Monthly Pain Update – February 2026

Ten Persistent Myths About Low Back Pain in the Elderly

Low back pain (LBP) is one of the costliest and most disabling conditions affecting older adults. Not only can pain and disability interfere with the ability to carry out activities of daily living, but proprioceptive deficits associated with low back pain can impair balance, increasing the risk of serious falls and injuries that can dramatically affect long-term health and independence. Despite clinical guidelines on effective management of low back pain in the senior population, these ten prominent myths persist and continue to hinder recovery:

• MYTH: Back pain is inevitable with aging. FACT: Back pain is common but not inevitable. Prevalence increases with age and then levels off after approximately age 60.
• MYTH: Back pain usually indicates serious disease in older adults. FACT: Serious underlying conditions account for fewer than 5% of cases. Most low back pain is classified as “non-specific” and is not associated with serious pathology.
• MYTH: Imaging is necessary in adults over age 50 with low back pain. FACT: Imaging in the absence of “red flags” (such as cancer, fracture, infection, or cauda equina syndrome) can lead to unnecessary interventions and can cause more harm than benefit.
• MYTH: Pain should guide behavior—avoid lifting, twisting, and bending when experiencing low back pain. FACT: Physical activity promotes recovery, while prolonged avoidance and inactivity are associated with worse outcomes. Pain during activity does not usually indicate tissue damage.
• MYTH: Bed rest is recommended for low back pain in older adults. FACT: Bed rest can cause more harm than good, particularly when prolonged, and may contribute to deconditioning and delayed recovery.
• MYTH: Medication should be the first-line treatment for low back pain. FACT: Clinical guidelines support nonpharmacological treatments as first-line approaches, including manual therapies such as those provided by chiropractors.
• MYTH: Surgery is effective for primary back-dominant low back pain. FACT: Surgery is not recommended for primary back-dominant pain and may result in worse outcomes or unnecessary complications.
• MYTH: Chronic low back pain in older adults is always caused by structural damage. FACT: Structural changes seen on imaging correlate poorly with pain severity or disability. Psychosocial factors play a substantial role in persistent pain.
• MYTH: Injections, ablation, and nerve blocks are highly effective treatments. FACT: For nonspecific low back pain, these interventions often provide no greater benefit than sham treatments and are associated with increased adverse events in older adults.
• MYTH: Disk herniations commonly cause leg pain in older adults. FACT: Disk herniations are less common in this population; clinical findings are often more reliable than imaging alone.

Unfortunately, this misinformation is frequently reinforced by family members, friends, social media, pharmaceutical companies, other industries, and even healthcare providers. These myths about back pain foster inaccurate attitudes, beliefs, and behaviors that can lead to inappropriate, costly, and sometimes harmful treatments. Additionally, such misconceptions can result in psychological consequences—including fear of movement, poor self-efficacy, low motivation, anxiety, stress, and depression—all of which contribute to greater disability and slower recovery. The good news is that, in most cases, chiropractic care serves as a conservative treatment option that can help reduce pain and disability, enabling older adults to more easily maintain independence and perform activities of daily living.

It Isn’t Always Carpal Tunnel Syndrome

When symptoms such as pain, tingling, numbness, and weakness affect the hand, the first condition that comes to mind for most people is carpal tunnel syndrome (CTS). While CTS is the most common nerve entrapment affecting the upper extremity, it is far from the only possible cause of these symptoms. So how does a chiropractor determine whether the problem is CTS or something else?

The process begins with the patient completing a detailed health history that addresses both current symptoms and relevant medical background. This information helps determine whether compression of the median nerve—central to a CTS diagnosis—is likely, or whether one of the other nerves supplying the hand should be considered. During the physical examination, the chiropractor performs specific provocative tests to help identify where the median nerve—or another nerve—may be restricted along its course. In some cases, though not routinely required, additional diagnostic tools such as nerve conduction studies or ultrasound may be used to help confirm the diagnosis.

If symptoms primarily involve the thumb, index finger, middle finger, and the thumb-side of the ring finger and are reproduced by wrist compression or sustained wrist positions, classic carpal tunnel syndrome is likely. However, compression of the median nerve at other locations along its pathway can produce a similar symptom pattern. Potential sites include the forearm, below or above the elbow, the shoulder, and even the neck. To further complicate matters, nerve compression can occur at multiple sites simultaneously. For example, a 2016 study found that approximately 1 in 16 patients with CTS also had median nerve compression in the forearm, a condition known as pronator teres syndrome.

The ulnar nerve, which supplies sensation to the pinky and the ulnar side of the ring finger, can also become compressed as it passes through a different anatomical structure at the wrist called Guyon’s canal. As with the median nerve, restriction of the ulnar nerve anywhere along its course from the neck to the hand can generate similar symptoms. The same principle applies to the radial nerve, which innervates the back of the hand and can become irritated as it passes through the radial tunnel near the wrist. This is why a thorough history and physical examination is so critical: the history helps identify which nerve is involved and the examination helps pinpoint where compression may be occurring.

In most cases, conditions involving median, ulnar, or radial nerve compression respond well to a multimodal conservative treatment approach. This may include manual therapies such as manipulation, mobilization, and soft tissue techniques; therapeutic exercises; nighttime bracing; activity modification; and anti-inflammatory strategies. Importantly, outcomes are typically faster and more favorable when patients seek care early, rather than waiting months or years before consulting with a chiropractor.

Conservative Management of Patellar Tendinopathy

The act of straightening the leg during walking, running, jumping, or standing is accomplished through a coordinated anatomical mechanism involving the quadriceps muscles that attach to the patella (kneecap), which is connected to the tibia (shin bone) via the patellar tendon. Repetitive and forceful knee-extension movements can overload this tendon, leading to injury or inflammation known as patellar tendinopathy, commonly referred to as jumper’s knee. This raises an important question: can conservative treatments such as chiropractic care effectively manage this condition or is surgery required?

The classic presentation of patellar tendinopathy is pain at the front of the knee associated with physical activity, typically localized to the patellar tendon itself. The condition occurs more frequently in males, particularly those participating in high-intensity sports during adolescence and young adulthood. However, adults who engage in repetitive jumping or high-load activities are also at increased risk. Diagnosis is usually made through a detailed patient history and physical examination, though diagnostic ultrasound may be used to confirm the condition. Treatment is generally divided into three phases: pain reduction, strengthening and load progression, and functional training with return to sport.

The initial phase focuses on pain reduction and involves a temporary modification of activity. This may include limiting jumping activities, reducing training volume, avoiding hard surfaces, and allowing for increased recovery time between sessions. Complete immobilization is discouraged, as it can lead to muscle atrophy and weakness that may delay recovery. Ice and other anti-inflammatory strategies may be used between training sessions to help manage symptoms.

The second phase emphasizes progressive loading through isometric and isotonic exercises such as wall sits, leg presses, and squats to gradually increase tendon stiffness and load tolerance. Because kinetic-chain dysfunction often precedes patellar tendinopathy, care may also include manual therapies—such as those provided by chiropractors—and targeted exercises to address contributing factors including quadriceps weakness, hip abductor and external rotator weakness, limited ankle dorsiflexion, and poor landing mechanics.

Once pain during rehabilitation scores no higher than 3 on a 10-point scale (0 = no pain; 10 = worst pain imaginable), symptoms resolve within 24 hours of activity, and discomfort during normal daily tasks is minimal, patients can begin a gradual return to sport. Full recovery typically takes three to six months; however, if the condition becomes chronic before treatment begins, the rehabilitation process may take considerably longer.

Surgical intervention is generally reserved for cases in which symptoms fail to improve after approximately twelve weeks of well-supervised conservative management. The good news is that conservative care results in satisfactory outcomes for most individuals with patellar tendinopathy.

Potential Causes of Post-Surgical Neck Pain

          Assuming patients and healthcare providers follow clinical guidelines for managing neck pain, most neck pain sufferers can experience resolution of their pain and disability with the aid of a conservative, multimodal treatment approach, such as those provided by chiropractors. However, for a variety of reasons, some patients may still undergo surgical intervention, and it is estimated that up to 40% may continue to experience persistent or disabling neck pain. Why is this the case, and is there anything chiropractic care can do to help these patients?

The first potential cause of persistent post-surgical neck pain is an incomplete or incorrect diagnosis. This can occur when imaging reveals positive findings—such as a disk herniation—that are attributed to the patient’s symptoms but may not, in fact, be the underlying cause. In some cases, a disk herniation may play a role; however, other contributing factors that are not visible on imaging or are missed during a physical examination may also be involved.

There are also cases in which the pain generator is correctly identified and treated, but complications from surgery result in ongoing neck pain. For example, scar tissue formation around nerves and soft tissues can tether nerves or create a chronic inflammatory environment that triggers pain. In addition, a decompressed nerve may continue to experience impaired function as though it were still compressed.

Finally, a new source of neck pain may develop following an otherwise successful surgical procedure. This can occur when spinal alignment is restored but the joints and soft tissues are not accustomed to supporting the altered loads and forces and subsequently become injured. Additionally, in cases of surgical fusion that restrict movement at a cervical spinal level, the vertebrae above and below the fusion may become hypermobile to compensate, pushing them beyond their normal range of motion and increasing the risk of injury.

With all of this in mind, how can a doctor of chiropractic help manage post-surgical neck pain? The first step is a thorough review of the patient’s history, which guides the physical examination. The examination not only seeks to identify potential pain generators but also helps detect red flags that contraindicate chiropractic treatment. In addition to traditional red flags (such as fracture, infection, tumor, severe osteoporosis, and vascular abnormalities), the chiropractor will also assess for signs of cervical instability or incomplete healing. To help restore normal movement and function of the cervical spine, a doctor of chiropractic will often employ a multimodal approach that combines low-force manual therapies, gentle traction, therapeutic exercises, and physiotherapy modalities.

Chronic Whiplash and Neck Muscle Endurance  

Whiplash-associated disorders (WAD) is an umbrella term used to characterize the myriad symptoms that can occur when soft tissues are injured during rapid acceleration and deceleration of the head and neck in a whiplash event, such as a rear-end automobile collision. Despite advances in the understanding and treatment of WAD, it is estimated that nearly half of whiplash patients continue to experience ongoing pain and disability for a year or longer. Recent studies have identified reduced neck muscle endurance as a risk factor for chronic WAD, but what happens in a real-world setting when neck muscle strengthening is included as part of treatment?

To explore this question, a May 2025 study recruited 140 patients with chronic WAD who completed pre-intervention assessments of neck pain, neck-related disability, neck function, and psychosocial factors. Participants were then assigned to one of two treatment groups: at-home exercises delivered through Internet-based instruction or in-office exercises facilitated by a physiotherapist. Treatment frequency ranged from two to four sessions per week over a twelve-week period. Participants completed the same assessments three months and fifteen months following the conclusion of care.

The results demonstrated that both in-person and at-home exercise approaches produced similar improvements in neck pain, disability, and function, and these improvements were associated with increased neck muscle endurance. While this finding provides important confirmation that addressing impaired neck muscle endurance may help reduce persistent WAD symptoms, the results related to psychosocial factors—how a person perceives, responds to, and recovers from neck pain and injury—were particularly noteworthy. The data showed significant post-treatment improvements in self-efficacy, fear-avoidance beliefs, depressive symptoms, and catastrophizing. This is especially meaningful, as these factors are known to be present early after injury and are strongly associated with the development of chronic WAD.

While further research is needed to confirm these findings and better understand the underlying mechanisms involved, the results suggest that assessment of neck muscle endurance should be included as part of the initial clinical evaluation, with targeted exercises prescribed for patients to perform between in-person visits with their chiropractor or other healthcare provider, if needed. Beyond the personal and family-level benefits associated with successful WAD recovery, any intervention that reduces the risk of chronic WAD may also offer substantial macroeconomic benefits, including improved productivity and reduced litigation-related costs, which could ultimately contribute to lower automobile insurance expenses.

Excessive Smartphone Use Can Be a Pain in the Neck

Since their introduction and rapid adoption in the mid-2000s, smartphones have become an integral part of daily life—not only by consolidating multiple technologies into a single device, but also by helping us stay connected with family, friends, clients, and colleagues. However, alongside these benefits, a growing body of evidence points to significant downsides. Excessive smartphone use has been linked to poorer mental health—particularly among teens and young adults—and may also negatively affect physical health.

Most notably, smartphone use typically involves prolonged downward gaze. While this posture may seem harmless at first, over time the body adapts by rounding the shoulders and shifting the head forward from its normal centerline. Beyond its impact on physical appearance, forward head posture places increased strain on the muscles and tendons of the neck and upper back that work to support the head. This pattern has been colloquially referred to as “tech neck” or “text neck.” In addition to neck pain, forward head posture may increase the risk of headaches as well as pain in the thoracic and lumbar regions of the spine. Moreover, screen time is often sedentary time, and excessive device use is associated with prolonged sitting and reduced physical activity—factors that can elevate overall chronic disease risk.

A 2017 study found that smartphone use tends to peak during young adulthood, with approximately 1 in 5 university students meeting criteria for smartphone addiction—defined as a pattern of compulsive smartphone use marked by loss of control, psychological distress when use is restricted, and continued use despite negative impacts on daily functioning, relationships, or health. Women were found to be at greater risk than men. In addition, up to half of young adults exhibit problematic smartphone-related behaviors, suggesting that these devices exert a substantial influence on this population.

To help curb excessive smartphone use, consider the following strategies: turn off non-essential notifications; establish phone-free times (such as before bed) and keep the phone in another room to reduce temptation; avoid bringing the phone into the restroom; use “Do Not Disturb” mode during focused tasks; install third-party apps to track and limit daily screen time; delete time-wasting apps; rediscover hobbies to fill leisure time; keep a paper book on hand for passive commutes or waiting periods; and tell friends and family about your goals so they can provide accountability and support.

Finally, if you are experiencing chronic spinal pain related to prolonged smartphone use, consider consulting a doctor of chiropractic. Chiropractors can provide in-office care to help reduce pain and disability, as well as prescribe simple exercises and posture strategies that can be performed between visits to help restore healthy spinal alignment.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.