Four Things Your Physician Won't Tell You About Back Pain

healthcare physical therapy Apr 05, 2019

By: Molly King


Back pain is the most common musculoskeletal complaint and the #1 reason for doctors visits among adults.  It affects over 80% of us at some point in our lifetime!  Unfortunately, most of these patients go to see their primary care physician, looking for answers.  They leave with a scary sounding MRI report, a prescription for opioids, and no real understanding of the cause of, or solution to, their back problem.  61% of patients who initially saw their primary care provider were prescribed a course of opioids and 18.8% of them became long term users.  A staggering 90% reported they did not understand the cause of their pain.  Americans spend $50 billion on low back pain treatments each year, and over $100 billion dollars in indirect costs (missed work, legal costs, etc.).  Here are four things to help you better understand your back pain and how to treat it.


The source of your back pain probably isn’t in your back:  

Quite often, dysfunction in neighboring joints, most commonly the hips, pelvis, and upper back, poor core stability, and/or inefficient movement patterns are the underlying drivers of low back pain.  In these cases, assessment and treatment solely focused on the low back will not address the true problem, and, therefore, will not relieve your pain. A doctor of physical therapy can perform a comprehensive evaluation of your low back, neighboring joints, and the way your body moves as a whole, allowing them to get to the true root of your problem.



You are not your MRI:  

We see patients all the time who come in with scary sounding MRI reports saying that their back is a wreck, full of degeneration and disk bulges, the damage is irreparable, and they’ll never be the same.  The truth is, disk degeneration and bulging viewed on an MRI are a normal part of aging and are not linked to back pain.

37% of 20 year-olds with no back pain have “degeneration” and “disk bulging” on MRI, and 96% of 80 year olds have “degeneration” and “disk bulging” with no pain.  

More often than not, the true cause of your pain is a combination of tight muscles and stiff joints throughout your back, pelvis, and hip, poor core stability, and inefficient movement patterns, none of which can be seen on an MRI or x-ray.  Think of an MRI as a photograph of you:  it can visualize the physical aspects of what is going on at one specific point in time (i.e. age, hair length, clothing, etc.), but it cannot reveal what you are thinking, feeling, doing, or experiencing.


A chemical solution will not solve a mechanical problem:

Pain relieving medications, from the Tylenol and ibuprofen in your medicine cabinet to the strongest opioid or injection therapy, will not fix your back pain because they try to treat a mechanical issue with a chemical solution.  While they may relieve your pain for a short period, they do not address the root cause of the pain and are not a long term solution. Additionally, they come with a myriad of side effects from stomach upset to ulcers, liver damage, and addiction.


Exercise is safe and beneficial:  

Many people believe they should rest when they have back pain, but a global review of low back pain treatment guidelines came to the consensus that bed rest should be strongly discouraged.  Exercise activates your body’s endogenous opioid system (your internal pain relief system), which relieves pain safely and naturally. In addition, tackling the mobility, stability, strength, and endurance deficits that are contributing to your low back pain will address the root cause of your pain and prevent future recurrences.  A physical therapist can teach you how to safely exercise to improve your back health and overall wellness.


I hope you’ve found this article informative and helpful.  If you have any questions, please email me at [email protected] or click here to schedule a physical therapy evaluation. 


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