Back to the Basics:

Understanding and Conquering Low Back Pain

Low back pain (LBP) is currently considered to be the most common cause of disability and time off in people over 45 years of age. It is reported that 84% of people will experience LBP at some point during their life.

There are two types of pain:

Acute: Pain that lasts from a few days to a couple weeks.

Chronic: Pain that lasts for 12 weeks or more. It is reported that 20% of people who develop acute LBP end up in the chronic LBP category, as their symptoms persist for almost a year.

If you look up: “What are risk factors to developing low back pain?” you are going to see a lot of medical and anatomical terms you may not understand. In fact, these terms may be triggering, so we advise against it.

In recent years we have discovered that there is WAY more that affects a patient’s pain than just strictly anatomical structures, tissue damage, and genetics. Emotional, Social, and Environmental aspects can play into our pain response. If you are interested more in how these factors affect our pain we strongly encourage you to read our blog post:

So, after reading these first few sentences you may be wondering “well, how can I avoid low back pain?!”

It’s actually quite simple.

Our favorite “next step option” would be booking a physical therapy evaluation to get a total body movement screen. This approach allows the patient to get feedback on his/her movements, as well as some one on one time with your physical therapist to discuss some areas of concern that might cause back pain in the future. If that is not something you want to pursue, we highly recommend you find something where you can move your body more often doing something you enjoy. We encourage a lot of our clients to walk, run, hike, bike, kayak, play tennis, golf, or participate in any sport or hobby of interest. We know what our bodies are anatomically designed to do and handle, so we encourage movement, but within reason for each specific person.

Ashlyn and Sarah both live active lifestyles. For instance, Sarah plays rugby for the Worcester Women’s Rugby team. She participates in a strength and conditioning training program. Sarah also runs, goes for walks, and hikes. Ashlyn started learning Muay Thai recently this year. She also participates in a strength and conditioning training program, as well as enjoys walks, yoga, runs, and hikes.  Ashlyn and Sarah both enjoy doing many things that keep them moving and that they have fun doing.

Now, how do you treat a person with low back pain or a low back pain patient?

You’re probably asking yourself “Well aren’t they the same thing?”

The answer is No.

If I were to treat a low back pain patient, I would just be looking at the low back. I would be treating the diagnosis. I would be searching for all the impairments and anything that seemed out of the ordinary in the low back and planning interventions around these to see if they worked.

If I were to treat a person with low back pain, I would be looking at the person wholly. However, to have this approach the clinician must completely understand the implementation of a biopsychosocial model vs your traditional biomedical model.

Our treatment of low backs has improved, but our treatment of people with low back pain has gotten worse. Why? Because the implementation of this biopsychosocial model is still something that practitioners struggle with. Biology is important, but it is only a small part of a very complex human who contains psychological and social perspectives.

It is important to understand how we interact with patients should be mindful of these complexities. If you’re still on the fence...

Look at this study. Positive age beliefs protect against dementia even among elders with high-risk gene (plos.org)

Short summary: Findings of the study suggest having positive beliefs change your risk factors from your genetic expression.

In the medical field we have made so many advances to make us better, so why are our people feeling worse? Could it be the healthcare clinicians and their interactions with patients? Food for thought.

Low back pain isn’t something people should have to “just live with.” If we are to start treating the person with low back vs the low back pain, I think we will see a change in the trajectory of this disability.

Unfortunately, there is no exercise that is superior to the other. We can’t give a patient a couple exercises and expect them to just magically fix their pain after 3-4 weeks. Yes it will help, but it is unlikely to be the solution. We must reframe our perspective to help effect long term relief for the patient. An truly effective treatment approach would be one that incorporates movements that fit the patient’s abilities, combined with a psychological component. The effects of these in combination are better and are maintained longer over time.

Resources:

• Puentedura, Emilio J., and Timothy Flynn. “Combining Manual Therapy with Pain Neuroscience Education in the Treatment of Chronic Low Back Pain: A Narrative Review of the Literature.” Physiotherapy Theory and Practice, vol. 32, no. 5, 30 June 2016, pp. 408–414, 10.1080/09593985.2016.1194663. Accessed 2 Dec. 2019.
• “Pain Neuroscience Education (PNE).” Physiopedia, 2012, www.physio-pedia.com/Pain_Neuroscience_Education_(PNE).
• Louw, Adriaan, et al. “Immediate Effect of Pain Neuroscience Education for Recent Onset Low Back Pain: An Exploratory Single Arm Trial.” Journal of Manual & Manipulative Therapy, vol. 27, no. 5, 4 June 2019, pp. 267–276, 10.1080/10669817.2019.1624006.