Episode 11: Low back pain fact 1: Scary but rarely dangerous


Low back pain is the worlds most disabling health condition and costs more than cancer and diabetes combined. A scientific journal article covering 10 facts about low back pain was recently published in the British Journal of Sports Medicine (http://dx.doi.org/10.1136/bjsports-2019-101611). The origins and motivations for that paper, as well as patient stories were covered in episode 4 and 5 of the podcast. This episode covers in detail low back pain fact number 1: Persistent back pain can be scary, but it’s rarely dangerous with Professor Peter O’Sullivan and Kevin Wernli.

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Episode Show Notes:

O’Sullivan PBCaneiro JO’Sullivan K, et al
Back to basics: 10 facts every person should know about back pain
Vaegter HB, Thinggaard P, Madsen CH, Hasenbring M, Thorlund JB. Power of Words: Influence of Preexercise Information on Hypoalgesia after Exercise-Randomized Controlled Trial [published online ahead of print, 2020 May 1]. Med Sci Sports Exerc. 2020;10.1249/MSS.0000000000002396. doi:10.1249/MSS.0000000000002396
Darlow B, Dean S, Perry M, Mathieson F, Baxter GD, Dowell A. Easy to Harm, Hard to Heal: Patient Views About the Back. Spine (Phila Pa 1976). 2015;40(11):842-850. doi:10.1097/BRS.0000000000000901
Bulging Infographic
Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. doi:10.3174/ajnr.A4173
Brinjikji W, Diehn FE, Jarvik JG, et al. MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol. 2015;36(12):2394-2399. doi:10.3174/ajnr.A4498
Too Much Medicine Infographic
Jeremy S. LewisChad E. CookTammy C. Hoffmann, and Peter O’Sullivan

Journal of Orthopaedic & Sports Physical Therapy 2020 50:11-4



body logic physiotherapy empowering people to achieve better health persistent back pain can be scary but it’s rarely dangerous persistent back pain can be distressing and disabling but it’s rarely life threatening and you’re very unlikely to end up in a wheelchair so you just heard from gilletta belton a prominent patient advocate presenting the first fact from a scientific paper published in the prestigious british journal of sports medicine earlier this year joletta was one of 10 people with a lived experience of pain who presented the 10 scientific back pain facts from that paper which we discussed in episode 4. in episode 5 we also heard patient stories behind the facts which many of you have given great feedback on but today look welcome to episode 11 of the empowered beyond pain podcast proudly brought to you by body logic physiotherapy we’re so grateful to have your ears to bring evidence to and we hope you’re well wherever you’re listening in from episode 11 corresponds with fact one of the back pain facts paper and we’ll be diving into the depths of exploring these facts over the next 10 weeks while the episodes have a particular focus around low back pain the messages actually apply to pain in all body parts in today’s episode professor peter o’sullivan and i talk many things back pain but one is the slightly backwards funding model in current pain management if you’d like to help in the quest to start funding back pain care that has a large evidence base instead of funding care that has a small evidence base which is what currently happens the easiest way is to spread the messages you hear in these podcasts as always relevant links to research papers infographics and websites that pete and i discuss in today’s episode can be found at www.bodylogic.physio forward slash podcast and remember to ask is there more to pain than damage [Music] so thanks for taking the time out again we’re going to discuss back pain fact number one today we’ve just heard joe letter talk about the fact which is that um well the myth is that back pain is usually as a result of something serious yeah and the fact is that low back pain is usually not a serious or life-threatening condition i think it’s probably important to just talk about um well first of all define low back pain yeah so back pain is um or low back pain is defined by pain that is from your t12 which is like the lower part of your back so you’ve got your thorax which is this bit and then below that is your back and then usually between pain between there and your buttock cheeks so any pain within that area is defined as back pain and of course back pain can be caused by lots of things which is partly what that fact is about um although there’s a general belief i think in the community that if you’ve got back pain it’s likely to be something really serious then it could even be life-threatening and certainly there are some causes of back pain that can be serious and you know any healthcare practitioner has to be alert to those things so examples of like a serious condition would be a fracture so it might be some kind of traumatic injury and i’ve certainly fractured my back came off the mountain violated over the back over a log and it crunched and i had severe pain and it was you know fractured a couple of bones in my back it was extraordinarily painful um so there’s a good reason for that like if you’ve broken a bone before you’re going to know about it so there’s a trauma that results in tissue damage which causes immediate pain there are other causes of back pain which are way you know again not common um like an infection in the spine very uncommon it’s something that may present um for someone who might be uh you know had an intravenous injection or it somehow there’s an infection that’s tracked into your body into your spine uh it’s usually linked to severe pain night pain fever um so you want to be aware of that but usually those problems go to emergency department they don’t come to see people like me in a primary care setting um and then you can have malignancy so um you know there are some cancers that can affect the bones or even the structures within the spine and certainly i have seen patients who have had back pain that has arisen from those you know that kind of cause and that is serious and can be life-threatening so you definitely want to identify those things and you know there are predictors of those around a previous history of cancer so if you’ve had a melanoma or a breast cancer for example then a secondary cancer could present itself in the bone which could be in the spine i’ve seen a young person with intrathecal tumor so tumor within the spinal cord um very rare but it they do present and we have to be a really alert to identify them but it’s a very small group of patients um and then you have other causes like um uh inflammatory disorders so um spondyloarthropathy which could be inflammatory disorder that could affect the structures around the spine and that’s something that a rheumatologist would you know a blood test could identify inflammatory markers and link to that and that’s often linked to a lot of morning stiffness and you know response to anti-inflammatories and discomfort of rest etc so there are there are key kind of um things that you would be alert to as a clinician that may um suggest that there are other causes that are going on in terms of back pain the the the fact is though that these kind of causes are really real like one percent of the population present with them and often they don’t present primary care but they may and we have to be alert to them um and then we’ve got to refer them on for further investigation um the common course of back pain is quite different i mean there are other causes like um where there may be a structural problem like a disc prolapse but that’s usually leg pain so people will be saying i’ve got pain right now radiant in my leg they may have some numbness or some lack of power and that’s because there may be some nerve compression around the nerve incredibly painful and of course in those situations if you’ve got a loss of bladder function bladder or bowel or sensory loss and around the perineal area that’s an immediate referral for scanning and potential surgery because that is serious condition that can compromise um someone’s confidence for example and i’ve certainly had a case in the last year where that is the case i reviewed this person they were operating that la that night and they’ve had a hard journey since then where to regain their continence and sensation or apparently your area as well as regain power and sensation in their leg so the other kinds of things we have to be alert to as healthcare practitioners to go there are these there’s a checklist of things we’ve got to screen for to make sure it’s not serious but the great news is the majority of people 95 or even greater percentage of people it’s not in that category and that’s a problem for people because often we think the worse i’ve got back pain on my god and yet it’s like a really small group where that is going on with a natural for the majority of people the natural cause of back pain is really different to that and it’s a whole different story so that’s for the 95 percent of people that’s what you’re talking about yeah exactly so so in that group that 95 yeah what would you say the cause is yeah so what we know is um there are different kinds of pain so um all of us have had pain from spraining an ankle before yeah and it’s really painful but we know that your sprained ankle is going to get better if you you know you might have to take it easy for a couple of days but you keep yourself moving you get that ankle mobile you get it strong and you’ll be back running and jumping and doing all your normal things and your egg will be back to normal should be within a few weeks time back in to do doing the things you love so you can sprain your back and we often hear this with people do a sudden loading event or they decondition they lift something you know way heavier than they expected or they have been sitting all week and they haven’t been doing much exercise they get out they dig a whole lot of holes in the garden and then they go to bend over and hang them back acute back pain incredibly painful can be incredibly painful but we would call that a back sprain so that’s where you sprain or strain your back and that’s like an acute tissue strain with a muscle spasm it’s really painful it can be very disabling um and limiting but the natural history is that will get better really quickly so within a couple of weeks the majority of people are significantly better and within you know six to eight weeks they should be really well on the way a bit like an ankle sprain um then there are different kinds of pain so you’ve probably had a headache before well i’ve had a headache before you might have had it from drinking well i don’t drink so much but um you might have had a headache also because you’re really tired and run down uh and so i had i had a bit of a virus um over the weekend i had a splitting headache now i knew i hadn’t banged my head i hadn’t damaged my brain i didn’t for a moment then i had a brain tumor i was run down tired under pressure and i had a splitting headache and what did i do i went to had a bath early you know chilled out um didn’t push myself so hard uh and just gave me some time to recover headache resolved now backaches can present like that so we know that um you can develop back pain at a time at a time in your life when you are under stress um where you run down it might be under pressure and and that can emerge without any injury at all and so that’s like a backache which we would see no differently than a headache but it might be really painful in the back just like a headache can be really painful but you know it’s not because you’re damaged now we often don’t think of backache like headache we often think of backaches like oh my god what’s going on we’re with a headache we wouldn’t think i’ll break your mouth you’d think yeah i’ve had a tough day i need to well hopefully you don’t think the brain tumor now if that if that headache persisted day after day of the day then you might think hang on a second what is going on and the same with backache if the natural history isn’t recovering and it may be because you haven’t addressed other things in your life that are driving that process and that’s something we see very commonly and the other thing i think that happens around that is often when we get pain we kind of go what do we think it is and we often go into protective mode and so often when we have pain in the body part we guard that part and by guarding we start to start reducing the movement and it can actually make the pain worse rather than the thing that you want to do is to relax and move and get going and get back to stuff and get your sleep and your general health and your mental health and often those that kind of pain can subside um and i i think there’s a hybrid so you can have for example we see this in say a work situation where you know i can think of a case where they strained their back and there was all these other factors so that there was work work-related stuff there was workers compensation stuff the person was under huge amount of stress that is not an environment the body like an injury can recover in so you can actually more from an injury pain and when the tissue is healed it becomes another pain and that’s when pain becomes persistent so it’s a bit like you sprain your ankle and you start over protecting that ankle and you start guarding that ankle you start thinking something’s terrible wrong with that and you start not wanting to use that ankle and i’ve had a case i saw yesterday just like that or day before just like that where six weeks later that ankle is not getting better it’s getting worse and in the same way back pain can become like that so the original sprain is well and truly gone that was the what we call nociceptor pain that’s like pain from a strain and and the inflammation settled and then it’s morphed into something else which is where the whole nervous system gets involved where you start over protecting something and guarding it and start fearing it and worrying about it and that’s when the nervous system starts creating a different kind of pain which is often called nosy plastic pain which is like pain that emerges where there is no injury and that can morph that can emerge from a point of stress in your life but it can also transition from an injury into that kind of pain if that makes sense so there’s lots of reasons why you could have pain and sometimes they’re really really simple and sometimes they’re a little more a lot more complicated um i saw a lady on monday who said you know if it wasn’t for you to have my back fuse and all i had to do was relax in my back and i’m so grateful that you helped me work that out yeah so sometimes you’re a biomechanical drivers that are linked to our beliefs that make us over protect or guard body parts that’s really unhelpful and actually can make pain worse but it’s not serious it’s not life-threatening but it can seriously mess us up in terms of um uh the impact it has in our life and the pain that we feel as well absolutely still be highly yeah absolutely about that yeah and that that is a really hard thing to realize but you know i can think of times in my life um where i’ve had back pain one linked to a fracture another time linked to a very stressful time in my life another link to a like a major repetitive physical load each of them probably were equally as painful but i know each one was related to different kind of pain yeah and so the way i managed it was really different the fracture one i knew i had to let it heal so i had to just go sensibly kept working kept moving kept exercising but i didn’t do a lot of stuff that would overload my back because i knew the bone needed to heal well the other kind of pain is like yeah i know what you are go to get some rest get good sleep care for my health get active get moving relax keep going yeah and that speaks to that kind of individualized management based on the specific contributing factors exactly that person at that moment in time exactly and that’s where the case the patient story is so important and unfortunately because you’ve got this diagnostic vacuum which is called back pain where like 95 you go what is it um then we go we kind of lump everyone in the same category where clearly there are different drivers and triggers and different pain types that may be present in different people and then our job is to work that out yeah and then target it i just want to touch on um the idea of non-specific low back pain we talked about it in last week yeah with sam barnsley yeah um the 95 percent that we’re talking about is the non-specific yeah and that’s a label that researchers probably have used to describe that yeah and it really annoys patients yeah and it’s really annoying clinicians yeah that’s why we don’t talk about that yeah so briefly i think it’s a really helpful it’s an exclusion label that’s to say to me as a clinician be reassured this is not cancer it’s not an infection it’s not an inflammatory disorder it’s it’s not a fracture be reassured and there’s no specific clear specific pathology where there’s nerve compromise or neurological deficit so now that you’ve eliminated that you’re sitting in this other category where there’s no serious identifiable pathology or tissue damage so be reassured like then you go back to basic principles and you go sprite ankle what would you say well a sprained ankle is a mechanism so you know you sprained your ankle what were you doing oh you did that so okay that’s his brain so what would you say to someone anchored to you want to go oh god my god you need to rest that up and you shouldn’t go to work you might say look mate you’re probably better off backing off you first make an estimate is to the degree you know the significance of that and then you would give simple strategies to say look it’s really important we keep that ankle moving it’s really important we get you gradually get you strong because there will be an inflammatory tail you know you’ll get pain secondary to some kind of tissue strain and then we’re going to get you fit and active and strong to get you back to loading that ankle up and moving it in a nor in all directions so it’s strong and capable of doing that back pain is exactly the same in that way and i think to say that you just there’s nothing we don’t know there’s nothing wrong with that doesn’t it defies logic yeah in my mind because the patient’s coming and telling you i’m mate i’m telling you i’ve got this problem yeah and that’s what it is i mean i saw a guy um last week he came and he said i’ve seen all these people and i know there’s something around my back but the x-rays all they show is i’ve got wear and tear but i presume that’s been there for a while i want to know what it is and this guy had adopted a strategy of movement was highly provocative to his back simply changing it took his pain away now you go can abnormal or can altered movement or abnormal protective guarding provoke pain yeah it probably can is it dangerous no it’s not dangerous it’s not dangerous to tense your body when you move but probably doing it a lot a lot over time could sensitize tissue make them really tender which means that you just keep provoking it it’s a bit like doing that to your finger you can do that probably for a couple of hours probably do it for a few days we get a bit sore and we probably say you know what it’s good to bend it the other way so we would see it that way in terms of backs it’s like they like movement they like variability they like to be strong for task you know healthy spines are mobile strong fit spines yeah absolutely and you highlighted a nice example before that talked about um the you know headaches and people wouldn’t necessarily worry about headaches the same way they do around back pain i just want to kind of talk through a little bit of a scenario so let’s say for example i’ve just hurt my knee and i walked down to some a random person in the street and said look i’ve hurt my knee um they might say oh that’s that’s unfortunate you know maybe rest it up for a bit if you’ve injured it but then get it loading get it moving and get it strong again if i saw that same person in the street and i said i’ve hurt my back straight away the alarm bells might go off in their mind and say wow you’re too young to have a back pain um you know this is it’s going to be a downhill spiral from here you’ve got to be careful with your back you’ve only got one i know a good spinal surgeon or my uncle had back pain and he had to be off work for the rest of the time so there’s a clear difference in terms of the fear that that the label of back pain has what you can talk about yeah so it’s a really interesting question it’s something we have explored um because we’ve done quite a few studies looking at back pain beliefs both in really young people like in adolescents and in older people like baby burmese and what we’ve seen in the population is there’s a general pessimism around back pain ben darlow and new zealand’s done some pretty cool research as well asking people what they think about backs and the the key quote from his paper which is the lead in his paper was um easy to hurt hard to heal hard to heal no yeah i think it is easy to harm hard to heal and that view is that the back’s a really vulnerable structure and once you’ve got it might be careful because that could be with you for a long time now where does that come from um is a really great question and if you ask people um it’s probably a bit like a um uh an urban myth i think that has become pervasive in our community and it’s probably been reinforced through occupational health and safety and through the messages that we give people like my god be careful we don’t say in a workplace be careful how you bend your knee be careful how you’ve been chilled out goodness sake be careful how you use your shoulder well they might say some of that but the big message is be careful how you bend your back because if you’re in a manual job and you you’re back well we know what happens to you and so we’ve got the firefighters back the farmer’s back the nurses back we don’t have the nurse’s knee nurse’s elbow we have the nurses back so there are whole industries that have kind of stigmatized back pain as something really threatening and look back pain can be really painful and it could emerge and it’s common in those in those in those trades but it’s probably made worse by the fear that is induced around it and the misinformation that goes with it um and you know i i had a again a farmer um just today who you know some distance to come and review with me and here’s why i i’ll be told i need a fusion and i i don’t want it and and he’s thinking terrible things about his back and and it’s completely up ruined his life but there are very simple things he can do to help his back no one’s given them but it’s around a belief that is oh my god my back is this and it’s i can identify it on a scan and my scan shows i’m wearing out and that’s a whole other story around the role of imaging which is what often happens in our community now is that you get a scam not to reassure the person they don’t have the one percent it frightens them by telling there’s all these things wrong with their back that actually is normal yeah the whole episode so we’ve created another monster by using pathology that is normal as a diagnostic label which frightens a whole group of people which you know creates another catastrophe and so we we have created this monster in our community around um frightening people with back pain giving them these myths around the the natural history is bleak you know your pain is going to persist and and we’ve kind of created it’s like fulfilling a self-fulfilling prophecy yeah it’s like we’ve set the disaster up and then we’ve over treated it and we’ve over imaged it and then we’ve told people to be careful with them we told them to you know keep these rules which are really unhealthy for backs like guard it protect it don’t use it you know we don’t tell someone with a knee god damn don’t bend that knee but we say i saw a young lady today who hasn’t been her back in years and she’s in real trouble someone told her not to bend and she’s done it it’s a really common society societal belief as well isn’t it it’s nuts and actually if you think about it just from a very basic point of view someone said to you mate don’t bend your elbow yeah because you might hurt it well you’d have a pretty limited time you wouldn’t better eat much but actually that’s what we’re doing to people in our population we give them these crazy rules around what is good and bad for their back and then they get those rules govern them and it really destroys it really disrupts their life yeah absolutely i think those rules kind of come from a good place typically yeah i think originally but they come from a lack of understanding of the nature of back pain yeah absolutely yeah and these are all these are old thoughts that are not evidence informed but they’ve just been self-perpetuated over time yeah you kind of mentioned the self-fulfilling prophecy that was one of the points that i sort of had written down i think if you know we we then create yeah like you said a big vacuum for ourselves if we if we think if our brains getting messages of threat and danger then ironically we end up producing more you know inflammatory cytokines chemokines and our system becomes more sensitive yeah as well in fact there’s zero biological very yeah there’s a very cool paper um from our colleagues in denmark that giving people scary information before they exercise and looking at their um the tissue sensitivity response yeah and the scary information before engaging in activity made their local tissue more sensitive so biologically it makes complete sense that our nervous system protects us when we’re doing things that potentially could do us harm so those diagnostic labels can be really threatening or like you said it could be that my um my parent had a back problem and had a fusion and my terror my fear has become like that yeah um totally understandable yeah but you know to make people realize that they’re not their father yeah and their journey could be a different journey and that all the same journey also the opposite is true as well if you um have credible evidence of safety that can reduce your pain as well yeah and look i think the other thing that’s probably worth pointing out here is um that’s this issue with the scan is really contentious so for example if i took an mri scan of your back and it showed this degeneration now do i know that is or not relevant because we know that there’s a higher prevalence of this degeneration of people with pain but we also know it’s common with people without pain and i see a little bit like you know you’ve got changes like oh wait changes in your knee so if those changes emerge really early in life they’re not so normal if they are there at the age of 50 they’re pretty normal right if they’re really advanced though the age 40 that’s not very normal so when we have a look at a scan result you’ve got to correlate it against the person that’s number one does it match the person so the guy i saw today i basically said look if i normalize how you move your pain gets worse so that’s telling me there’s nothing serious going on with you because sorry your pain gets better so if we get you to relax and stand up and use your back as it’s designed it feels better yeah you can’t do that with damage backs you can’t do that with fractures you can’t do that with prolapse this it doesn’t work like that when you normalize movement it gets worse right it’s like tell some of the broken leg to just walk normally it doesn’t feel good i tried that with the shoulder once it didn’t work very well um but you know so part of our um process of reasoning with someone is to do these experiments with them to go okay let’s just check you out let’s examine you let’s look at what happens when we get you relax and move normally and if it feels better there’s a really high chance there’s nothing seriously going on with you your body’s just in protective mode yeah and so rather than judging someone and saying look mate you know you there’s nothing wrong with your back which i think is never helpful um because everybody’s back pain is real and backpack can be really destructive to someone’s life and very distressing and hugely disabling so it’s not to trivialize it but it’s to just say that it’s it is a really important problem that has got that is serious for you but it is not life-threatening and that so it’s and that probably isn’t very reassuring for someone when it is threatening their life in terms of the impact of pain in their lifestyle but then it’s to say look there are other factors that we can address you can’t change what your back looks like but it can change how you think about it how you use it your confidence is moving at your ability to engage with things and usually that’s a journey that makes people feel better yeah absolutely and you probably don’t have to change what their back looks like well you definitely don’t have to change it to yeah and look i i think the longer i’ve worked as a clinician i’m forever amazed at what people structures are capable of doing and irrespective of what they look like yeah i am amazed what they can do i’ve seen backs that you know you would look at and just go oh my goodness and watching people move with those backs who move normally and without threat and without a sense of discomfort and then i’ve seen people with perfect looking spines who are profoundly disabled yeah so you know what your back looks like is you know in some cases it’s a great predictor for those specific pathologies fractures acute prolapses progressive stuff one to five percent but a lot of the time they’re just opportunities to frighten people yeah um it kind of reminds me of a timer um a case that i when i was in nepal i had an international placement in nepal we’re working at a university university hospital over there and we saw this guy who had a really large scoliosis so an s curve in his spine and it was phenomenal at how large this curve was like parts of his um upper thoracic spine was touching his lower thoracic spine basically and um i was all right this is a case that i’m going to go see for pain and so we started sort of examining and asking questions and he said oh no i’m not here for my pain i’m here because i’m having trouble breathing so that for me was a really big experience to say okay hang on a second like if this guy can have this sort of scan yeah but he’s not he’s not in here for his pain because he can’t breathe because his lungs are getting compressed yeah that really stuck to me and we get worried about a leg length difference of a centimeter like hello like those things don’t really count and i think it’s a real trap for physio physiotherapist people working with back pain is we often look for things that don’t matter yeah you know we often examine stuff that really doesn’t it’s not predictive of anything yeah we look at asymmetry symmetry is normal no superhuman beings are built the same all of us have got asymmetry somewhere and that’s a normal part of being human um that’s red herrings in clinical practice yeah yeah what is it ninety percent of people have a leg length description yeah great and then clinicians are always wanting to homogenize it i get this ridiculous ad that keeps popping up around trying to make people sick with postures look like like this well go do that for a day and you’ll see how you don’t feel too good but these rules that we put on people are just so it’s they’re not kind they come from some archaic part of our past i think around prescribing what people human beings should do i don’t know that don’t make much sense to me yeah yeah they’re not supported when you look at when you’re trying to test them no strong beliefs in clinical practice but they’re they’re not supported when we try to see whether they’re true or not yeah um i want to sort of wrap it up for the list now i also wanted to briefly touch on the burden of back pain while we’re doing 10 episodes just on back pain facts yeah we published so back pain amazingly is the most disabling of all health conditions in the world yeah it’s huge problem amount of money spent on back pain it’s enormous days lost for work um medications you know opioid crisis a good chunk of that is spent on back pain so it is a huge problem in our society um and i think the more we’ve thrown money at it the more we treat it the more we scale it the more we advise people to do scary stuff the worse we’re made at and we know this that the burden of of disability related backgrounds actually got worse over time um we know there are people in our population in back pain who never seek here they’re not disabled i’m one of them um i get back pain but but it doesn’t worry me and i engage it reminds me to keep active keep healthy go to bed on time do those kinds of things so i’m lucky that you know i have an understanding of that yeah um but for other people it can have a devastating effect on their lives and the problem is and we know this from research that if you look at the things that predict someone had with an acute episode of back pain not getting better they’re not things like what your scan looks like they’re things like your beliefs if you have beliefs that this is a terrible thing and it’s not going to get better and that this is something i have no control over and then i need to take time off work and i need to go out and protect it and rest it those are the things that make back pain get worse and that kind of feeds into this negative emotional stuff around fear and worry and distress which we know fires the nervous system up to become overprotective and linked to that are all the physical components around guarding and protecting and tensing and painful structure that’s the mess that we’ve got at the moment yeah there’s a lot of that and so we’ve got a huge job um as a profession i think um and as a society to try to change the narrative around back pain to de-threaten it and actually reassure people that um back pain can be managed well and effectively if you have the right mindset and if you have the right coach and you have the right approach yeah and and it will get better on its own for a number of people and if it doesn’t get the right coach but don’t go and see someone who’s going to front you and tell you sit straight don’t bend brace your core come and see me three times a week for the next 12 months don’t know people who are giving you evidence-based care go find someone go and find someone who’s going to become your coach to get you back to doing the stuff in life you value that’s the thing that makes the difference absolutely and it’s not an equal pathway for each person and for some it’s a hard journey and for others an easier journey yeah and and just in terms of cost as well i mean back pain is um more costly than diabetes and cancer combined yeah so look like crazy some tangible yeah um but you know the sad thing around the cost issue is um if you think of around the cost of care is that we’re spending an enormous amount of money delivering care that has a very poor evidence base and we’re under funding care that has a large evidence base and that’s a massive issue with the health industry is that there are vested interests and you know industries that are um for driving care pathways that are not really helping the problem yeah i wanted to finish off with um just some potentially some advice you know so maybe the listeners or the the patients of the listeners are probably more than likely they’re in that 95 category um what sort of advice do we give them if particularly if they’re thinking i have i’ve got i think i’ve got something seriously wrong with my back but he’s now saying that um back pain is usually not uh related to yeah so i’ve been going look if you’re really worried about it first rule of thumb is have you had significant injury that’s not been picking up a sock it’s like a trauma yeah big fall you know sudden loading event um you know could there be a fracture or maybe that you’ve got a you know i can think of people who are osteoporotic where it’s not a major event but they’ve had an extra cute they’ve had acute back pain but in saying that those people get better as well because the bones heal um bones are wonderful structures they’re bloody painful but they get better and they get better really well um so number one rule of thumb is that if you if you’re worried about something serious you know if you’ve got a fever have you had cancer before you know those are the kinds of questions to ask you know you’ve got pain at night that is you know you know not remitting and you’ve got a fever then you know you’ve got rapid weight loss and you’ve got other you know ill health that goes with it yeah go and see your doctor yeah and there’s no harm in getting checked okay now that may involve a scan and if you get a scan just be aware that if you’re as you get older the more stuff will show up on that scan so be reassured that you will have stuff on the scan so for me i would expect stuff in the scan and i had an mri scan for a different reason and i’ve got disc bulges and you know narrowing and god knows what in my spine but it’s nowhere near where i might get sore so there are a lot of things that are normal scans are very sensitive so be reassured again if it’s an acute pain and there’s a being like a sprain then be reassured it will get better within a few a couple weeks but do the right thing keep moving keep active use a heat pack gently move relax get mobility back into your spine keep working don’t lie don’t rest don’t over protect and have a positive mindset it will get better if it doesn’t get better seek care but seek care from someone who’s going to provide you an evidence-a-brace approach to managing your pain yeah and and that usually is don’t let someone take over your care make you the partner in your care so that you’re given stuff to be in control of your pain and that’s really important in health and i think you have to be demanding of that yeah um the other thing is you know there are a number of like the pain health websites i think it’s a really useful website give some really cool information around back pain um the pain ed website has some wonderful information and patient stories that it can really is reassuring and i think for people who do have persistent disabling back pain they are the ones who need to seek out care from someone who can take them on a journey and it takes time but make sure you’re in the driver’s seat yeah for that journey that you’re not a passenger out the back waiting for something to happen yeah yeah okay it’s a really good place to leave it um thanks for your time pete we also uh episode 14 is all about scans so we do have an upcoming episode yeah great all about scans so make sure you stay tuned for that one like to thank you again for your time see in the next episode thank you wow what a cracker that episode was if i dare to say so myself if you enjoyed it consider rating sharing or subscribing my take-homes although pain is very real and can be debilitating and severe the chances you have anything serious going on are very low especially if you’ve had it for some time despite its convincing nature back pain is very unlikely to put you in a wheelchair now i know these may be hard take homes to swallow for some so finding a trusted coach to help you along the way can be vital perhaps the silver lining of the coronavirus pandemic is that with telehealth now being so widespread coaches are far more accessible than they were this time last year show notes for this page are available at www.bodylogic.physio forward slash podcast and next week we dive into fact 2 all about busting the myth that back pain is because you’re getting old but until then remember to ask is there more to pain than damage [Music] please note what you heard on this episode of empowered beyond pain is strictly for information purposes only and does not substitute individualized care from a trusted and licensed health professional if you would like individualised high-value care for your pain sports or pelvic health problem head to the body logic website and make an appointment fee 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