If you know me outside of this blog, you may have heard me at some point say that “I wish I could do a Ted talk”. I wish I could get on top of a stage, without nerves, and educate everyone on the power of exercise, Physical Therapy, and how strong our minds and bodies really are! For now, it all starts here on this blog. Today I want to talk about 10 facts everyone should know about low back pain.
My first posts on this blog have been all about mindset. But I also want this blog to be about the positive effects that exercise has on the mind and body. As a Physical Therapist I get to work with a lot of people. And with this, I get to witness a lot of reasons why people do not exercise.
Some Reasons Why People No not Exercise
- Time constraints
- Don’t know how to
- They don’t enjoy it
- Costs too much money
- Too tired
- Commitment issues
This list can go on and on. Eventually I want to tackle each of these and give insight on how to overcome these road blocks.
But today I want to begin to skim the topic of pain. In doing so, I want to talk about the 10 facts everyone should know about Low Back Pain. Last year the British Journal Of Sports Medicine came out with a though provoking editorial about beliefs of Low Back Pain and I am using this to help frame today’s post.
Low Back Pain
Low back pain is very common. Myself and most of you reading this will most likely have Low Back Pain at some point. It is the leading cause of disability worldwide. However, most healthcare professionals are still horrible at treating it! Treatment for Low Back Pain can end up becoming very costly and ineffective.
One of the reasons why Low Back Pain can be seen as difficult to treat is because of the negative mindset associated with it. Negative mindset can mean many things but let me paint a picture for you.
The Story of Susy
Susy spent all winter curled up inside with a warm cup of coffee and a good book. Then Susy wakes up on a beautiful spring day. She goes out to tend to her garden. Eight hours later she finally comes in for her first break. Some low back soreness come on that evening. Then the next morning she wakes up and cannot move. The pain is so severe, she doesn’t even want to walk downstairs. Susy ends up calling her Primary Care Physciain, who can’t see her at all that same week. So she crawls down the stairs and takes herself to the emergency room. While there, they take images and provide pain medication. Susy gets to go home with a prescription for medication and the news that she has………. degenerative disc disease! Insert Sarcasm.
Susy looks up Degenerative Disc Disease and fears she may need surgery. The pain continues so she rests some more and continues to take her pain medicaiton. Obviously, her spring gardening is put on hold. Over the course of a few weeks she finally gets an appointment to see her doctor. Of course this leads to a referral to an orthopedic surgeon or a neurologist. At this point, she has been resting for over a month and the pain has not gone. And she is less and less active. Susy may now be contemplating surgery as her only answer, simply because she was not accurately educated by any of the members of her healthcare team.
I will now list the 10 facts everyone should know about low back pain. Then I will replay Susy’s story with a plot twist.
10 Facts Everyone Should Know About Low Back Pain
- Low Back Pain is not a serious life-threatening medical condition.
- Most episodes of Low Back Pain improve and it does not get worse as we age.
- A negative mindset, fear-avoidance behavior, negative recovery expectations, and poor pain coping behaviors are more strongly associated with persistent pain than is tissue damage.
- Imaging does not determine prognosis of the current episode of Low Back Pain, the likelihood of future disability, and does not improve clinical outcomes.
- Graduated exercise and movement in all directions is safe and healthy for the spine.
- Spine posture during sitting, standing and lifting does not predict Low Back Pain or its persistence.
- A weak core does not cause Low Back Pain and some people with Low Back Pain tend to overtense their ‘core’ muscles. While it is good to keep the trunk muscles strong, it is also helpful to relax them when they aren’t needed.
- Spine movement and loading is safe and builds structural resilience when it is graded.
- Pain flare-ups are more related to changes in activity, stress and mood rather than structural damage.
- Effective care for Low Back Pain is relatively cheap and safe. This includes: education that is patient-centred and fosters a positive mindset, and coaching people to optimise their physical and mental health (such as engaging in physical activity and exercise, social activities, healthy sleep habits and body weight, and remaining in employment).
Susy’s Story with a Plot Twist
Susy loves spending time during the winter curled up with a warm cup of coffee and a good book. But she also feels so good when she gets to stretch and gets her sweat on. So she does yoga 3 days a week in her home and bundles up to walk in her neighborhood 3 other days a week. Then Susy wakes up on a beautiful spring day. She goes out to tend to her garden. Eight hours later she finally comes in for her first break. She feels some low back soreness come on that evening. Then the next morning she wakes up and she cannot move. She talks to herself and calms down her anxiety over this. After a few deep breaths and some gentle stretching, she is able to sit up and get out of bed. She takes a hot shower and continues with some gentle stretching.
A phone call is made, but in this story, to a local Doctor of Physical Therapy. Susy gets an appointment that same day because a referral from a medical doctor is no longer needed. A full evaluation is then performed and a treatment plan is created. This evaluation includes screening for other serious medical condiionts that would warrant a referral to another medical provider. The treatment plan would most likely involved a lot of patient education on pain, movement patterns, and where to start based on findings of strength, flexibility, and movement patterns from the evaluation. Graded exercise would be prescribed specific to what Susy presents with. Manual therapy may be performed to help decrease symptoms, improve mobility, and to help improve movement mechanics. Susy would then have tools to take home to start implementing on a daily basis to help combat her low back pain.
This, along with time, and appropriate increase in activities and exercise will help Susy with her Low Back Pain. This will also decrease her cost of care, since medication and imaging is deffered, and she will not be infiltrated with a negative mindset. Meaning, she won’t be told by her doctor that she has Degernative Disc Disease. Therefore the idea of surgery in non existent and not a part of the negtaive mindset.
Side note, and more to come with this on another post, Degernative Disc Disease is a normal aging related process and you will see this finding on images of people that are asymptomatic. Imaging does not always reveal the source of the pain.
I Will Hop Off My Soapbox Now
I write all of this with love and for enlightenment.
Typically, I like to give some sort of thought provoking paragraph at the end of my posts. But today I would like you to just consider this case and remember this for if or when you experience back pain. However, if you are currently experiencing back pain and you want to have a conversation with me about this, please feel free to leave a comment or email me at [email protected]