Lower Back Pain FAQs
Most people will get lower back pain at some point in their life; here are answers to the questions I get asked most frequently about it.
In this edition of Momentum you’ll learn the answers to the questions I get asked most frequently about lower back pain.
If you're like most other humans on planet earth you will probably experience some back pain at some point in your life.
Fortunately, lower back pain is rarely indicative of anything serious and usually resolves as spontaneously as it arrived with most cases resolving in 5 days to 3 weeks.
Even though most back pain is benign, it is still the leading cause of disability worldwide.
Lower back pain is the 5th most likely reason for someone in the US to go see a doctor.
Basically… lower back pain sucks.
As a sports chiropractor and trainer I work with people every single day that have lower back pain.
It is either their primary concern or it comes up during the course of a performance based training cycle.
So, you’ve got lower back pain and you’ve got questions… here we go.
Question 1: Should I get an MRI?
My short answer: Probably not.
My long answer is below:
Patients, and many clinicians, often think that getting imaging done on the spine will answer all the questions and provide a path to the solution for back pain.
Unless you have weakness in one or both legs, have lost control of your bowels, or have extreme numbness in the leg/genital region then an MRI is probably not warranted.
The truth is, most people without pain have findings on their MRI.
And we have known this for over 30 years.
This study first published in the New England Journal of Medicine found that only 36% of people without symptoms had completely normal MRI findings.
Half of people without symptoms had evidence of disc bulging and a quarter of people without symptoms had disc herniations.
These findings have been repeated time and time again in various populations.
So, if you don’t have what we in the biz call progressive neurological deficits like severe weakness, loss of bladder or bowel control, or an inability to feel or move your legs it is not recommended to pursue an MRI.
Here are a few snippets from the American Academy of Family Physicians.
In the absence of progressive neurologic deficits or other red flags, there is strong evidence to avoid CT/MRI imaging in patients with non-specific low back pain
Don't do imaging for low back pain within the first six weeks, unless red flags are present
Now, it isn’t your job to decide whether or not you need an MRI. You should go see a qualified healthcare professional if you are having symptoms and pain that concerns you. But, if they don’t give you an MRI that is probably a good thing because it means they know their stuff.
Generally, unless someone is presenting with the severe symptoms like I mentioned above I don’t really care about what their MRI says because it is almost meaningless because so many of these findings are normal.
Question 2: Do I Have a Herniated Disc?
My short answer: Maybe? But it probably doesn’t matter.
My long answer is below:
Patients and unfortunately many clinicians think that a herniated disc is a life sentence of pain.
I have seen the look of relief on patients faces when I tell them that “no, I do not believe you have a disc herniation.” Its like I just told them that the treatment worked and they are going to live another 40 years.
Which is great, I’m glad I can provide piece of mind for those patients.
But, disc herniations often times are really not even that big of a deal. Here’s why:
Like discussed above, many people have disc herniations with zero symptoms
1-3% of people with lower back pain have a symptomatic herniated disc; so chances are you don’t have one that is actually an issue
Disc herniations heal; research has demonstrated that between 60-80% of herniations spontaneously resolve… so, if you are one of those people who has a symptomatic disc just know that it will heal
Every single week I have patients tell me that they had a herniated disc in their 20’s. And now they are 62.
While they certainly can be experiencing severe symptoms I highly doubt that the disc herniation in their 20’s is relevant.
Yes, you can still lift weights after or during a herniation. You may just have to modify things.
Yes, you can still run and jump and do anything and everything you want. You may just have to modify things and use a gradual approach to return to pre-injury levels.
Disc herniations are often times unrelated to the patient’s symptoms and are not a life sentence of pain.
Again, if you have concerns that you may have herniated a disc and are concerned that it is causing you symptoms I again recommend seeking help from a qualified healthcare professional to help you decide on an appropriate course of care to get back to your life.
So, maybe you have one? But it probably isn’t relevant to anything. If you do have one and it is relevant, fortunately it will heal and you can absolutely manage this injury with conservative care and do not need surgery.
Question 3: Is It From the Way I Sleep? Or Stand? Or Sit?
My short answer: No
My long answer is below:
I’ve used this picture many times when talking about lower back pain. Here it is again:
The experience of lower back pain has many, many, many inputs.
It is seldom attributable to just one thing.
Dare I say, it is never attributable to just one thing.
You could get stabbed in the back, literally not figuratively, and while you may think “oh, hey, my pain is because I have a knife in my back” you would still have a very strong emotional response to the knife in the back that affects your symptoms and experience of pain.
You aren’t sleeping wrong.
You may just experience more pain at night because there is nothing distracting you and you are hyper-focused on your pain. Or your mattress is uncomfortable. Or being in a certain position for too long causes increased symptoms.
You aren’t sitting wrong.
You may just experience pain while sitting because your chair is uncomfortable. Or because being in certain positions for too long causes increased symptoms.
You aren’t standing wrong.
You may just experience pain while standing because being in certain positions for too long increases symptoms.
And you sure as shit aren’t breathing wrong.
I don’t even know where to begin here…
We are exceptionally complex organisms that want really simple answers. So telling someone you’re sitting wrong and “fixing their posture” provides a simple fix. Makes a nice story and makes sense in our simple minds.
These things have been studied extensively to try to find the answer to the question: “why do people get lower back pain?”
This 2020 systematic review of systematic reviews (a mega study of other studies) was unable to establish any relationship between prolonged standing, prolonged sitting, or awkward postures and the onset of lower back pain.
My general advice here since people ask me every single day:
Sleep in a way that is comfortable for you and that allows you to get quality sleep.
Sit or stand in a way that is comfortable for you and periodically take breaks so you are more generally active throughout the day.
Breathe. Your body literally does it for you every second of every day. You’re fine.
Question 4: What Exercises Should I Do To Get Rid of My Back Pain?
My short answer: Literally anything that you want
My long answer is below:
Many different exercise types have been found to be effective at helping reduce back pain symptoms.
Yoga, Pilates, core stability training, stretching, bodyweight workouts, running, and even powerlifting have been found to be helpful for lower back pain.
Exercise works in a number of magical ways to help with lower back pain.
Exercise can help to improve the psychological aspects of lower back pain like regaining confidence in your body and in your ability to move without symptoms.
Exercise can help you to reach physical goals like increasing strength or flexibility to help with activities of daily living you were once unable to perform.
Exercise can help to improve any impairments you may have from limitations in flexibility or strength as compared to baseline or asymptomatic populations.
Exercise can produce endorphins and other chemicals that help to produce a pain relieving effect.
So what I usually do with patients is assess the type and amount of exercise they are currently doing and then prescribe exercise to help get them moving again, improve function despite pain, and meet physical activity guidelines.
This prescription can span from heavy lifting to a walking program to table-based exercises.
It depends on where you’re starting and where you want to go. But the important thing to remember is that…
When it comes to exercise for reducing back pain, you can do whatever you want and get good results.
If, of course, you have specific goals like being able to compete in a weightlifting meet or run a 5k then your rehab plan should build towards those goals.
Question 5: How Can I Prevent This From Happening Again?
My short answer: Do all of the things that you would do already to live a healthy and active life
My long answer:
Patients are often pleasantly surprised when I tell them that they don’t need to come in and see me 3 times a week for the rest of their life.
The best things to do to reduce your chances of getting lower back pain are the same things that you should be doing to live a long and healthy life.
Here’s the plan:
Exercise in a way that is meaningful to you and meets (or hopefully exceeds) the physical activity guidelines for strength and for cardio
Take care of your mentals - people with anxiety and depression have higher incidences of chronic lower back pain, and other body pains
Don’t smoke, try to maintain a healthy weight, and eat an overall health promoting diet because preventable chronic diseases like Type II Diabetes, Cardiovascular Disease, and conditions associated with cigarette smoking are all associated with higher incidences of lower back pain
I hope this information helped you in some way! Of course, this is not meant to be specific medical advice. I do provide rehab programs and consultations to help people with lower back pain as well as see patients in my office in Hazlet, NJ. If you are in pain and want to chat, reach out to me!
Wrapping Up
Lower back pain sucks. Unfortunately, there is a lot of misinformation out there about lower back pain. If you are in pain and want answers try to find a qualified healthcare professional to help you find an appropriate care plan for your symptoms.