Are you more likely to have back pain if you bend your back?
I would argue it’s very similar to asking:
Are you more likely to have shoulder pain if you move the shoulder?
The answer? Maybe. It depends.
Am I saying that back and shoulder issues are the same? No. I’m just saying they’re a part of the same body, which lives by certain common rules.
Let’s use this example for the shoulder: you clean the windows in the house. Whether that triggers shoulder pain probably depends on many factors:
- What is your pre-training level? Are you used to sway your arm around in the air?
- What is your shoulder injury history? Would this be painful episode #13?
- What is your current sensitivity level? Were you already a little sore?
- Was it too much too soon? Too intensive? Too many windows? Too little rest between?
- What other activities have you been doing in the same time period? Beating all the carpets?
- Concurrent trigger factors? Sleeping more on that side? On the sofa because the kids aren’t sleeping well? You aren’t sleeping well you say?
- Was there a certain MOVEMENT that you are currently sensitive to, like lifting the arm above your head?
A few thinking points:
- Could we not use the same reasoning for a back problem?
- Note that the last point, a MOVEMENT you were sensitive to, was just a small part of a big picture. Is “lifting the arm” the only issue here? Just like, is “bending the back” the only/most important issue with back pain?
- Movement can be both a trigger, and protective for pain. It probably just depends on the other factors above in the list.
And, is flexion inherently bad for the back? Well, what movement do most of us usually do besides flexion? Not many. So surely, if you move and get back pain, it’s likely to be in flexion. So, is flexion the “reason”, the “bad movement”?
We usually don’t say that lifting the arm is “dangerous”, or that it’s a “bad movement” for the shoulder. Why do we say it for the back?
But research/a social media meme/a Twitter guru says it´s safe to bend!
One important question that arises for me is; how on earth would research ever be able to take account for this level of complexity? Can we ever trust research to provide anything but general advice about back flexion, based on likelihoods and probabilities? Will we ever get a solid ”rule” to how we should advise an individual in the clinic? Can we translate current research into a trustworthy meme that will suit patients and clinicians?
Listen, I can get behind the idea of fighting the demonising of back flexion, and memes can have a great impact on that. After all, bending the back in general seems safe, just like lifting the arm seems safe for the shoulder. Why? Because, again, it’s just human movement, a part of a bigger picture.
But HEY, as most of you probably know, sometimes it’s also THE movement to avoid for a period of time:
- A Jefferson curl program will suit one back patient perfectly, while flaring up another.
- Just like a shoulder press program will do with shoulder patients. It just depends.
I have under loaded people, over loaded people, and I’ve got things just right. And rarely do I get things right by rigidly following a social media meme.
The only meme that works for me is: It depends!
The reality is that the risk of having a back or shoulder issue from a certain movement has probably increased during the last years as we are failing on many of the other points on the list. We are moving less in general, musculoskeletal pain is on the rise and our psychosocial health is declining. Try making a working meme out of that!
To me It’s clear that we need to differentiate between:
What is the “right” thing to do with the individual
Vs
What is the ”right” message to the public?
Vs
What is the ”right” message to the musculoskeletal therapy profession?
For me, that would be:
- Individual: It depends
- The Public: Whatever message that doesn’t neglect that we are individuals, or that scare people away from choosing an active and balanced approach to get better
- The MSK profession: Whatever message that doesn’t swing the damn pendulum far towards mindless activity avoidance, or mindless loading where everyone starts pushing Jefferson curls on every single back patient
