Musculoskeletal Myths. Journal of Bodywork & Movement Therapies

(From the July 2012 issue of “The Scope” – by Steven T. Tanaka, DC)

Liebenson C. Musculoskeletal Myths. Journal of Bodywork & Movement Therapies April 2012; 16 (2):165-182.

ABSTRACT: This paper discusses a number of common myths in the musculoskeletal pain management and rehabilitation/athletic development fields. The origins or rationale for these beliefs are reviewed. New scientific evidence disputing or refuting the myth is presented followed by an explanation and evidence for an updated perspective.

Myth #1: Low back pain is a benign, self-limiting condition. The statement that 75% to 90% resolve within 4-6 weeks comes from insurance data that tracks disability. He notes that studies have disputed the concept of acute episodes resolving quickly and completely [pain is a symptom, not a condition]. Second, it is more cost effective to prevent a chronic condition in at-risk individuals. About 7.4% who develop chronic disability incur most of the costs. Acute original episodes tend to last up to 3 months, not 4-6 weeks and it usually does not resolve completely and has periodic flare-ups.

Myth #2: The cause of musculoskeletal pain can be found on an x-ray or MRI. It has been found that over 90% of the time, there is structural evidence of lumbar disc herniation with the appropriate symptoms, but 28-50% of asymptomatic individuals also have the same positive findings. Imaging studies in the case of neck pain has a 75% false positive finding in asymptomatic individuals. Prediction for future problems cannot be determined from imaging studies. [Dr. Gonstead said that you find the problem on the patient, not on the x-ray.]

Myth #3: All back pain patients are alike. 85% of back pain patients are said to have non-specific back pain. A top priority is to classify the various forms of “nonspecific” back pain. It would help to direct the patient to the appropriate treatment(s). Myth #4: Let pain be your guide. It is a way that can lead to chronic conditions and deconditioning.

Myth #5: Acute & chronic pain are similar. “Pain is an alarm, signaling tissue damage or threat.” It is “up-regulation from peripheral tissue to the central nervous system.

Myth #6: More is better. Rather than on numbers, movements should be done skillfully. For example, lifting a lot of weights frequently is not as important as doing it skillfully and using proper biomechanic movements.

Myth #7: The deep intrinsic muscles such as the transverse abdominis are the keys to stability. The lumbar spine requires an appropriate combination of muscle for stability and movement.

Myth #8: We should breathe out with exertion. Not always true. Many times there is a balance between the abdominals and diaphragm that must be coordinated.

Myth #9: Why does my back hurt – I do 100 sit-ups every morning. As we know, disc load is high during sit-ups. Also morning is probably the worst time for the spine to do sit-ups. About 54% of the disc height is lost in the first 30 minutes after rising with disc-bending stresses increased to 300% and ligament stresses by 80%.

Myth #10: No pain, no gain. This can be true to a point for an athlete who can tell the difference between injury and a hard workout (some of the time, anyway). Muscle pain isn’t always bad; joint pain is.