Fear and Back Pain

A lot of people are afraid of back pain. I think that most of that fear comes from misinformation that has been passed down through generations. One of my favorite things about being a Doctor of Physical Therapy is that I have the opportunity to challenge unhelpful previously held beliefs and make people less fearful of movement and even pain. There is something special for me about working with back pain and I think that’s because the fear around back pain is so prevalent and often so unnecessary. My role in reducing that fear is very important and very impactful—for me and my patients!

Unhelpful Beliefs About Back Pain

A relatively common remark we hear from patients is something to the effect of, “my dad has a bad back” or “bad backs run in my family.” I can believe that “unhelpful beliefs about your backs” run in your family (i.e. a mindset that all back pain is bad, back pain requires rest, deadlifts are dangerous, etc.), but in most cases back pain is not genetic or predestined.

Before resigning yourself to a fate of constant back pain, I want you to assess your family’s physical activity habits and the ways in which they attempted to deal with their back pain. Were they active and moving as much as possible when they had a flare-up? Did they attempt to strengthen their back in an attempt to get rid of pain and become more functional? Or did they take a passive approach—rest, ice or heat, pain killers, surgery? We control a lot more of our destiny when it comes to pain than what people tend to think.


Imaging For Back Pain

Another topic that comes up with many conditions we see, especially with back pain, is imaging. Somewhere along the line, many people get the idea that they need an image of their pain area in order to know what is causing the pain and how to treat it. Did you know that the source of low back pain can be identified in LESS THAN 10% of cases via MRI? Did you also know that trying to identify the pathoanatomic source of pain is NOT recommended? Instead, it’s recommended that we identify what movements your back pain responds best to and start from there. (Clinical Practice Guidelines) So we can guess the source of your pain, but most of the time it won’t change how we treat you or change the outcome of that treatment.

As Doctors of Physical Therapy we are well trained in determining when imaging IS necessary. The American Academy of Family Physicians recommends against imaging within the first 6 weeks of symptoms unless red flags are present (e.g. progressive weakness/sensory changes, bowel/bladder changes, suspected fracture, etc.) Imaging isn’t usually even necessary outside of those 6 weeks if you haven’t yet tried physical therapy. If your symptoms haven’t improved in 6 to 8 weeks with properly dosed physical therapy, then yes, imaging may be necessary.

Final Thoughts

So we’re not against imaging, we’re just against unnecessary imaging and we understand that imaging that may end up “hurting” more than helping. What happens when a patient gets an MRI result that shows a structural abnormality—even one that wasn’t likely causing any pain or dysfunction? It sits with them forever in the back of their mind and makes them think that they are fragile and broken, when in reality, finding changes on imaging is NORMAL and not necessarily associated with pain. There is even a push among medical providers to move away from diagnoses like degenerative disc disease in favor of using terms such as age related changes.

With all that being said, if you need a hype man (or woman) to tell you how strong and resilient your back is, we are your people.