Medical Myths & Bad Advice
In the realm of healthcare, misinformation often spreads faster than truth, which is ironic. From old wives' tales to internet fads, misbeliefs about the human body are abundant. As physical therapists, we're no strangers to encountering these myths in our daily practice. In this blog, we'll debunk some of the most prevalent misconceptions that we frequently hear and encounter, along with (in our opinion) bad medical advice.
Myth 1: "My Back is Out of Alignment"
This phrase is a frequent flier. It likely has its roots in us healthcare providers doing a poor job at explaining someone’s symptoms. The idea of the spine being "out of alignment" implies that it’s in a static, fixed position, which is not accurate. The spine is a dynamic and resilient structure, capable of adapting to various movements and positions. It's designed to have stability AND mobility.
Furthermore, the concept of the spine suddenly shifting out of alignment overlooks the intricate and robust nature of its design; the spine is one of the most resilient structures in the human body. The vertebrae are stacked in a precise manner and held together by strong ligaments and supported by muscles, making it highly unlikely for the spine to easily become misaligned. Studies have shown that it would require an impact created by a 500lb car crashing into a wall at 30mph to fracture the cervical vertebrae. Injuries to the spine tend to occur when the body does not have an opportunity to tense the supporting muscles.
It’s also common for folks to think that when their back “pops” that it is “popping back into place.”
Well, this is also not true. Research from 2015 demonstrates that the separation or pulling force from cracking a joint (like a knuckle, for example) creates a negative pressure in the joint fluid allowing dissolved gas to escape – this forms a bubble. The bubble forming is what makes the “pop” sound. It takes about 20 minutes for the pressure to build again to be able to crack the joint another time.
So, why do back cracks (spinal manipulations / adjustments) feel so good if they aren’t realigning your spine segments? This is because manipulations create a neurological effect which leads to short term pain relief. In fact, a study in 2013 demonstrated that subjects had immediate pain relief in the lower back whether the manipulation occurred in the lumbar (low back) region OR thoracic (mid-upper back) region. Honestly - that’s GREAT news because it gives us more ways to help reduce someone’s pain!
Instead of focusing on spine alignment as the source of discomfort, it's more beneficial to consider factors such as muscle imbalances, poor posture, and biomechanical issues when addressing back pain. These factors can contribute to sensations of "misalignment" but are typically related to muscle tension, joint stiffness, or nerve irritation rather than an actual structural misalignment of the spine.
Myth 2: "Cracking Your Knuckles Causes Arthritis"
Said by everyone’s grandma everywhere! There is loads of research on this topic, so rest assured: cracking your knuckles does NOT cause arthritis. This age-old myth has persisted for generations, but rest assured, cracking your knuckles does not lead to arthritis. While excessive knuckle cracking may irritate the surrounding soft tissues, it does not increase the risk of developing arthritis.
Myth 3: “ You are not supposed to let your knees go over your toes in a squat or lunge”
It’s surprising that this one has really stuck around, especially considering our evolution where the majority of activities of daily living were performed in a squat position. Many cultures still revolve around deep squat positions because chairs are not as common!
While there is some reduced stress (~22%) to your knee joint when kept in vertical alignment with your ankle joint, studies have shown that there is a massive increase to additional torque (~1000%) applied to the low back and hip joints. Yikes.
Furthermore, research reveals that patellofemoral joint forces are actually at their highest when the knee is flexed at 90 degrees during a squat.
It's important to work your joints through their full range of motion for longevity, and distribute loads effectively. There are times when we elect to keep someone in vertical shin alignments, however this is not the norm
Long story short, the idea that knees should never move past the toes isn't supported by the evidence.
Bad Advice: “You Have Back Pain, Get an MRI”
Most folks with back pain think that they need diagnostic imaging. The reality is quite different. Research indicates that only a small percentage of cases of low back pain can be attributed to a specific spinal issue. The majority of individuals experiencing back pain don't have any serious underlying structural problems.
We get that folks “want to know” the source of their pain, that’s totally normal and reasonable. Pain is complex, multi-faceted and the spine is one area in the body that just because there might be tissue damage showing on an image, does not mean that is the source of the pain. More to come on this.
We will refer someone for imaging if the pain was caused by a traumatic event, i.e. back pain following a mountain bike crash, or there are other red flag symptoms that don’t follow typical back pain presentation patterns, i.e. cancer or infection. Those are serious conditions, should be addressed, and only make up 1-2% of all cases of low back pain.
Relying too heavily on imaging can actually be counterproductive. It can lead to increased fear, which then leads to increased pain because of where our body processes pain in our brain. That’s a spiraling road that we don’t want to go down.
Most of us (regardless of age) will have something pop-up on an x-ray or MRI. Honestly, it is far more rare to have an image done and have it be 100% clear.
A systematic literature review in 2015 looked at Spinal Degeneration in ASYMPTOMATIC populations. To be clear, this study looked at back images for folks who had ZERO pain. They utilized 33 articles that met their criteria that included 3110 people ages 20-89 years old. That’s right… over 3000 people included in this review.
The findings?
Disc Degeneration: 37% of 20 year old individuals to 96% of 80 year olds
Disc Bulge: 30% of 20 year old individuals to 84% of 80 year olds
Disk Protrusion: 29% of 20 year old individuals to 43% of 80 year olds
Annular Fissure: 19% of 20 year old individuals to 29% of 80 year olds
Imaging findings of spine degeneration are present in high proportions of asymptomatic folks and it increases with age. This is an example of how the body can have tissue damage/degeneration without pain.
It’s a much better approach to perform a functional assessment and learn someone’s mobility restrictions, muscle imbalances, stressors, sleep patterns, nutrition, etc. That will paint the most complete picture for why someone is experiencing back compared to what the photo shows.
Bad Advice: “You have pain, rest.”
Ok, now if you have a fracture, sure, we can get on board with the “rest” prescription. But, we know that some injuries do NOT get better with rest. For example, patellar tendon pain requires stress (not rest) to heal. Early movement helps with blood flow which helps with healing. It also helps reduce fear avoidant behaviors which only turn up the pain dial.
Bad Advice: “You’ve had back pain before? Don’t deadlift.”
Deadlifts are one of the best exercises to improve hip and back strength, not to mention FUNCTIONAL because we pick things up from the floor in everyday life. Folks with low back pain often have weakness in their spine, core, and hamstrings…which a deadlift will strengthen. So, why wouldn’t we want to teach folks how to properly deadlift?!
Plus, there have been multiple studies that had folks with back pain perform deadlifts (and they were heavy!) in their treatment protocol and they all show reduced pain and improved quality outcome scores.
In summary, we encounter a myriad of medical myths and poor advice. By debunking these misconceptions and educating our patients, we aim to empower individuals to take control of their health and make informed decisions about their bodies. Remember, not everything you hear about health and wellness is true. There was a time when Shake Weights were “the thing”…