For my first, low-key social outing after the recent pandemic-induced confinement I went over to a friend’s house for a barbecue. I spent some time chatting to Thomas, a motion graphics designer from Bretagne who was there with his wife, Rosine and their one year-old daughter.
Thomas had just started a new fitness regime, so when he found out I was a personal trainer he said he was interested in having a look at my website. We exchanged numbers, both with the idea that perhaps we could use each other’s professional expertise some time in the future.
However, I don’t think either of us expected that time in the future to be that very same evening.
A few hours after I left the barbecue I got a text message from Rosine. She had injured her back on the way home – an old injury that had flared up after spending an hour sitting in the overly-soft passenger seat of their rental car.
After they got back Thomas had been looking at my website and saw that I help people with low back pain. He showed Rosine, who was by now unable to get her body into a position that didn’t trigger her pain.
Given that she had tried, as she later told me, ‘everything’ to fix her back pain yet still suffered periodic episodes like this, she was becoming desperate. She’d had enough of not being able to pick up her daughter, or even bend down to play with her without provoking her pain.
She did some cursory internet research of the 'McGill Method' that I use to help clients with low back pain and decided it was worth a try and sent me the SMS.
When I called her back I managed to help her get her pain down from an estimated eight (on a scale of 1 to 10) to zero by guiding her over the phone into a position that didn’t trigger her pain. This was good news as it meant that I could probably help her. If she was able to have even short periods with no pain then there was a good chance we could extend those pain-free periods to hours, then days, then weeks.
She’s now been following the program I took her through for a month and at the time of writing she’s had the past two days entirely pain-free. That doesn’t mean that she’s ‘cured’ because often when there is instability caused by damaged ligaments, complete healing can take years.
However, if she's careful to avoid the postures, movements and loads that provoke her pain (and she maintains the muscular endurance she has now developed that helps her to do this) she should be able to avoid having debilitating episodes like the one she had after the short car journey.
So, why am I telling you all this when the title of the article promised information on myths about back pain?
Because if Rosine hadn’t been misled by one of these persistent myths then she probably wouldn’t have had to suffer her pain for so long.
For the previous few months she’d been practising yoga because she’d read that it’s good for getting rid of back pain. Every morning she would do, amongst other, well-intentioned exercises, some ’sun salutations’ and ‘child’s pose’ stretches that put her lumbar spine into positions of flexion (bending forwards) and extension (bending backwards).
The problem, as I discovered during Rosine's initial biomechanical assessment, was that she was both flexion-intolerant and extension-intolerant. In other words, both flexing her spine and extending her spine triggered her pain.
Rosine would later tell me that she had suspected that the yoga postures may be preventing her back from healing. But, at the same time she thought that perhaps she would just have to live with her pain because she’d always had a bad back. And maybe without yoga it could be even worse.
Because of the persistent myth that ‘yoga is good for your back’ it was harder for her to see that her pain would probably have got better if she’d just stopped doing yoga.
To be clear, I’m not saying that yoga is bad for everyone's back. I’m saying that it shouldn’t be given as a generic exercise prescription to people with back pain because there are certain positions in yoga that will exacerbate pre-existing back issues.
It’s a common mistake to think that more mobility is always better. Sometimes, as in Rosine’s case, more mobility causes more pain. Unstable spines need more stability, not more mobility.
Is a belief in any of the following myths stopping your back pain from getting better?
Myth #1: If physical therapy didn’t cure my chronic pain then surgery is my only option
People who have seemingly tried everything to cure their back pain including physical therapy, Pilates, chiropractic treatments, etc. are frequently told that surgery is their only remaining option.
However, Dr. Stuart McGill, widely considered one of the world’s leading low back pain experts, states in his book, The Back Mechanic: ’Ninety-five per cent of the challenging patients I see do NOT need surgery, even though many were told that was their only cure.’
McGill warns that most surgeons believe that pain can be ‘cut out' with a scalpel. However, in reality, it’s rare that the tissue being targeted for removal is the only cause of the pain. Also, during surgery, healthy tissues, including nerves, are often severed and destroyed when cutting through to reach the spine.
While surgery does work for some people, studies show that a few years after surgery, patients are no better off than others who opted for non-surgical treatment. This is mainly because the flawed movement mechanics that led to the original injury are never addressed. Often, the operated site is stabilised, but the level above or the level below now suffers the same injury.
Instead of risking surgery, McGill recommends trying 'virtual surgery’. This involves doing what you would do after surgery – without doing the actual surgery. In other words, rest and avoid provoking your pain through faulty movement patterns. This often reduces your pain enough to be able to start a rehab program. This usually involves learning movement patterns that don’t provoke your pain and improving the endurance of the torso muscles.
Myth #2: Back pain gets worse as you get older
Many people believe that their back pain is only going to get worse as they get older. However, the reverse can often be true. Most people report having less pain around the age of retirement than they had in their thirties and forties.
This is because as you age, your joints begin to gristle and stiffen up, making you less likely to suffer damage to your intervertebral discs which are often the source of pain for people under the age of 55.
Myth #3: A herniated disc means the end of your athletic career
While a damaged disc in your spine can be extremely painful and debilitating, it doesn’t necessarily mean you won’t be able to practice your favourite sport any more. If you’re able to stabilise your spine sufficiently and correct the poor movement patterns that caused the injury in the first place, then it may even be possible to improve on your pre-injury performance.
An extreme example is Brian Carroll, a world record-holding powerlifter who suffered not only disc herniations, but multiple fractures in his spine from years of lifting with, by his own admission, sub-par technique. After seeing numerous medical experts who told him he would never recover, he had a fortuitous meeting with McGill.
After an extensive rehab program, his spine healed to the point where he became 100% pain-free again. In Gift of Injury, the book he co-authored with McGill, he describes the healing process and his insistence on pristine technique when he resumed training. This enabled him to improve on his previous performances and go on to break more powerlifting world records. The video below shows him post-recovery, squatting with 1,000 lbs on his back.
Myth #4: An MRI is all my doctor needs to diagnose my back pain
MRI images can unfortunately only provide limited information regarding the causes of your back pain. In essence, they are static images of your back taken in one position (usually while lying on your back) at one moment in time. They don’t show what happens to your back tissues when you move and change position.
Also, as well as showing current injuries, they show a history of the injuries you’ve previously suffered. So, the herniated disc that you see on the MRI may in fact be an old injury which isn’t the source of your current pain. And, even if a correct diagnosis is reached, such as sciatica or a disc bulge, this information alone won’t help you cure your back pain.
McGill emphasises that the title of your condition isn’t the most important information you need to know to cure your back pain. What’s more important is to find the cause of your symptoms and address them directly in order to recover.
While an MRI may be useful as an extra piece of evidence to establish a hypothesis about the cause of your pain, it shouldn’t be relied on exclusively for a diagnosis.
To determine the cause of your back pain, it’s necessary to undergo an assessment by an expert who administers pain provocation tests. Only then can you determine the postures, movements and loads that cause your pain, and design an optimal recovery plan.
Myth #5: Bed rest is good for back pain
Although bed rest is often recommended for treating back pain, too much time spent lying down can actually exacerbate your pain. When you’re lying in a horizontal position your intervertebral discs fill with fluid, gently pushing the vertebrae away from one another. This makes the spine longer, and as a result, actually makes you slightly taller first thing in the morning.
This is good for your back because it allows the discs to get the nutrients they need, but it comes with the additional side effect of making your back feel slightly stiffer when you wake up. This isn’t a problem if you spend about eight hours in bed, but if you spend much longer than this your discs will continue to swell and may become painful.
Myth #6: Yoga and Pilates are great for alleviating back pain
We’ve already seen how yoga can, in fact, be detrimental to people suffering from low back pain. The same can be said for Pilates, another mode of exercise mindlessly recommended by some doctors and therapists because they believe it is good for strengthening your ‘core’.
While some movements and poses may be beneficial or feel good, there are components of both yoga and Pilates that will aggravate your pain if you have low back issues.
Quoting McGill from Back Mechanic: 'There is no such thing as an exercise program that is beneficial to all back pain sufferers and to broadly prescribe either yoga or Pilates to a patient with undefined back pain is, in my opinion, irresponsible. Every single exercise should be justified and then modified to suit each person.’
He reserves particular criticism to the practice of flattening the spine down and ‘imprinting’ it to the floor when lying down. This disrupts the spine from its neutral position, placing unnecessary stress on the intervertebral discs.
McGill has conducted numerous scientific studies on the common 'sit-up' showing it to be a poor exercise for most people due to the stress it places on the posterior aspect of the discs. The ‘Rollup’ from Pilates has taken this essentially bad exercise and made it even worse. The emphasis on moving through the spine places even greater stress on the discs than during a sit-up.
If the goal is to train the muscles of the torso whilst minimising stress on the discs there are a number of other superior exercises that do so by maintaining the spine in a neutral position. Movement should be encouraged through the hips, not the spine while there is stress being placed on the discs.
Myth #7: Stretching is good for back pain
A new client who had low back pain told me that her back always felt worse after the sessions with her physiotherapist. When I asked her what treatment her physiotherapist was giving her she showed me a series of stretches that put her spine into a flexed position.
After conducting an assessment involving provocative testing it was clear that she was flexion-intolerant. One week after stopping her prescribed stretches her back pain had disappeared.
The idea that stretching is good for back pain is outdated and needs challenging. Well-meaning therapists often prescribe inappropriate stretches with the goal of improving mobility in the spine. However, for most back pain sufferers this is the opposite of what they need.
On a physiological level, lying on your back and pulling your knees to your chest triggers the ’stretch reflex’. This is a neurological phenomenon that reduces pain sensitivity in the short term, providing about 15 minutes of pain relief for some people. However, when you put your spine into this flexed position you can aggravate your discs which can make your pain come back worse than before.
If you have disc issues, instead of stretching your spine and making it more mobile, your focus should be on stabilising and controlling it in a ’neutral’ position. This will allow your pain to subside. Increasing the mobility of other parts of the body such as the hips and shoulders will help you maintain your spine in a neutral position when you move.
Myth #8: Nothing works for back pain, so I should just get on with it
The problem with studying back pain is that its cause, and consequently, its optimal treatment varies so much from one individual to another. It’s unlike more homogenous conditions such as diabetes where the cure is the same for everyone.
It’s therefore impossible for individual studies to determine the success of back pain interventions. If the same methodology is used on the participants (as is required in scientific studies), there will always be some of them that get better and some that get worse. These inconclusive results are what lead some journalists (and even some doctors) to conclude that nothing works for back pain.
However, what Stuart McGill has shown after spending 30 years studying people’s spines is that it’s often possible to cure even the worst cases of back pain.
If you can identify and eliminate the mechanisms that cause your pain, and you’re willing to play an active role in your own recovery there’s a good chance that you can get rid of your back pain once and for all.
These myths about low back pain have been adapted from Stuart McGill’s book, The Back Mechanic.
Andy Marlow is the founder and head trainer of 360 Personal Training, based in Paris. He is the only McGill Method Certified personal trainer in France.