Two weeks ago I gave you five things to do, and last week six mistakes to avoid. So here are 7 back pain myths you can stop believing today. How many of these do you believe?
TLDR
- The pop when you crack your back is gas.
- Lowest: bed rest. Highest: walking and strength training.
- 41 reviews couldn't agree posture causes back pain. Change positions often.
The 7 myths
1. "Cracking your back realigns your spine." The pop is the sound of a gas cavity forming in the joint, caught on MRI in a 2015 study of finger joints (the same joint type as your spine's small facet joints) [1]. There's no evidence anything goes back into place. A 2022 review found hearing a pop wasn't linked to less pain [2]. So chasing the pop doesn't seem to matter.
So this isn't to say that spinal manipulations do nothing. A 2026 review found about 7 points less pain than a sham (fake) treatment on a 100-point scale (very low certainty), and little to no difference from other care like exercise [3]. But chiropractic relief does seem to help some people. Some get soreness or stiffness, and no trial recorded a serious complication, though fewer than half reported side effects.
2. "Bad posture is causing your back pain." 41 reviews couldn't agree that posture causes back pain (more on this below) [4].
3. "Tight muscles are causing your back pain." Feeling tight isn't always the same as being tight. In one small study, how stiff people's backs felt didn't match their measured spinal stiffness [5]. In my opinion, tightness and weakness often show up together, so focus on mobilizing and strengthening instead.
4. "Your mattress is causing your back pain." I think your sleeping position matters more than your mattress. When in doubt, go medium-firm. It beat firm in a 2003 trial [6]. More in my newsletter on the best sleeping positions for back pain.
5. "A scan will show what's causing your pain." Pain-free people's scans show bulges and "degeneration" too: about 30% of pain-free 20-year-olds have a disc bulge, rising to 84% by age 80 [7]. An MRI describes anatomical abnormalities (or lack thereof), not pain.
6. "Surgery is the only thing that will make your back pain better." Most new episodes of back pain get better fairly quickly [8]. In a 2024 meta-analysis of 31 studies, about 70% of disc herniations shrank on follow-up scans without surgery [9]. And a 2007 sciatica trial found surgery eased leg pain faster than waiting, but recovery was similar at one year [10].
See a doctor immediately for red flags: loss of bladder or bowel control, groin or saddle numbness, worsening leg weakness, fever or feeling generally unwell, or unexplained weight loss. Without them, give conservative care a proper go first.
7. "Pain equals damage, and damage equals pain." Pain isn't a reliable damage meter. The overwhelming majority of back pain is non-specific, meaning we can't identify the specific source [8]. Some people avoid movement because they interpret pain as dangerous.
12 remedies, ranked
F tier
- Bed rest. Two days of it gave the slowest recovery in one trial [11]. In my opinion, resting mostly just lowers our capacity, and we need to keep moving as much as we can.
- An MRI with no warning signs. Early imaging doesn't lead to better pain or function [12].
D tier
- Stretching on its own. No better than no treatment [13], though it has its place in a good program.
- Hanging upside down, traction and dead hangs. Some people may get short-term relief, but traction has only been tested in 3 small trials [14].
- Back braces and posture correctors. On their own, braces may give little to no benefit for chronic back pain, and correctors haven't been tested [15].
C tier
- Massage. Short-term relief only, with low-quality evidence [16].
- Spinal manipulation and back cracking. Just like with massage, a small short-term benefit (see myth 1) [3].
- Icing. No evidence it improves outcomes over time [17], but if it feels good, go ahead and try it.
- Steroid injections for sciatica. Injections can be useful, but they're only slightly better than placebo for short-term leg pain [18].
B tier
- Heat. Hot take: unless you've had a trauma injury, heat has better evidence than ice [17].
S tier
- Walking. A walking and education program delayed the next bout of back pain [19].
- Exercise and strength training. If you've been reading my newsletter for a while, you probably know where this is going. It has some of the strongest evidence for lowering back pain [20], and strength is never a weakness.
Does posture matter?
Your bad posture may not be what's causing your back pain. Posture may still matter a little bit, but those 41 reviews couldn't show it causes back pain [4]. A 2014 review found no difference in the lower back curve or pelvic tilt (how the pelvis tips) of people with and without back pain [21]. That's going to make some people in the anterior pelvic tilt community mad.
So why does everyone talk about the importance of posture? I think the answer might be more social than physical. Good posture is seen as socially desirable, even attractive.
As a biomechanist, my read is that holding one posture for a long time is what really strains our tissues. Focus on changing positions often, and don't worry so much about having perfect posture.
What to do this week
- Every 30 to 45 minutes, stand up or walk for 2 to 5 minutes.
- Keep walking and get stronger. If pain climbs above 4/10 during an exercise, or you're noticeably worse the next morning, scale back.
As always, have a great weekend.
Best,
Mitch
Want to know which back pain pattern matches you? Take my free 2-minute quiz and find out.
My free Back Again Basics programs have a plan for each pattern.
References
[1] Kawchuk et al., 2015. Real-time visualization of joint cavitation. PLoS One. doi:10.1371/journal.pone.0119470
[2] Moorman and Newell, 2022. Impact of audible pops associated with spinal manipulation on perceived pain: a systematic review. Chiropractic & Manual Therapies. doi:10.1186/s12998-022-00454-0
[3] de Zoete et al., 2026. Spinal manipulative therapy for adults with chronic low back pain. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD008112.pub3
[4] Swain et al., 2019. No consensus on causality of spine postures or physical exposure and low back pain: a systematic review of systematic reviews. Journal of Biomechanics. doi:10.1016/j.jbiomech.2019.08.006
[5] Stanton et al., 2017. Feeling stiffness in the back: a protective perceptual inference in chronic back pain. Scientific Reports. doi:10.1038/s41598-017-09429-1
[6] Kovacs et al., 2003. Effect of firmness of mattress on chronic non-specific low-back pain: randomised, double-blind, controlled, multicentre trial. The Lancet. doi:10.1016/S0140-6736(03)14792-7
[7] Brinjikji et al., 2015. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology. doi:10.3174/ajnr.A4173
[8] Hartvigsen et al., 2018. What low back pain is and why we need to pay attention. The Lancet. doi:10.1016/S0140-6736(18)30480-X
[9] Zou et al., 2024. Incidence of spontaneous resorption of lumbar disc herniation: a meta-analysis. Clinical Spine Surgery. doi:10.1097/BSD.0000000000001490
[10] Peul et al., 2007. Surgery versus prolonged conservative treatment for sciatica. New England Journal of Medicine. doi:10.1056/NEJMoa064039
[11] Malmivaara et al., 1995. The treatment of acute low back pain: bed rest, exercises, or ordinary activity? New England Journal of Medicine. doi:10.1056/NEJM199502093320602
[12] Chou et al., 2009. Imaging strategies for low-back pain: systematic review and meta-analysis. The Lancet. doi:10.1016/S0140-6736(09)60172-0
[13] Owen et al., 2020. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. British Journal of Sports Medicine. doi:10.1136/bjsports-2019-100886
[14] Vanti et al., 2021. Vertical traction for lumbar radiculopathy: a systematic review. Archives of Physiotherapy. doi:10.1186/s40945-021-00102-5
[15] Arienti et al., 2026. Assistive technologies (lumbar supports and other devices) for treating chronic low back pain. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD015492.pub2
[16] Furlan et al., 2015. Massage for low-back pain. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD001929.pub3
[17] French et al., 2006. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD004750.pub2
[18] Oliveira et al., 2020. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD013577
[19] Pocovi et al., 2024. Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial. The Lancet. doi:10.1016/S0140-6736(24)00755-4
[20] Hayden et al., 2021. Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD009790.pub2
[21] Laird et al., 2014. Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. doi:10.1186/1471-2474-15-229
Disclaimer: this content is educational only and does not constitute medical advice. See a practitioner if you suspect serious spinal trauma from a fall or accident, or if you experience any of the following red flag symptoms: loss of bowel or bladder control, numbness in the groin or saddle area, rapidly worsening leg weakness, back pain with fever or feeling generally unwell, or unexplained weight loss with back pain.