The Surprising Reasons Your Lower Back Pain Treatment Isn’t Working
In landmark research, back experts around the world report that many back patients are receiving the wrong kind of therapy—here's what you need to know.
You stopped moving
When it comes to back pain, there’s a lot of confusion and a lot of suffering. “Low-back pain is now the biggest global cause of disability,” says professor Martin Underwood of the University of Warwick in the UK, one of the authors of a new series of papers on low-back pain published in the medical journal The Lancet. Currently, more than 540 million people worldwide are suffering, he points out. According to the new findings—put together by an international team of doctors and researchers, many doctors are treating the problem wrong. “Public beliefs, healthcare practices, and workplace policies have increasingly led to the widespread but mostly unhelpful idea that back pain is a medical problem that necessitates stopping usual activities,” Dr. Underwood says. The opposite is true—here’s what you do and don’t need for your back.
Here are some exercises for lower back pain that will keep you active.
You don’t need MRIs or imaging
Once your doctor rules out serious issues like cancer, fracture, infection, and arthritis, a back scan is an unnecessary expense. “Everyone else has ‘non-specific’ low back pain and we manage it in the same way,” says the lead author of the Lancet research, professor Rachelle Buchbinder, PhD, a researcher of clinical epidemiology at Monash University in Australia. “Unfortunately sometimes patients become very focused on needing to find a specific diagnosis.” Although back pain sufferers may push for scans, says Dr. Buchbinder, the evidence indicates that imaging isn’t much help in identifying the source of pain.
Here are more secrets pain doctors won’t tell you.
You don’t need injections
If a doctor suggests spinal injections of anesthetics or steroids, pump the brakes. Dr. Buchbinder says this is part of the “medicalization” of low back pain: “Rather than treating low back pain as an everyday, normal part of life, it has become to be seen as a medical problem. Doctors often think they have to do something—unfortunately, they often do something that is wrong.” Doctors overuse spinal injections, the Lancet authors agree. “The evidence does not support their use, and they are not included in best practice guidelines for the treatment of non-specific low back pain,” Dr. Underwood says. “The potential for serious side effects [such as nerve injury] means that these treatments are best avoided.” If you wake up with back pain, here are ten things you must do next.
You don’t need surgery
Surgery—including spinal fusion—is another highly invasive and overused treatment. The Lancet authors recommend against this choice. Sadly, doctors and patients have misconceptions about this risky procedure, Dr. Underwood says. According to Dr. Buchbinder, there simply isn’t high-quality evidence to merit surgery for non-specific pain. Yet some doctors and other health professionals still believe in these treatments, she says.
You don’t need pain meds
If you want to relieve your backaches once and for all, check out what science confirms really works. It’s definitely not popping painkillers. “Strong opioids such as fentanyl and oxycodone have little effect on persistent low back pain, and might even make the pain worse when used over the long term,” says Dr. Underwood. “We know they carry a substantial risk of addiction or dependence, overdose, or even death.” Dr. Buchbinder says they may be used for a short time, but then should be stopped as soon as possible because the harm outweighs the benefits. Yet doctors continue to prescribe the drugs because “it’s much easier to provide pain medication for people with disabling low back pain than providing multi-component pain management programs that will help people self-manage their pain better in the long term,” Dr. Underwood says. If you’re already taking these drugs, talk to an expert who can help wean you off, and see a new doctor about how to get rid of your lower back pain.
You do need less invasive procedures
The good news is that simpler, low-tech, less-invasive lower back pain treatment really works. Physical therapy, massage, and stretching programs can all help patients make it through, says Akhil Chhatre, MD, director of spine rehabilitation and assistant professor of physical medicine and rehabilitation at Johns Hopkins Medicine. Here are some stretches for lower back pain you should try.
You don’t need bed rest
The one low-tech intervention most people try is bed rest; it doesn’t work, even though some doctors still erroneously prescribe it. “The most important thing we have learned is that back pain does not equate to bed rest in almost all cases,” says Dr. Chhatre. According to Dr. Underwood, you rapidly lose muscle strength in your back once you take to bed, and that only makes matters worse. “Traditional advice to rest a bad back is harmful,” he says. Plus, resting might promote the idea that passive treatments are the best way to manage back pain. For nighttime rest, here are the best sleep positions for back pain.
You do need physical activity
“Exercising the muscles around the back is key to improving its function and to helping people to be confident that they can manage their back pain themselves over time,” Dr. Underwood says. “This does not need to be a specific exercise program—walking, swimming, cycling, or other activities people enjoy will help protect the back and reduce pain and disability.” Dr. Buchbinder also suggests pilates, yoga, or tai chi. After being evaluated by a doctor, you may benefit from physical therapy, Dr. Chhatre says. If you’ve got back pain, these five exercises can make it better.
You do need to lose weight
Obesity is connected to all kinds of health problems, and lower back pain is a common one. Whether or not losing weight reduces back pain, says Dr. Underwood, it delivers many health benefits. Starting a diet-and-exercise plan can help improve your overall health and keep you more active—which is good for your back. Avoiding refined sugars, processed foods, and trans fats may also help reduce inflammation that leads to back pain. “Changes to lifestyle and diet to can prevent further flares down the road,” Dr. Chhatre says. And avoid these everyday habits that are seriously damaging your spine.
You do need to consider your outlook
“As pain is a malady that extends beyond the physical, the treatment approach should also extend beyond the physical,” says Dr. Chhatre. to focus on “mindfulness, pain psychology, meditation techniques, biofeedback, and coping strategies.” Some people become so fearful of the pain that it can limit what they do, Dr. Buchbinder says. Cognitive behavioral therapy can help these patients reduce stress and relieve their anxiousness. “As we have learned more about the relationship between pain and mood, treatments that combine physical and psychological approaches to the management of back pain can be helpful,” Dr. Underwood says. Try these yoga poses for lower back pain to set your mind and body in the right direction.
You do need to consider alternative treatments
Dr. Underwood recommends seeing an osteopath, chiropractor, or employing other alternative methods. “These treatments can include a detailed assessment of the back, education, advice, a prescribed exercise program, and manipulation or mobilization of the back,” he says. Acupuncture may also help: Although the findings aren’t consistent, Dr. Underwood points to research suggesting that people treated by an acupuncturist seem to do better than those who only see their family doctor. Check out the home remedies for back pain with science on their side.
You do need to keep working
The Lancet authors argue that back pain patients do better when they continue working. “We know that being off work delays your recovery, as does being on workers’ compensation,” Dr. Buchbinder says. As long as supervisors and co-workers collaborate to help the patient at work, patients recover much faster and have fewer relapses, she points out. Modifications to your job or workspace might help you function, so talk to your employer, doctor, and insurance provider. Find out the rules of desk ergonomics for a more productive (and pain-free) work day.
You do need a new outlook
“Our perspective and attitude should change as a whole with non-emergency spine care,” says Dr. Chhatre. “It is great to know what options are out there in terms of medical treatments, but often the body will heal on its own given the right direction and discipline.” Dr. Buchbinder believes doctors also should address misconceptions about care with patients. They should “do the right thing, which is to provide some education about back pain, correct any misunderstandings, and provide advice to keep as active as they can, trying to continue their usual activities including to exercise and to remain at work,” she says.
Next, don’t miss these signs your back pain in serious trouble.