Two Back Pain Diagnoses That Science Doesn’t Support

In my last blog, I covered the most common back pain myth: that you should avoid bending your back.

To summarise, the wisdom for safely lifting heavy objects has been misapplied to all lifting, resulting in people squatting down just to pick up a pen. Rather than reduce the chance of back injury, this increases it through deconditioning your back muscles.

If you want to learn more about why bending is actually good for you, click here.

This time, I’m busting two myths that arise when diagnosing back pain. These are myths not only spread by the general public and bad internet wisdom but also by fellow physiotherapists.

Tight hamstrings DON’T cause back pain

Tight hamstrings are often cited as a cause for back pain, the thinking being that it throws off the position of your pelvis and thus overloads your lower back.

It sounds like the sort of biomechanical imbalance that makes sense. After all, there is often a relation between pelvic tilt and back pain.

However, the evidence just isn’t there. Large scale, reliable research hasn’t managed to find any link between the two in the average person or athlete.

Professional athletes such as footballers will benefit from longer hamstrings in terms of their performance; longer hamstrings allow more momentum into a kick. But there is no association with the incidence of back pain.

Neither does having two different length legs

A difference in leg length is often blamed for back pain as, like tight hamstrings, it is believed to result in a deleterious pelvic tilt.

But a discrepancy in leg length is very easy to find. In fact, it’s far more rare to find someone with legs that are exactly the same length. This means that most people with back pain will have one leg longer than the other, making it very difficult to separate cause and effect.

If you have a leg length discrepancy – even if it is quite significant – you will have had it since your bones finished growing. By the time you’re in your 40s – when back pain is most likely to strike – your body will have had more than 20 years to adapt.

A sudden onset of back pain is very unlikely to be caused by something that hasn’t caused symptoms for decades. Just because your leg length discrepancy is outside of the normal range doesn’t mean that it is going to cause you any issues.

And that’s really the core issue of so many back pain myths, both those accepted generally and the self-diagnoses that we hold individually. Every body has “abnormalities”. Every body, over time, develops degeneracies. Few ever cause pain.

It’s very easy when trying to determine the cause of symptoms to blame abnormalities and degeneracies, but we need to be very careful not to exaggerate their clinical significance.

An analogy I like to use is: when I look in the mirror, I see evidence degenerative change in my face, but that doesn’t mean my face is in pain! And if it was, I wouldn’t blame my wrinkles.

And you shouldn’t blame your other “wrinkles” for your back pain, whether it’s one leg that’s longer than the other or expected disc degeneration in your spine.

What you should do is look at you see one of our physiotherapists so we can put you back on track to a body that hurts less and moves more.

To book your appointment, email info@coventgardenphysio.com, call 0207 497 8974, or book online.

Cameron Tudor

B.PHYSIOTHERAPY PG CERT INDEPENDENT PRESCRIBING, MCSP, MHCPC