The 10 biggest back pain mistakes you’re making
Nothing’s worse than when your back’s in pain. While your back pain should get better quickly, some may find that they only become worse with time and care. If this is you, there’s a good chance some of your treatment techniques are actually making your pain worse. Here we’ve rounded up the ten biggest mistakes you’re making.
1. Avoiding a diagnosis
The cause of sudden back pain may be obvious, but long-term discomfort can often spring from a less obvious trigger. “If you’ve been in pain for more than three months, it’s classed as chronic pain, and diagnosis is important,” physiotherapist Matthew Stanlake, from Upwell Health Collective in Melbourne, says. Finding the cause is vital because it may be something that’s treatable, but also because nerve-based pain needs to be treated differently to muscular pain. Also, the earlier you treat it, the better. “Think of pain like water running down a cliff – in time, the water carves a groove in the rock, and that’s what happens to your nerves with chronic pain,” Stanlake says. “The longer it goes on, the more readily you feel the pain and the more you have to do to manage it.”
2. Trying ineffective treatments for too long
When you use professional help to treat your pain, it’s important that this leads to regular improvement. “You should discuss with your team how you might expect to be progressing and what should happen by when,” Stanlake says. “If you’re just floating along and nothing is changing, then you – or they – need to explore other options.”
This doesn’t mean jumping from quick fix to quick fix, though. Stanlake explains that it can take as long as 12 months to see a significant improvement when working with a chronic pain condition because you’re effectively having to completely change the way your body responds to pain. “Take things in four-week blocks,” he advises.
“Even a medication might take that long to reach a therapeutic dose in the body.”
3. Doing too much on ‘a good day’
“In 32 years of treating chronic-pain patients, I’d say that doing too much is the biggest mistake people make,” physiotherapist Katrina Evans, from Holistic Touch Physio in Newcastle, NSW, says. “It’s tempting if you’re having a pain-free day to try and make up for all those other days, but don’t. Pace yourself to do just 80 per cent of what you think you can do and try to extend that by about 10 per cent each time.”
4. Demanding an MRI
Your GP can’t refer you for an MRI for normal back pain under bulk-billing, so firstly, having one will cost you money.
Secondly, it might not explain things anyway. “An MRI is good at getting a picture of what’s going on in the back and joints, but any damage it spots may simply be degenerative changes and not actually the cause of your pain,” Dr Jill Thistlethwaite, from NPS MedicineWise, says. “Another problem is that once you know those changes are there, this can alter the way you move, act or think about pain in ways that actually cause problems,” Stanlake adds. In fact, in one US study of more than 3000 people, those who had an early MRI ended up with a decreased sense of wellbeing and higher fees, thanks to the ‘false alarm’ findings.
5. Taking extra painkillers
It can be tempting to pop a few extra tablets to eliminate bad pain, but in the case of particular pills, this can be extremely dangerous.
A study by the University of Edinburgh in Scotland found that taking just two to three extra paracetamol tablets a day for four or five days could cause potentially fatal liver damage. Even when taking the recommended dose to ease back pain, you need to be wary if you’re prone to tension headaches or migraines as it could make them worse. “Taking painkillers too often can cause the pain receptors to become over-sensitive and this can trigger rebound headaches when you stop using them,” pharmacist and clinical pain program consultant Joyce McSwan says. If this happens, speak to your GP about the best way to control both types of pain.
6. Trying to eliminate pain
In some cases of chronic back pain, it can’t be completely cured, and accepting this can make a huge difference to your experience. A trial at the University of Chicago in the US found that those who’d worked on accepting pain reported lower pain intensity and better function than others. “The more you stress and worry about pain, the more you prime the nerves to feel it,” Evans says.
Working with a psychologist is an important part of a pain management plan. If you can’t access this help, Evans suggests reading the book Rewire Your Pain or accessing the free advice on the NSW Government’s pain service site at www.hnehealth.nsw.gov.au/pain
7. Putting heat on a new injury
This increases blood flow to the area and can actually increase pain and inflammation. “As a general rule, if an injury is hot to the touch, put ice on it. If it’s cold, use heat,” physiotherapist Kusal Goonewardena, from Melbourne’s Elite Akademy, says. “Another mistake is using either for too long – don’t apply them for more than 20 minutes at a time,” he adds.
“Also, never apply ice directly to the skin.
Use a towel or you could get ice burns.”
8. Using the wrong language
Stop using disempowering language, like referring to yourself as a ‘sufferer’. “This language can increase pain intensity and lead to poorer outcomes,” Evans explains. If you work with a pain psychologist, they’ll help you reframe your thinking, but as a general rule, try to replace words that create feelings of anger, resentment or powerlessness with factual words. For example, say, “I have back pain,” rather than, “I suffer back pain.”
9. Searching for that ‘one magic solution’
“There’s no ‘magic bullet’ that will switch off chronic pain – and believing there is can lead to you chasing every new idea out there,” Stanlake says.
“I know, because I did this for 10 years myself. Instead, take a more holistic approach. Things like diet, meditation and exercise could each give you a 10 per cent improvement. Put together a team of approaches – and a team of people – to create the optimum result.”
10. Resting a sore back
While complete bed rest used to be recommended for back pain, it’s no longer suggested as the best option. “We’re made to move and when we don’t, further problems start,” Goonewardena says. “We lose flexibility, our joints stiffen and our muscles contract, leading to less range of movement and more pain. Moving little and often, within tolerable pain levels, is the key to getting better faster.”