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There are many misbelieves(myths) regarding low back pain not only among the general population but also among the treating physicians. Low level of education among the population is considered as an important factor for the prevalence of these myths. These myths are also difficult to remove or eradicate from the minds of the people or treating physicians. Not surprisingly myths about low back pain and its management are also highly prevalent in Indian subcontinent3. These myths are obstacles in the management of the low back pain.Understanding and accepting the facts help in the proper management of the low back pain.
MRI of the lumbo-sacral spine is a must whenever there is a patient of acute low back pain in the clinic.
Fact- MRI of the lumbosacral spine is not indicated in acute low back pain in the absence of red flags. 70- 90 % of patients recover from acute low back pain within 2-4 weeks of onset with conservative therapy in the absence of red flags. There is a poor correlation between the low back pain and the MRI findings6. Patients with severe degenerative changes in the spine may not have any pain. Similarly, abnormal findings are also frequently seen in MRI of asymptomatic individuals. Immediate imaging in case of acute low back pain without any serious underlying cause (red flags) is of no help and doesn’t improve the overall outcome. It is associated with radiation exposure, increased treatment costs and may lead to unnecessary procedures9. Hence physicians should refrain from advisingMRI of the spine in case of acute low back pain if there are no red flags.
Spondylosis is the most common cause of the low back pain.
Fact- spondylosis is not the cause of low back pain.
Sponylosis is a not a clinical but radiologic terminology and it merely indicates degenerative change in any part of the spine. It does not constitute a specific diagnosis. The most common cause of low back pain in elderly age group is facet joint arthropathy due to degenerative osteoarthritis, followed by sacroiliac joint arthropathy (again degenerative). The common cause of low back pain in middle or younger age group is internal disc disruption. Spondylosis is a nonspecific term and hence its use in the clinical setting should be discouraged.
Complete bed rest, restriction of bending or extreme movements and lying down on a hard surface is helpful and is indicated until the patient is fully recovered from the pain.
Fact- Prolonged bed rest and restriction of movements is not indicated.
Again this is a commonest myth among many treating physicians and neurosurgeons and spine surgeons. As previously thought prolonged bed rest is not required and early return to work and staying active is encouraged. Bed rest is contraindicated according to some guidelines. Bed rest is indicated only for short duration (1-2 days) and patient is encouraged to stay active. Prolonged bed rest may cause muscle wasting due to disuse atrophy and thus may actually be harmful.
Lumbo-sacral belt or brace helps in reducing the pain.
aFact- Lumbo-sacral belts or braces are no more recommended. This is also a common practice among many orthopaedic spine surgeons and neurosurgeons. More than 99% of orthopaedic surgeons in USA admitted that they prescribe lumbo-sacral braces for low back pain17. Lumbo-sacral braces or belts have not shown to improve the prognosis of the low back pain18. Use of the braces may lead to lumbar muscle de-conditioning and weakness of the paraspinal muscles. Para-spinal muscles are the important muscles supporting the spine and wasting of these muscles can do more harm than the benefit.