Chronic pain myth-busting
Throughout my career I’ve heard lots of do’s and dont’s from both patients and other healthcare practitioners which have no research backing OR have been completely busted in the past. The fact is – our society’s chronic pain is getting worse, not better. Sickness levels are increasing and more people are complaining of back and neck pain. What I’d like to do is try to touch on what drives pain and a few myths that I commonly hear.
Pain is a multidimensional OUTPUT of the brain triggered by actual or potential tissue damage. The purpose of pain is to warn us before tissue damage is likely, preventing any damage from occurring. In chronic pain, the threshold increases – so pain kicks in a long way before tissue damage is likely. This process is incredibly complex. Several areas of the brain light up with pain and change with chronic pain. For this reason we know that there are several drivers to any ‘one pain’. For example – back pain starts but you’re not sure why. It may be that you have a desk job, is posture causing it? Maybe. You have also had an incredibly stressful few weeks at work. So is stress causing it? Maybe. You also started exercising for your summer holidays after a 6 month break. So the exercise must have caused it? Actually, all of the above add into the pain pie. After this very quick explanation, if you learn nothing else, it’s this. Generally, there will be a number of reasons causing pain. So if you’ve not fallen over or lost a fight, you can still have pain.
Myth 1 – ‘I can’t exercise/bend over/sit because it’s dangerous for back.’
Exercise is great! Having strength and stability in your joints allows both freedom of movement and helps prevent falls and accidents – however, you need to work (hard) to get there. It is important that you use pacing and graded exercise to achieve and seek help if unsure to avoid short term aggravation.
Postures and bending are not dangerous. It is not mechanically unsafe to sit or to bend, though it is important to move/exercise if you spend any amount of time sitting. BUT if you lose the stability to perform an action then it may be sore to do. Again, make sure you grade the return back to the sore action or activity.
So – make sure you move and exercise through all available range. If you are worried then seek help from a physiotherapist.
Myth 2 – ‘I have to brace my core muscles before I move to make sure I’m safe.’
It is not necessary to brace before moving! It’s important that you have strength and stability throughout your joints, it’s also important that you allow movement and avoid fixing (or as I like to call it ‘Tree-like’ movement). Studies have found an increase ‘bracing’ in people with chronic pain. This stops the back from moving ‘normally’ and prevents blood flow/loading in the tissues within the fixed or stiff segment.
Myth 3 – ‘I have a slipped disk so I can’t move normally and I’m in pain.‘
Often disc changes are normal and shouldn’t restrict movement. We’ve shown through studies that disc changes are more normal than abnormal. There’s also no correlation with pain! (E.g. people without pain can have disc changes; people with pain can have no changes on MRI)
**As we get older, a healthy adult without pain is 50-60% likely to see disc changes on MRI. There are ‘bad’ disc changes, but these are more rare.
Maybe there’s something else driving your pain – lack of movement, stress…??
Don’t avoid anything in the long term – though it may be that you need to adapt an exercise or activity. If you are in pain, seek help and start exercise and activities that you can enjoy!