Outdated Healthcare Practices Worsen Lower Back Pain: 4 Ways to Fix Your Back

August 3rd, 2020  by  Dr. Dylan Peterson, Doctor of Physical Therapy

For many back pain sufferers, when you receive an MRI and find the cause of your back pain, you think this is the beginning of your road to recovery. Identifying the cause of back pain seems like it would be the first step and most important step to any recovery plan. But research suggests that this may actually do the opposite and in fact, worsen your pain, not improve it.

Outdated practices cause chronic back pain

A study in the British Medical Journal (BMJ) shows persistent back pain can, in part, be blamed by outdated healthcare practices and treatments. Overutilization of MRI scans and blaming specific structures of the back for a person’s pain have long been known to lack evidence, according to research in Physical Therapy.

Outdated healthcare approaches focus heavily on abnormalities and scans, rather than leveraging the innate strength and resilience of the human body.

Costly MRI scans often distract people from what they have control over--how they can move and heal their own body through lifestyle changes and exercise therapies. When a scan comes back showing disc bulges, disc degeneration, scoliosis, arthritis, or other common findings, it is only natural for people to be cautious about their movement.

After a scan, bad habits often emerge such as moving less, avoiding pain, muscle tension, and increased stress. All factors that can drive pain to persist.

Mis-education on the cause of lower back pain

The BMJ study demonstrates that people are often mis-educated on the cause of their back pain with MRI scans.

Everyone wants to find the cause of their back pain, but scans often misrepresent what’s really going on or only show a fraction of the whole picture. Pain is due to many factors and according to Physical Therapy research, other common factors often include: inflammation, fatigue, deconditioning, low or erratic activity levels, stress, pain system changes, muscle guarding, and much more.

Without the right information, back pain can evolve into a vicious cycle of pain--a downward spiral that worsens your condition. However, the right advice can change the trajectory of your recovery in a more positive direction. Advice like feeling safe with movement, knowing that some pain with movement is normal, and understanding findings on your scan--can make a big difference in setting you on the right path to recovery.

Breaking this vicious cycle of pain takes time and practice. At Hinge Health, our clinical care team addresses chronic pain more effectively by combining digital sensor technology with the expertise of physical therapy doctorates like myself and health coaches who drive user motivation and behavior change. Read more about our clinical care model. As a physical therapy doctorate at Hinge Health, I help our users adopt ways to move their body that launches them on a more positive road to recovery. Here are 4 important physical habits I recommend to my Hinge Health users to reduce their lower back pain.

4 ways to set you on the right path of recovery

1. Relax Your Belly. It sounds counterintuitive, but research shows that people with back pain are more tense. Unfortunately, the healthcare system often reinforces increased muscle tension with common advice to protect the back, build up your strong core, and move cautiously, according to Physical Therapy research.

But engaging our core and muscle bracing or guarding only puts more tension on sensitive back structures. It is important to be strong with certain tasks, but according to the British Journal of Sports Medicine (BJSM), relaxing through everyday activities like bending and twisting is safe and important to recovery.

Hinge Health utilizes relaxed movements within our exercise therapy program, while also building relaxed movement habits throughout the day (e.g. bending down to put on your shoes).

2. Get Back to Bending, Lifting and Twisting (even if it hurts). A myth surrounding back pain is that bending, lifting, and twisting is dangerous for a back that may show scan findings like a disc bulge, disc degeneration, or other changes, according to British Journal of Sports Medicine (BJSM).

For example, after an ankle sprain, many types of movements may hurt or cause flares, but that does not mean that the movements are inherently dangerous or bad.

Back Experts Kieran O’Sullivan and Mary O’Keefe state:

“People are generally worried about activities and hobbies involving impact, bending, lifting, and twisting. People in pain often avoid these things for fear of doing damage to their body (and back). However, these things are safe (even if sore initially) and people should feel confident to return to them.”

Avoiding any movement for too long will only make the back less resilient. Avoiding aggravating activities for a bit of time can be helpful, but limiting the amount of rest you give your back is actually important to recovery.

3. When Flares Occur, Keep Moving. Flares are scary but rarely dangerous. It’s only normal to think one has caused more damage, but research in BJSM reassures us that this is unlikely. Flares often occur due to things like unaccustomed activity, poor sleep, fatigue, inactivity, and tension.

A natural response when pain or flares occur is to rest and avoid activity, but pain flares are a favorable time to “reinforce new ways to respond to pain,” according to Physical Therapy research. Recommended habits during flares include continuing to move, staying relaxed, and focusing on what is within your control.

4. Focus On What You Can Control. My grandmother shared infinite, ancient wisdom with the serenity prayer and it holds true with back pain:

“To accept the things I cannot change; Courage to change the things I can; And wisdom to know the difference.”

Many factors on the journey to recovery are less within our control, like pain flares from moving more. Accepting this can help focus on important habits that we can control.

At Hinge Health, we help make sense of back pain through our clinical model of care that combines virtual physical therapy & clinicians, health coaches, and digital sensor technology. Our clinical model layers in physical therapy expertise with behavioral coaching to ensure participants develop positive habits in their lifestyle--ensuring participants achieve lasting pain reduction. Read more about our clinical care model.

Hinge Health’s virtual clinical care model empowers individuals to tap into the innate strength and resilience of their body to more effectively overcome their chronic back and joint pain than traditional healthcare options.

Dr. Dylan Peterson, Doctor of Physical Therapy

About the Author

Dylan is one of Hinge Health’s Clinical Specialists. He is originally from Minnesota and earned his BA in Philosophy with a minor and Psychology at Fort Lewis College. After that he earned his Doctorate of Physical Therapy at California State University - Sacramento. When he is not in the office helping the Hinge Health community as a physical therapist and pain consultant, he is an avid trail runner and not-quite-sub-4-minute-miler.

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