Alex Simotas, MD

Hospital for Special Surgery
Board Certified Physiatrist
Specializing In Spine & Sports Medicine

Home > Learning Center > Anatomy > Myths or Truths in Back Pain

Myths or Truths in Back Pain

Myth 1: Getting plenty of rest is the best defense against back pain. Right? Wrong!
Truth: Resting in bed or lying on the couch for too long can actually delay recovery and make your pain worse. That’s because staying in the same position for too long can result in stiff joints and muscle weakness. Most cases of back pain do not require bed rest and are better dealt with by continuing your normal routine. According to studies, not using your muscles can result in a 12% loss of muscle strength a week.

Even though you might not feel like it, experts say it’s important to get up and walk around every hour or so to help keep your back strong. Daily exercising and conditioning can support the back by building muscle, improving posture, balance, flexibility and reducing pressure on the vertebrae.

Myth: Activities that involve compression are harmful to your spinal discs. Right?
Truth: Although spinal discs do undergo some compression with loading of the spine during upright activity, such as running, jumping etc., – new studies suggest that some loading is actually important for the spine. Not only does this help reduce unnecessary spine pain sensitivity, but it may actual be important in retarding spine degeneration that occurs as we age.

Myth: Back pain usually requires surgery. Right?
Truth: Despite what many might fear, in most cases surgery is not needed to treat back pain and is usually only helpful for certain specific conditions. Even in cases of disc herniation, small fractures and nerve problems, back pain will likely resolve on its own over time using more conservative therapies.

Myth: People who perform manual labor for a living are at greater risk for spinal degeneration and back pain. Right?
Truth: Most people who perform manual labor for a living show no greater incidence of spinal degeneration than others who perform more sedentary work. Even though lifting and transporting heavy objects puts pressure on the back, recent evidence suggests that people who work with some lifting and loading may actually prevent spinal degeneration by keeping their muscles strong. Only extreme lifting and contact sports have been definitively linked to the wear and tear of the back.

Likewise, lost work days from back pain and back-related injuries seems to occur in both sedentary and physically demanding occupations. Interestingly, third world countries that rely greatly on manual labor report no higher rates of back pain problems than highly industrialized nations where a greater proportion of citizens have sedentary occupations.

Myth: The cause of back pain is usually easy to identify. Right?
Truth: Back pain can be complex and often difficult to diagnose. For example, the vast majority (upwards of 85%) of low back pain cases cannot reliably be attributed to a specific disease or spinal abnormality. In some cases, back pain can also be a signal of a more serious health issue (for example, kidney problems, spinal infection or tumors).

Myth: Walking and hobbies like gardening are bad for my back and may slow down my recovery. Right?
Truth: In most cases, staying active is a key part in managing back pain, and doing so will also help you feel better mentally, physically and emotionally.

While it’s understandable and appropriate to initially avoid activities that cause you more pain, be careful not to let the fear of hurting yourself get in your way. Movement can actually help speed up the healing process and prevent future flare-ups. In contrast, being inactive can potentially complicate and prolong the pain.

It is important to focus on strengthening your core: your pelvis, back and abdominal muscles. As always, talk with your health care provider about the type and amount of exercise that is right for you. Ask how you can modify your favorite activities so they will be easier on your back.
If you suffer with chronic back pain (pain that lasts more than three months), you may benefit from the more intensive conditioning offered by physical therapy. Physical therapy is a program of specific exercises and treatment techniques designed to ease pain and improve function and range of motion while seeking to avoid future back pain flare-ups.

Myth: A firm mattress is best. Right?
Truth: For years, people with back pain have been told to sleep on a hard mattress. But harder is not necessarily better. Research has shown that those who sleep on a medium-firm mattress are twice as likely to report a lessening of back pain symptoms while lying in or getting out of bed. They are also less likely to need pain medications than those sleeping on a firm mattress.

Experts believe that the softer mattress may place less pressure on the shoulders and hips, allowing a more natural position for sleep.

Myth: Only people who are obese or overweight are more at risk for back pain. Right?
Wrong again! Well, partially wrong.
Truth: People of all shapes and sizes can experience back pain. However, there are many other risk factors for pain. Smoking, for instance, is a strong independent risk factor for back pain. Chronic smokers under the age of 45 are more than twice as likely to have back pain problems. Obesity is also is an independent risk factor. The likelihood of having back pain progresses with increasing weight.

Myth: As long as I’m physically fit I won’t get back pain. Right?
Truth: Physical fitness makes you less likely to have an episode of back pain, and recovery may occur faster. Episodes are likely to be less frequent and less severe. The extent to which back pain interferes with an individual’s normal activity is significantly less.

Nevertheless, short-lived periods of back pain can occur in individuals of all fitness levels. This supports the idea that spinal degeneration and its associated problems, such as disc herniation and spinal stenosis, are strongly linked to genetics.

Myth: You should expect to have an X-ray, MRI or other diagnostic scan to help diagnose back pain. Right?
Truth: Imaging tests like X-rays, MRIs and CT scans are usually indicated if you have suffered a trauma to the back or if your back pain persists without relief for several weeks.

In most cases of back pain, even the most sensitive imaging will not definitively detect a specific visible abnormality. Many factors causing common back pain, such as muscle spasm and nerve sensitivity, are not detectable on these tests.

Myth: Most back pain is due to irreversible injury to the spine. Right?
Truth: In fact, a common precipitator of back pain is muscle strain. A muscle strain or spasm may develop for numerous reasons: overuse, tension, or after an unexpected force. Other tissues in the back may become sensitive and painful in the presence of muscle spasms, without any significant injury. Fortunately, this can resolve quickly.

Myth: Once treated, back pain won’t return. Right?
Truth: Unfortunately, if you’ve had an episode of back pain, you’re at a greater risk of experiencing back pain again.
The good news is that there are many things you can do to help prevent or minimize a reoccurrence of back pain. Simple steps include:

  • exercising and strengthening your core muscles
  • improving flexibility
  • overcoming the fear of reoccurring pain

Myth: There’s nothing that can be done for chronic back pain — you just “have to live with it.” Right?
Truth: Back pain has a terrible rap in this country. Unfortunately, too many people living with chronic pain have heard these words. They have also heard many other statements under the guise of truisms that are sources of the misinformation that has insidiously led to many people suffering needlessly with chronic back pain.

In most cases, over time back pain goes away on its own. But for the 26 million Americans dealing with frequent and persistent back pain, there are many options for treatment. No one should have to suffer through it.
There are many approaches for alleviating back pain. Be persistent in telling your health care provider how your back pain is affecting your everyday life. If your pain continues, ask about other approaches you might be able to try.