1 Back Pain is common and normal. Eighty percent of people will experience an episode of back pain during their lifetime. Most acute back pain is the result of simple strains or sprains and the prognosis is excellent. Within the first two weeks of an acute episode of pain, most people will report a significant improvement in their symptoms with almost 85% of people fully recovered by three months.

2 Scans and surgery are rarely needed. All the evidence suggests scans only show something truly important in a tiny minority of people with back pain. Studies have shown that even people who don’t have back pain have things like bulging discs, degenerated or black discs, herniated discs and ‘arthritic’ changes visible. Remember, these people do NOT have pain!

3 Back pain is not caused by something being out of place There is no evidence that back pain is caused by a bone or joint in the back being out of place, or your pelvis being out of alignment. Many people feel better after undergoing treatments like manipulation. However, this improvement is due to short-term reductions in pain, muscle tone/tension and fear, NOT due to realigning of body structures.

4 Bed rest is not helpful. In the first few days after the initial injury, avoiding aggravating activities may help to relieve pain, similar to pain in any other part of the body, such as a sprained ankle. However, there is very strong evidence that keeping active and returning to all usual activities gradually, including work and hobbies, is important in aiding recovery.

5 More back pain does not mean more back damage.  The degree of pain felt can vary according to a number of factors, including the situation in which the pain occurs, previous pain experiences, your mood, fears, fitness, stress levels and coping style Furthermore, our nervous system has the ability to regulate how much pain a person feels at any given time. If a person has back pain it might be that their nervous system has become hypersensitive and is causing the person to experience pain, even though the initial strain or sprain has healed.

6 The perfect sitting posture may not exist. No specific static sitting posture has been shown to prevent or reduce back pain. Different sitting postures suit different people, with some people reporting more pain from sitting straight, others from slouching. The ability to vary our posture, instead of maintaining the same posture, together with learning to move in a confident, relaxed and variable manner is important for people with back pain.

7 Lifting and bending are safe. Of course, a person can strain their back if they lift something awkwardly or lifting something that is heavier than they would usually lift. Similarly, if a person has back pain, these activities might be more sore than usual. This, however, does not mean that the activity is dangerous or should be avoided. While a lifting or bending incident could initially give a person back pain, bending and lifting is normal and should be practiced to help strengthen the back, similar to returning to running and sport after spraining an ankle.

8 Poor sleep, tress, low mood and worry influence back pain. Improving sleeping routine and habits can be very helpful in reducing pain. How we feel can influence the amount of pain we feel. Back pain can be triggered following changes in life stress, mood or anxiety levels. Managing our stress, mood and anxiety levels through doing things we enjoy, and engaging in relaxation can be really beneficial in helping back pain.

9 Exercise is good and safe. Many people with pain are afraid of exercise and avoid it as they think it may cause them more problems. However, this is not true! We now know that regular exercise helps to keep you and your body fit and healthy, and actually reduces pain and discomfort. It relaxes muscle tension, helps mood and strengthens the immune system once started gradually. All types of exercise are good, with no major differences in effectiveness between them – so pick one you enjoy, can afford and which is convenient. When you are in pain, starting exercise can be very hard. Under-used muscles feel more pain that healthy muscles. Therefore, if feeling sore after exercise, this does not indicate harm or damage to the body.

10 Persistent back pain CAN get better. Since back pain is associated with many factors that vary between individuals, treatments that address the relevant factors for each individual can be effective. Failing to get pain relief after lots of different treatments is very frustrating and cause people to lose hope. By identifying the different contributing factors for each individual and trying to address them, pain can be significantly reduced and people can live a happier and healthier life.

* Mary O’Keeffe (University of Limerick), Dr Kieran O’Sullivan (University of Limerick), Dr Derek Griffin (Tralee Physiotherapy Clinic)