Low back pain: myths, facts and the role of physiotherapy

Low back pain is one of the main causes of functional limitation worldwide, affecting millions of people every year. It is estimated that in 2020 around 619 million people will have experienced episodes of low back pain, which corresponds to approximately 1 in 13 individuals. Despite its high prevalence, there are still many myths and misinterpretations surrounding this condition.

A better understanding of what science currently describes about low back pain is an important step towards more informed management that is adjusted to clinical reality. This is precisely the focus of World Physiotherapy Day 2024, marked on 8 September, which highlights low back pain and the role of physiotherapy in its management.

Low back pain can happen at any age

There's a perception that lower back pain is a problem only for older people. However, episodes of low back pain can occur at any stage of life. Although most people will experience at least one episode throughout their lives, only a small percentage develop persistent low back pain, generally defined as pain lasting longer than three months.

This distinction is important because it helps to reduce unnecessary fears and to understand that, in most cases, low back pain has a favourable evolution.

What non-specific low back pain means and how it is assessed

One of the most common misconceptions is to assume that low back pain is always associated with an identifiable structural lesion. Scientific evidence indicates that around 90% of low back pain episodes are classified as non-specific, i.e. they are not directly associated with a pathology or a specific structure, such as a muscle, joint or intervertebral disc.

In these cases, the pain does not necessarily indicate the presence of a serious condition, but is rather the result of multiple interacting factors, including load, movement, life context and the body's individual response.

Physiotherapy plays an important role in different phases of low back pain

Among the various health conditions, low back pain is one of those in which the greatest number of people can benefit from rehabilitation. Regardless of the stage of the pain, acute or persistent, rehabilitation plays a central role in clinical follow-up.

Physiotherapy contributes not only to functional recovery, but also to:

• Improve understanding of pain
• Reduce the fear associated with movement
• Supporting a gradual return to everyday activities
• Preserving autonomy and functional independence

This process is particularly important for helping people to return to the activities they enjoy in a safe and appropriate way.

In most cases, surgery is not the first option

It's common to associate low back pain with the need for surgery. However, the overwhelming majority of people with low back pain do not require surgical intervention. In most cases, conservative approaches are the first line of treatment.

Physiotherapy can include:

• Educational programmes to help understand and manage pain
• Supervised exercise programmes tailored to individual needs
• Manual therapy, where appropriate, integrated into a global approach

Surgery is reserved for specific situations that are carefully assessed in a clinical context.

Demystifying common beliefs about low back pain

Some widely held ideas can negatively condition the way in which low back pain is experienced and managed.

• Severe pain does not necessarily mean serious injury: The intensity of the pain doesn't always reflect the severity of the condition. In most cases, low back pain is not associated with serious conditions.
• Imaging tests don't always explain the pain: Findings such as disc protrusions or signs of wear and tear are common in people without pain. For this reason, imaging tests should only be ordered when clinically indicated.
• Bending or carrying weights is not in itself harmful: The spine is a robust and adaptable structure. Progressive strengthening and movement training help you perform everyday tasks with greater confidence.
• Prolonged rest does not favour recovery: Although it can be useful to temporarily adjust some activities, movement and a gradual return to activity are important components of the recovery process.

The role of physiotherapy in monitoring low back pain

Physiotherapists are professionals who specialise in assessing and monitoring low back pain. Through an individualised approach, they provide advice, guidance and intervention tailored to each person, supporting functional recovery and pain management over time.

Exercise plays a central role in this process. Current evidence suggests that there is no universally superior type of exercise. The most important thing is to keep active and exercise regularly and appropriately, and the Physiotherapist is the right professional to help identify the type of exercise best suited to each case.

Understanding low back pain from an informed perspective

Understanding the myths and facts associated with low back pain allows for a more careful and informed approach to this condition. Movement, when appropriate and progressive, is an essential component of spinal health. An appropriate clinical assessment and individualised follow-up can support the management of low back pain over time, respecting each person's individuality and life context.