Low back pain is the leading cause of pain and disability worldwide. Statistically, the prevalence of lower back pain is increasing, so what are we doing wrong? Historically, people have often been told to rest or to strengthen their core muscles, and for many, that is not helpful advice to get to the root of the problem.
We need to change that message. The structures in the back that cause pain, and the biomechanics of spine do not seem to be as important as we once thought they were. We need to stop thinking that someone will break when their spine is put under load. Our bodies are much more resilient than that, and it is never helpful to promote fear. The spine is designed to move in all directions, and it is important that it does. Telling someone NOT to move in a certain direction as it will damage the spine is both wrong, and can change their brain over time. If someone is scared to move into flexion and tries to avoid it at all costs, when they have to move into flexion to tie their shoes, they will consistently be thinking that they could damage themselves. Is tying up a shoe really dangerous? No it’s not.
We can train ourselves to do almost anything, and the risk of injury is dependent upon much more than how we move.
Several studies have shown that spinal flexion cannot be avoided, even when trying to keep the spine in a “neutral” position with activities like squats, dead lifts, or a multitude of ab exercises. If such movement cannot be avoided, no matter the loads or conditions, why do we teach people this will result in low back pain? Fear and limiting beliefs about the fragility of the spine are hurting us more than actual movements.
People with low back pain need to hear reassuring, positive and empowering language. A person who has lower back pain WILL get better; they WILL get back to what they love to do. Almost everybody does. As a Physiotherapist, it is important to ensure people with lower back pain are empowered to stay active and strong in ways that they enjoy.
One of the most important messages to convey to someone who is suffering from lower back pain is to remind them that they are strong, their spine is robust, and they will recover. Each person needs to keep moving in ways that feel good, and temporarily avoid positions that seem to create pain. The big word here is temporarily—once pain settles down, there should be no restrictions in movement. Get back to everything!