other important factors like leg strength, general health, beliefs about pain, cardiorespiratory fitness and stress.
Core training can be part of a well-rounded rehab plan, but increasing core strength alone will not necessarily improve your outcome.
4. Rest Is the Best Option
It might seem logical to rest when you have back pain, but too much rest can actually slow down recovery. Prolonged inactivity can lead to:
- Stiffness and muscle deconditioning
- Increased fear of movement, which can make pain worse
Instead of complete rest, staying active with modified movements is usually the best approach. Gentle mobility work, strength training, and walking can help keep your back healthy and resilient.
5. Bad Posture Causes Back Pain
Many people believe that poor posture is the root cause of back pain. While certain positions may trigger discomfort, research shows that no single posture is inherently “bad.”
Instead of thinking of certain postures as “good” or “bad,” a better perspective is:
- Some positions may be more sensitive than others
- Prolonged postures (sitting or standing too long) are more of a problem than any single position
- Movement variety is more important than maintaining a “perfect” posture all day.
Images like the one above are all over the internet and are not true. Both the posture on the left that is considered wrong and the one on the right can both be helpful postures depending on the context. Staying in one or the other all day could be worse than switching between both to provide more variety to your every day movements.
The Bottom Line
Back pain is complex and influenced by multiple factors, not just structural issues. The best approach is to focus on:
- Staying active with progressive movement
- Managing stress, sleep, and overall health
- Avoid unnecessary fear and catastrophizing
- Seek evidence-based rehab strategies
Want to help with your low back pain? Book a consult today!
