Back pain myths.
Busted.
There are many persistent misconceptions about back pain that fuel anxiety and hinder recovery. Below we debunk 9 common myths with scientific evidence. Scroll through them one by one.
“You should stay in bed when you have back pain”
What the evidence says
Cochrane reviews (2010) consistently show that bed rest delays recovery in non-specific back pain. The NICE guideline (2020) and WHO (2023) explicitly recommend staying active.
Stay as active as possible within your pain limits. Short breaks are fine, but prolonged lying down is harmful. Movement promotes blood circulation, prevents muscle weakening and reduces anxiety.
“A scan (MRI/X-ray) shows what is wrong”
What the evidence says
Brinjikji et al. (2015) showed that among people without back pain at age 40, 68% have disc degeneration and 50% have a bulge on MRI. The KNGF guideline (2021) advises against imaging for non-specific back pain.
Scans show normal age-related changes that also occur in pain-free people. Imaging is only useful when a serious underlying condition (red flags) is suspected.
“Back pain means your back is damaged”
What the evidence says
The biopsychosocial model (Engel, 1977; Foster et al., Lancet 2018) shows that pain is a complex signal influenced by biological, psychological and social factors. Pain correlates poorly with tissue damage.
Pain is a protection signal, not a damage meter. Your back is strong and resilient. In 90-95% of back pain cases, there is no structural damage.
“Lifting with a rounded back is dangerous”
What the evidence says
Saraceni et al. (2020) found in a systematic review no evidence that a specific lifting technique reduces the risk of back pain. The back can safely bend and twist; that is what it is designed for.
There is no evidence that a particular lifting technique offers better protection. What matters is that you train for the tasks you do, build up gradually, and are not afraid to move.
“You need a strong core to prevent back pain”
What the evidence says
Smith et al. (2014) showed that specific core stability exercises are no more effective than general exercise for back pain. The concept of an unstable core as a cause of back pain is scientifically outdated.
General movement and fitness are more important than specific core exercises. Walking, swimming and cycling are equally effective. The best exercise is the one you keep doing.
“Paracetamol is a proven painkiller for back pain”
What the evidence says
The PACE trial (Williams et al., Lancet 2014) showed that paracetamol works no better than placebo for acute low back pain, and the Cochrane review (2016) confirmed it. The WHO (2023) and NICE do not recommend it. The Dutch GP guideline still starts with it, for a different reason: Thuisarts.nl says “start with paracetamol, it has the fewest side effects”.
Paracetamol did not beat placebo in trials, so do not expect much from it. That is not the same as your GP being wrong: since no painkiller works particularly well here, the Dutch guideline picks the safest one first. NSAIDs (ibuprofen, naproxen) do have a small effect in acute back pain; use them briefly, at the lowest effective dose, and check whether they suit you.
“A herniated disc always needs surgery”
What the evidence says
In about 7 out of 10 herniated discs the bulging material shrinks on its own, across 31 studies put together (Zou et al., 2024). That was measured on scans; the symptoms are a separate matter, and for most people they settle over weeks to months. The Sciatica Trial (Peul et al., NEJM 2007) showed that after 1 year, outcomes are equal whether you had surgery or not.
Most herniated discs heal on their own. Surgery is only needed for cauda equina syndrome (emergency) or persistent severe neurological deficit. When in doubt: wait and monitor.
“Your back wears out from moving and working”
What the evidence says
Belavy et al. (2017) showed that running is actually associated with healthier intervertebral discs. The spine adapts to load, just as muscles and bones become stronger through training.
Movement is nourishment for your back. Your spine becomes stronger and more resilient through regular loading. Inactivity is actually a risk factor for back pain.
“Chronic back pain is untreatable”
What the evidence says
The PRT trial (Ashar et al., JAMA Psychiatry 2022) showed that 66% of participants became pain-free or nearly pain-free after 4 weeks of Pain Reprocessing Therapy, against 20% on placebo. The RESTORE trial (Lancet, 2023) found clearly fewer daily limitations with Cognitive Functional Therapy than with usual care, still present at 12 months. And in 75 trials with 15,395 participants, CBT and mindfulness were still measurably better one to two years on (Jenkins et al., 2025).
Chronic back pain is treatable. Approaches such as PRT, CFT, CBT and multidisciplinary rehabilitation genuinely help, and among all the options they are the ones whose effect is still there a year or two later. Be realistic: those effects are usually modest, not miraculous. It starts with understanding that pain is changeable.
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