Somewhere between 60-80% of all people will experience non-specific, low back pain in their life time. With a prevalence rate that high, naturally there have been efforts on many fronts to try and alleviate the problem. The key word there is try. To be honest, as a healthcare system - we're not that good at treating low back pain.
That's no small admission coming from a physical therapist that is often tasked with doing just that. But I don't think the current patterns will change unless the public at large is aware of the limitations in many treatment strategies.
I believe that's where a significant portion of treatment ineffectiveness stems from - patient's buying into ineffective strategies. But don't just take my word for it. Let's go straight to the research to see what is says:
(A quick aside - The following studies include 3 systematic reviews which are the highest level of scientific evidence. Healthcare decisions based on information gleaned from systematic reviews are considered to be the most sound. More can be read about systematic reviews in general here. Keep in mind that current recommendations are based on the best current available evidence, and that they are subject to change in light of new data of equal or greater value.)
Misconception # 1 - Moving with 'Bad Mechanics' Causes Back Pain
There are some potential caveats though. The study discussed some possibilities for why this strategy has failed:
There was no consistency among studies reviewed and the education presented to the audience.
Educational interventions were relatively short, and left little time for practice of discussed techniques.
Presentation of information to the audience does not guarantee the information was utilized to change daily habits.
So given these additional considerations, it is possible that in certain scenarios biomechanical education holds some value in treating low back pain. However, used alone it is not able to have any significant effect in preventing low back pain.
Misconception # 2 - If You Have Back Pain, You Must Have a Weak Core
The studies included in this review primarily used the training of deep core muscles (transverse abdominis, multifidi) as a strategy to alleviate low back pain. The results:
Core stability exercises offer very minimal short and medium term benefit, in terms of pain and disability.
No significant benefit identified in the long term, over other forms of exercise.
Using such treatment strategies can actually promote unhealthy thoughts and beliefs related to pain and movement.
The results of this study are fairly definitive. This is not to say core musculature training can never be used in a rehabilitation program if a weakness is identified. However, just like any strength training program, the intensity needs to be high enough to cause an adaptation. One of the major problems of traditional core stability programs is that they are performed at too low of a level (% of Maximal Voluntary Contraction) to stimulate any kind of strength adaptation.
Misconception #3 - Sitting with 'Bad Posture' Results in Back Pain
When comparing people with and without back pain, there is no difference in lumbar lordosis angle, and no difference in pelvic tilt angle. People with low back pain consistently showed decreased total ROM, reduced proprioception, and reduced movement speed compared to people without back pain.
So can posture never be the culprit of low back pain? It's plausible, but as the research shows on average it has little to do with most people's source of back pain. It doesn't hurt to try it as a solution, but if you've been working on your posture and you still have back pain, it's time to try another strategy.
In my experience, the best posture is one that is always changing. Hold anything for long enough, even 'perfect posture' and it will become uncomfortable after some time. Based on the results of this review, rather than try to 'fix' posture, it would be more fruitful to spend time improving general mobility, proprioception, and movement speed in order to give the spine more options for more movement variability.
As always thanks for reading. Let me know your thoughts in the comments section below.
-Dr. Piotr