As a physical therapist, I receive a lot of questions about the human body — and most often, those questions are about low back pain. Here are five of those questions — and the answers that may surprise you!
“Am I the only one with low back pain?”
Though the experience of having low back pain can feel isolating, it actually is quite common. In fact, research suggests that nearly one in three people have low back pain over a one-month time period. That’s very common. The good news: because low back is among the most common sources of pain, medical professionals like physical therapists and physicians have devoted much time and entire careers to refining treatment strategies and discovering new ones.
“My healthcare team found ‘degenerative disc disease’ on my X-ray. Is this what’s causing my low back pain?”
Degenerative disc disease is common and often benign. So, too, by the way, is disc herniation — also sometimes called “a bulging disc.” Tissue changes associated with degenerative disc disease are often normal with aging. Further, these changes may only minimally contribute to low back pain or they may not contribute at all. In the latter case, the diagnosis is perhaps better described as “wrinkles on the inside” and the X-ray findings are merely incidental. An excellent healthcare team will use X-ray findings to inform decisions about treatment, but will not base decisions solely around them. An excellent team will account for a variety of factors that contribute to low back pain, such as muscle weakness, work responsibilities or family support.
“I was recently diagnosed with chronic low back pain. Should I be concerned?”
A diagnosis of chronic low back pain sounds very concerning, like something that cannot be corrected. However, the word “chronic” in “chronic low back pain” is merely a term used by clinicians to describe the past — it means the patient has pain that has persisted for “greater than three months.” Receiving such a diagnosis does not mean that symptoms cannot or will not improve.
“I have seen someone for my low back pain, but it still hurts when I move. Am I making it worse by moving?”
Hurt does not always equal harm. The brain and nervous system together produce the sensation that we perceive as pain. In individuals with persistent low back pain, the brain and nervous system may be sensitive to — and cause pain with — movements that would otherwise be non-aggravating. The movements themselves may not be inherently dangerous, despite them aggravating one’s pain. Symptom aggravation does not necessarily mean that damage has been done, rather that the body’s alarm system is more easily triggered. The good news is that physical therapists have many techniques they can use to calm the body’s alarm system, and one of the most effective of these is — you guessed it — exercise. Therefore, movement — in spite of symptoms and perception of pain — can be beneficial even to those with low back pain.
“Do I need surgery to fix my low back pain?”
The good news is that many individuals find that nonsurgical treatments, and even no treatments at all, can produce significant improvements within the first 30 days. Should an individual with low back pain need formal treatment, many nonsurgical approaches are effective and recommended. Just a few of these nonsurgical approaches are manual therapy, exercise, and advice to remain active. Several medications are also widely recommended for curtailing low back pain. All of these strategies are part of a comprehensive nonsurgical treatment plan. In some circumstances, surgery is indicated and physical therapists can be an integral part of the post-surgical team, as they facilitate a return to home, work, community and even sporting activity.
Benjamin Davis, PT, DPT is a physical therapist with a keen interest in incorporating pain science into clinical practice and in improving the lives of people with pain. He is a board-certified orthopedic clinical specialist at Shirley Ryan AbilityLab in Chicago, and a fellow-in-training in advanced orthopedic physical therapy practice, research and education at Northwestern University’s Department of Physical Therapy and Human Movement Sciences. Benjamin earned a doctor of physical therapy degree from the University of Wisconsin–Madison and completed an orthopedic physical therapy residency at the University of Miami (Fla.).
1. Hoy D, Bain C, Williams G, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum 2012;64(6):2028-37. (In eng). DOI: 10.1002/art.34347.
2. Henschke N, Kamper SJ, Maher CG. The epidemiology and economic consequences of pain. Mayo Clin Proc 2015;90(1):139-47. (In eng). DOI: 10.1016/j.mayocp.2014.09.010.
3. Kos N, Gradisnik L, Velnar T. A Brief Review of the Degenerative Intervertebral Disc Disease. Med Arch 2019;73(6):421-424. (In eng). DOI: 10.5455/medarh.2019.73.421-424.
4. Delitto A, George SZ, Van Dillen L, et al. Low back pain. J Orthop Sports Phys Ther 2012;42(4):A1-57. (In eng). DOI: 10.2519/jospt.2012.42.4.A1.
5. Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001;344(5):363-70. (In eng). DOI: 10.1056/nejm200102013440508.
6. Butler DS, Moseley GL. Explain Pain. Adelaide: Noigroup Publications, 2003.
7. Marin TJ, Van Eerd D, Irvin E, et al. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain. Cochrane Database Syst Rev 2017;6(6):Cd002193. (In eng). DOI: 10.1002/14651858.CD002193.pub2.
8. Kamper SJ, Apeldoorn AT, Chiarotto A, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev 2014(9):Cd000963. (In eng). DOI: 10.1002/14651858.CD000963.pub3.
9. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine 2017;166(7):514-530. DOI: 10.7326/m16-2367 %m 28192789.
10. George SZ, Fritz JM, Silfies SP, et al. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. Journal of Orthopaedic & Sports Physical Therapy 2021;51(11):CPG1-CPG60. DOI: 10.2519/jospt.2021.0304.
11. Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev 2010(6):Cd007612. (In eng). DOI: 10.1002/14651858.CD007612.pub2.
12. Hagen KB, Hilde G, Jamtvedt G, Winnem M. Bed rest for acute low-back pain and sciatica. Cochrane Database Syst Rev 2004(4):Cd001254. (In eng). DOI: 10.1002/14651858.CD001254.pub2.
13. Pengel LHM, Herbert RD, Maher CG, Refshauge KM. Acute low back pain: systematic review of its prognosis. BMJ 2003;327(7410):323. DOI: 10.1136/bmj.327.7410.323.
14. Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. European Spine Journal 2003;12(2):149-165. DOI: 10.1007/s00586-002-0508-5.
15. Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. European Spine Journal 2018;27(11):2791-2803. DOI: 10.1007/s00586-018-5673-2.