10 Common (and Totally Debunked) Myths about Lower Back Pain

Chronic lower back pain (LBP) is a persistent and debilitating condition that affects adult populations across the world. According to recent data from Statistica, around 620 million people world-wide suffer from chronic lower back pain, with projections that the condition will affect up to 7% of the world population by 2050. In the United States, a 2022 survey of adults found that 28% reported having chronic low back pain, with almost half of those experiencing pain for five years or longer, diminishing their quality of life.

Despite its commonality, medical practitioners are often at a loss for eradicating lower back pain, opting instead to manage pain until surgery becomes a final option. However, evidence suggests that surgery is no more effective than alternative care for non-specific chronic lower back pain, and carries much higher health risks, with no guarantee of success.

Learn about common lower back pain myths, peer-reviewed research that debunks them, and new advanced therapies that go beyond symptoms management to completely eliminating low back pain at its source.

Fact: Pain does not always indicate structural damage. In many cases, back pain is non-specific, meaning it has no immediately apparent structural cause involving the spine itself. Imaging modalities like X-ray or MRI often deliver normal scans in people with severe low back pain, while those whose imaging reveals structural damage like a herniated or degenerative disc may feel no pain at all.

Multiple non-structural factors can be involved in low back pain, including:

• Systemic inflammation
• Chronic mental stress
• Poor sleep habits
• Hypersensitized nerves

However, there are often structural or mechanical issues not directly located at the spine that can contribute to low back pain.

These include:

• Fascial restrictions and adhesions
• Sacroiliac joint (SIJ) dysfunction
• Muscle strain from lifting
• Hip flexor tightness
• Nerve compression or entrapment
• Poor posture
• Gait mechanical deficits
• Obesity
• Sedentary lifestyle

According to a 2022 article published in the New England Journal of Medicine, between 80-90 percent of low back pain cases are nonspecific in nature, and are associated with the interaction of biologic, psychological, and social factors. Low back pain rarely indicates a serious disease, and conditions like cancer or infection are rare.

Myth #2: The lower spine is fragile and should always be protected from mechanical stress.

Fact: The spinal column is a strong, adaptable structure designed to move freely and assist in load transfer. The fact that the spine houses the nerve roots that transmit signals between the body and the brain often causes concern among people who fear potential paralysis. But the spinal structures adapt to mechanical stress by becoming stronger, and avoidance of normal load-bearning activities can actually weaken the spine and increase your risk of injury.

According to the Spine Health Foundation, the spine is uniquely structured to support your body weight while standing, and to provide dynamic stability during physical activities.

Structures that protect, support and stabilize the spine include:

• Vertebrae – the bones that make up the spine. The vertebrae stack on top of each other, separated by spongy discs, forming a hollow tube that protects the spinal canal.
• Discs – soft, gel-like structures that separate the vertebrae and provide shock absorption and flexibility.
• Spinal cord – the tubular bundle of nerves that descends from the brain, traveling down the vertebral column. The spinal cord is protected by cerebrospinal fluid in the spinal canal, and protected by bone and strong ligaments. The nerve roots exit the spinal cord at strategic places, to innervate peripheral structures.
• Facet joints – these small joints connect the vertebrae to one another and allow for spinal mobility and stability.
• Ligaments and fascia – the spinal column is protected and supported by tough, fibrous bands of connective tissue.

Fact: Static imaging like MRI is generally not recommended for nonspecific low back pain, especially in the first few weeks. This often does not sit well with patients suffering from chronic low back pain who want to find a solution. When imaging comes back negative, it can lead to over-treatment as doctors attempt to placate the patient.

By contrast, when operated by an experienced integrative clinician, dynamic high-resolution ultrasonography is often able to shed light on the causes of low back pain that are not directly related to the spinal column itself. Factors like fascial dysfunction, myofascial trigger points, nerve entrapment, and SIJ dysfunction can all be detected with diagnostic ultrasound that renders dynamic images in real time.

In a 2023 study, ultrasound imaging of the thoracolumbar fascia (TLF) revealed a significant link between TLF density and low back pain and stiffness. Fascial density is a key indicator of fascial dysfunction, where the tissue becomes dense and sticky, inhibiting frictionless gliding and often entrapping nerves and blood vessels.

Fact: While spinal pain and stiffness is a common characteristic among many older adults, it is not an inevitable consequence of aging. Lifestyle behaviors play a key role in spinal health at any age, and active older adults often experience no significant back pain. Factors like obesity, sedentary lifestyle, metabolic disorders, and poor diet can profoundly affect spinal health.

A 2022 review on skeletal aging published by Mayo Clinic points to several factors related to spinal health, including:

• Genetics
• Sex steroid levels (particularly estrogen) in both men and women
• Nutrition
• Physical activity levels
• Vitamin D status

Fact: In cases of chronic low back pain, bed rest can actually weaken the spine’s supporting structures and slow the healing process. New research indicates that exercise reduces pain at the earliest follow-up after the initial consultation, compared with no exercise at all. Exercise has been shown to improve spinal function, both at the end of treatment and in the long run, and to reduce workplace disability. Short bouts of rest may help with occasional flare-ups, but physical activity typically accelerates recovery in the long term.

Fact: Regular exercise like walking, swimming, stretching, and targeted resistance training can help to prevent and manage back pain by improving strength, flexibility, and endurance. By contrast, avoiding physical activity can lead to degeneration of the structures that support and protect the spine, causing pain and reduced mobility.

A 2022 meta-analysis published in the Journal of Orthopaedic & Sports Physical Therapy concluded that most exercise interventions were beneficial for managing pain and disability in chronic LBP. They found that the most beneficial exercise regimens included core-based exercises and strength training.

Fact: While a herniated disc or disc degeneration are common causes of low back pain, specific low back pain more frequently stems from muscle or ligament strains, poor posture, facet joint issues, or spinal stenosis, all of which can cause compression of the nerve root. In more cases than not, chronic low back pain is non-specific, and does not stem from the discs themselves.

According to PainTeq, multiple non-spine-related issues can cause low back pain, such as:

• Sacroiliac Joint (SIJ) dysfunction, where the motion of the SIJ is altered, causing either from too much or too little movement. This can cause lower back pain, along with symptoms like difficulty standing or walking.
• Fibromyalgia, a condition whose symptoms include hypersensitized pain and tenderness throughout the body, including the lower back.
• Piriformis Syndrome, a condition where the piriformis muscle becomes tight or spasms, compressing the sciatic nerve and causing lower back pain.
• Iliopsoas tendonitis, where the tendon that attaches the iliopsoas muscle to the hip becomes inflamed, causing pain in the lower back and hip.

Fact: Improper lifting technique is a common cause of acute lower back pain, and it can become chronic if you continue to lift heavy loads with poor form. Poor posture, sedentary lifestyle, and obesity are likely to play a role, and can cause low back pain even when no heavy lifting is involved.

If you are a recreational weight-lifter, or your occupation requires heavy lifting, learning proper technique is critical to avoiding injury. Technique involves a whole-body approach that engages the core muscles and lower extremities, shifting loads away from the spinal structures themselves, and onto the musculature that is designed to bear loads and protect the spine.

One study found that during freestyle lifting tasks, people with LBP tend to move more slowly, with greater stiffness and a deeper knee bend than pain-free lifters, indicating more cautious movement, in an attempt to protect the back. The researchers suggested that adopting a lifting style more similar to that of pain-free lifters could potentially help reduce LBP.

Fact: A strong core does help to protect the lower back, but core strength alone may not be enough to prevent LBP. Muscle endurance, overall movement patterns, and posture can all have a profound impact on the lower back. Over-focusing on core training to the neglect of whole-body conditioning will not necessarily prevent lower back pain.

A recent article published in the New York Times emphasizes the importance of daily movement that includes walking, core exercises like planks, and whole-body exercises like pushups and bridges. The key takeaway is that staying physically active on a daily basis is the best way to avoid chronic lower back pain.

Fact: Most cases of lower back pain, including disc issues and sciatica, will self-resolve over time. Conservative interventions like physical therapy, shockwave therapy, myofascial release, and dry needling can help to relieve pain and expedite recovery. Surgery is rarely called for, and is reserved for cases involving severe, persistent symptoms or neurological deficits.

In a recent narrative review, researchers noted that spinal surgery for chronic LBP is becoming increasingly common, despite a lack of clinical data support. They recommend that chronic LBP should be managed conservatively, via a holistic approach that addresses LBP from a biopsychosocial perspective.

To manage lower back pain, medical doctors rely on conventional therapies like ice/heat, NSAID medications, pain reliever drugs, and physical therapy. When pain persists and the condition does not respond to conservative care, surgery may be recommended as a last resort. But in the case of non-specific chronic low back pain, where there is no identifiable mechanical cause, surgery is unlikely to resolve the issue, and relief may be temporary at best.

By contrast, integrative practitioners use a holistic approach to low back pain. They treat the whole patient, not just your symptoms, looking beyond the spinal structures themselves to find the root cause of your pain.

Common non-spinal causes of LBP include:

• Fascial dysfunction
• Pregnancy
• Piriformis syndrome
• Chronic mental stress
• SIJ dysfunction
• Muscle imbalances (too tight or too weak)
• Poor posture
• Physical inactivity
• Obesity
• Excessive sitting

Alternative treatment methods seek to not only manage pain, but to correct its source, with the goal of restoring long-term, pain-free functional mobility.

Alternative therapies for low back pain include:

• Prolotherapy – a minimally invasive therapy where a neutral solution is injected into damaged ligaments, tendons or joints to trigger an immune response. The immune system then delivers stem cells and growth factors to the treatment site, to stimulate cellular repair, reduce inflammation, and suppress pain. Prolotherapy provides significant pain reduction compared to placebo or physical therapy alone – especially for non-specific back pain.
• Extracorporeal shockwave therapy (ESWT) is a non-invasive approach that delivers high-energy acoustic waves to targeted tissues. The waves induce mechanotransduction, converting mechanical energy into biochemical signals that promote cellular repair.
• Interfascial plane and nerve hydrodissection is an ultrasound-guided procedure where a saline solution is injected into densified fascial layers, separating the layers and releasing entrapped nerves and blood vessels.
• Ultrasound guided dry needling uses filament-thin needles, inserted into myofascial trigger points – tight nodules of hypercontracted fibers that cause pain and interfere with muscle action. The needle triggers a twitch response that causes the fibers to relax, immediately relieving pain.

• Stecco fascial manipulation, an evidence-based manual technique that targets dysfunctional fascial layers, helping to restore their mechanical properties of elasticity and gliding.
• Posture correction training, to restore optimal joint and spinal alignment, taking pressure off of discs and nerves.
• Targeted physical therapy, to promote spinal mobility and stability, restore muscle balance, and promote strength and stability
• Dynamic neuromuscular stabilization (DNS), to restore the body’s innate developmental movement patterns.

Holistic practitioners typically steer clear of medications with harmful side effects, opting instead for methods that tap into the body’s own natural healing mechanisms. Rather than just addressing symptoms, the end goal of integrative medicine is to restore pain-free functional mobility.

Low back pain can be severely debilitating, limiting your daily activities and diminishing your quality of life. Patients suffering from chronic non-specific low back pain often go from doctor to doctor, failing to find a lasting solution for pain relief. When all else fails, surgery may be attempted as a last resort, but often fails to resolve the condition.

At NYDNRehab, we treat the whole patient, not just your symptoms. Our advanced technologies and cutting-edge therapies have helped scores of patients to find fast and lasting lower back pain relief. Don’t settle for pain management that fails to resolve your low back pain. Contact NYDNRehab today, and get long-term relief so you can get back to your active and productive life.