Episode 12: Low back pain fact 2: It’s not caused by getting older

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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 2: Getting old is not a cause of low back pain. Professor Peter O’Sullivan and Kevin Wernli. welcome patient voice, Jan, who has a 40 year history of low back pain and sciatica. We’re so grateful that she shared her story with us all, and hope that you find the episode useful.

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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

Transcript

*AUTO-GENERATED*

body logic physiotherapy empowering people to achieve better health but i can’t imagine that anything is going to exacerbate the pain to the degree that i can’t deal with it right so you feel in control of it oh totally right did you three years ago no did you 10 years ago no 20 years ago no right so that’s a new thing it’s amazing welcome to episode 12 of the empowered beyond pain podcast proudly brought to you by body logic physiotherapy this week we discuss fact 2 from the 10 scientific facts about back pain research paper published in the bjsm that fact was getting older is not a cause of back pain although it’s a widespread belief and concern that getting older causes or worsens back pain research does not support this and evidence-based treatments can help at any age so in today’s episode pete and i sit down with jan who is proudly 77 years young and had a 40-year history of back pain and sciatica which as you were here took her to some very dark places which is unfortunately quite common for people with persistent pain luckily her optimism and dedication combined with finding the right coach a few years ago and life has been much richer since now before we start today the topic of suicide does come up in this conversation suicide takes the lives of eight australians every day more than double the road toll and it’s the leading cause of death for those between 15 and 44 years old 75 are male and the suicide rate in aboriginal and torres strait islander people is twice that of their non-indigenous counterparts it’s important to remember that if you’re thinking of suicide you are not alone and help is available please tell someone you trust today if you’re in australia that lifeline number is 131114 and they’re ready to help 24 7. persistent pain is associated with higher rates of suicidality so this is something we take very seriously as always show notes for this episode are available at www.bodylogic.physio forward slash podcast and if you found value in this episode please let us know via twitter share it subscribe and if you’re feeling extra generous rate and review we’d also like to let you know that we’ll be moving to fortnightly releases of the podcast so every other saturday but for now on to today’s conversation so jan welcome to the podcast um first of all can we start by you introducing yourself yes my name is jan and i’m 77 years old i’ve been retired for about the last 15 years but i’m a very active person so can you tell me your story with your back pain then so you yes um i don’t want to sound melodramatic but my journey with chronic lower back pain and sciatic pain has been a hell of a journey and i look upon where i am at now at my age when i’ve been told um i’m going to wear out uh that i’m i’m as active as i’m as i am and i seem to have although i haven’t found a panacea i’ve got the skills to deal with the pain now you’ve had one hell of a journey so can you talk me through the i suppose the processes that you’ve been through the process is gone i’ve had every everything known to man and perhaps how did it begin okay i attribute my first really acute back pain from a fall off a bus when i was 19 years old a green stick fractured my wrist and all the consultant was interested in was in fixing the wrist and he wouldn’t even listen to me when i said my back was sore so i think it was perhaps a bruised coccyx or something but it was always from that time onwards always my lower back was irritated on sitting then but of course at that at that age at 19 i was indestructible so over a period about 40 years both in the uk and in australia i’ve had bouts of non-specific back pain varying in degree varying in length of time not bad enough for me to take time off work but not popping pills and trying to keep trying to keep active but without any aiming view just keep it at bay rather than to try and fix the problem just keep it to the level where i can manage um obviously during our lifetime we do things which are we’re told our back is fragile for a start but we do do things i mean i’m a very keen gardener so i’ve lifted things that are too heavy i’ve been in the garden perhaps for a long time so my back has got so stiff but i have learned that excessive sitting is the key factor for me and what sort of job did i do i was in human resources i was interviewing counselling i was sitting all day okay so can i just ask you jan across your journey have you had much treatment i’m sorry i don’t mean to laugh have i had much treatment um i think there’s a curiosity factor here i think when you present to a to a practitioner uh because of their duty of care they they seem to think that the the more expensive the treatment the more in-depth the treatment the better the treatment so what have i had i’ve had um mris which i believe are global but there are certain practitioners who will not treat you without without an mri that’s their first route you go to the gp who sends you to someone else who then wants you to have an mri i’ve had a myelogram all of them proved pretty inconclusive uh then there was the theory that i had conjoined nerves l45s1 which this another mri a few years later disproved that so here’s the patient confused doesn’t know the implications of it i’ve had nerve root sleeve injections i’ve had facet joint injections i’ve had nerve blocks when i had one of the nerve root sleeve injections although it was under x-ray control they hit the nerve so i levitated so for two days i was useless um ongoing treatment chronic pain specialist physio twice a week which i then kind of treat manipulation was that helpful not terribly um it was soothing you feel like you have to be active in your with with your own treatment you feel that you’ve got to be doing something you’ve got to be pursuing something to resolve it if if not you you know you just get resigned and you there’s a difference between acceptance accepting something and resignation [Music] so what what the kind of diagnosis that you were given for this problem well the diagnosis for heaven’s sake did i ever get a diagnosis um i don’t think i ever got a real diagnosis the last person i saw which made me think this is enough the last person i saw um had had an mri done and had looked at it and said oh i think we could tidy things up a bit here it was like having a haircut and this and i was at that stage i was being offered nerve blocks and rhizoctomies and we all do anecdotal stuff we all do miss dr google and you have to be extremely careful because everyone’s case is different but when he offered me the rhizotomy um i went home and i talked to a guy that i respected a great deal and he’d had three rights on me and he said jen the third one i had i said no more because by the time i’d left the hospital and got into my car the pain was back so i was looking and i think all pain sufferers look for a panacea outside of themselves they cannot believe that there is a way within ourselves to tease out what are the things that are beneficial what are the things that are aggravating and i think until you can work that out um the pain will continue to be there okay so i’m really interested in that the fact you’ve had back pain for most of your life since the age of 19. and what were you thinking when you were younger you would be like when you’re at this age i was still well look i think when you young you you do feel you’re indestructible um i don’t what was the age when you started to be concerned about okay i suppose you know how you would be at this point well i don’t know if this has any relativity to it but as a woman it was at menopause that i was most uh most worried about it and also i didn’t have a very good role model in the fact that my mother had very debilitating rheumatoid arthritis right so you saw a picture of someone who wasn’t yeah so i saw a picture of this of this tall lady uh who did everything she could to help herself that was in a a corset with bones in like that steel bones and a corset so i’m thinking to myself oh hell so i i was around my middle 40s okay and did you have any um healthcare practitioners who gave you the expectation that you would get worse with age yes i think um since being in australia um i saw a medical practitioner a neurosurgeon and he said um there’s a there’s some disturbance here but it’s not quite clear what it is um and at that stage they were thinking that i had conjoined nerves and the nerves were perhaps touching together as they came out of the socket um he said to me i’d like you to i i don’t want to concern you too much he said i’d like to go away he said this will in inevitably degenerate with time so every time i’ve had an mri they say oh this degeneration well i’m sure everybody as they get older has disc degeneration but you were thinking that was going to result in you getting worse but yes yeah yes and was there any mention of wheelchairs yes he said that panera so he said to me said go home he said um there will be a time when you’ll need to be in a wheelchair all right how did that make you feel powerless powerless yeah did you feel like that was something that was going to happen to you i felt like no i don’t think i did i i thought i’ll show you right as far as possible i remember taking for instance i remember taking a job and the the the director said to me he said well our hours are 8 30 until five o’clock so i didn’t say anything during the interview and i thought 8 30 no that’s not going to work for me i have to say i want to be there a quarter tonight i am going to the gym i don’t care what happens i would have given i would have given away the job rather than not the other there’s something in you is that someone someone who told you to do that was that within you that you made that decision no i knew that um i made that decision within myself there wasn’t a health care practitioner told you to do that no no i knew that i couldn’t get through the whole day sitting down unless i got my body moving at the beginning of the day okay so you work that out for yourself you’re your own detective yes right that output okay so um so that picture that you paint is of um that kind of around the 40 mid 40s period where you were thinking my god this is going to get worse and what was the your great you had your mum which was that kind of like not a good role model of what that she had a different problem yeah and you’d also be given some scary information around the scans of the degeneration was going to get worse so you were thinking your body was going to get more and more frail yeah or more vulnerable or i think i thought could let you down with age my body could let me down right and so you you were like i’m gonna try and keep as fit as i can to try and limit that inevitability so as a measure to uh sort of circumvent that i thought now what transferable skills do i have because i i have no children right so i’ve always been a career woman i’ve always worked i thought now what transferable skills have i got that i can change my occupation without changing my occupation so um someone said to me um you’ve done public speaking i said yeah i said they said could you do some presentations for us so then i became a trainer and i could stand up doing that so i was able with the combination of the gym um during periods when it wasn’t flared after um with combination with the gym and standing up all day i was able to reinvent it so if you look back three years ago so yes and you look at to where you are now yes are you better or worse oh i’m better than when i was three okay so you’re three years older yes you’re closer to 80 and you feel better yes much so that goes against the idea that you’re going to get worse with that yes so why are you better what’s made you better what’s made me better even though you’re three years closer to 80. what’s different because your body’s three years older okay what’s different is i’ve given myself permission to give some people the flick um look your social my social network is very important to me but being that compassionate person as i am i found that other people wanted to dump all their stuff onto me and of course i accepted it all and then there’s no debriefing so if you don’t debrief and get rid of it you’re overwhelmed by it so does that affect your pain uh i i it was a burden it was how did that impact on your pain though uh i can’t put my finger and say oh look i was talking to so and so today and my pain got worse i can’t i can’t pinpoint it in that way but i can say i didn’t sleep well because i was thinking about the things and i do know that for me good sleep is important critical so those those social interactions disrupted your sleep which then disrupted japan yeah so it was kind of like a step process right so what else is different so you’re protecting your social world yes to ensure that your sleep is good yeah everyone’s burden yes what else is good i have um i do meditation okay what’s that do for your pain um it’s very it’s very calming um my husband is a very good leveler for me because just sitting next to him not touching him just sitting next to him on the sofa i feel that his calmness can help me so by transferring it to meditation that i can do anywhere at any time uh in whatever state i am just eases eases me and distracts me it’s another distraction okay i do colouring in books yeah great okay but i think three years ago you were with your husband weren’t you yes so were you relaxing and meditating then with him or is that a new thing um it’s something that i do that i have done on and off when the pain was so so bad that i couldn’t i could hardly sit at all i remember going out with i remember going out for dinner one night uh and the pain in my back was so bad that i i said to bob do you think people will mind if i if i use my cushion to kneel down and just sit at the end of the table like that and that’s what i did for the whole meal so then i got to the stage that i people would ring and say look we’re inviting you we understand if you can’t come right so do you think it was helpful when you guarded your back and set up straight no right why did you do it then uh because we’re tall we’re taught about posture and i’m i have to say a chiropractor that i’ve been to bang bang bang come back on wednesday bang bang bang bang come back on friday um uh the people that i’ve been to uh have said to me you’ve got to think about your posture you you’ve got a luxation in your back your um your your tense uh you’ve got to protect your core and yet the latest practitioner that i got that i’m seeing says oh let that belly go and it’s just like a breath of fresh air because you go right so you’ve told me a few things that have changed for you yeah the way you hold yourself your ability to relax some of your beliefs around your body yep yeah the way you manage your social interactions your sleep what about the way you move has that changed and the way that i move like if you were bending over or picking something up or using your body do you think that’s changed well i ca i can definitely say that um i’ve always been taught you must bend your knees you must not lean over from from a straight back you must always protect by bending yourself no not at all because i because um when i did yoga you bend from the waist and bend forward and bend down and put your hands flat flat on the floor in front of you which i find extremely good because it it releases all right okay so you’ve learned to ignore quite a lot of advice on your journey basically and it’s made you feel better in spite of the fact you’re older yes so if someone said to you back pain gets worse with age or i’m worried then it’s going to get worse with age or i could end up in a wheelchair or if you heard that kind of you’re not going to the joint’s going to wear out what would you say to them i would say to them be i i would say be prudent don’t do stupid things like oh for instance uh there’s a box to be moved well i will kick the box and see if it moves and if it doesn’t i don’t bend down to pick it up you’ve got to be prudent but yeah but not paranoid i would also say to them we’re all responsible for our own health we do know the things that i don’t want to say our good for us but we all know the things that can spark off uh an episode uh and i feel that so many of us um are overprotective i think that the the challenge for me has been keep moving but you were fearful of doing that yeah so what overcame that fear how did you overcome that fear of movement um uh by being i i by being given by being asked to do follow a specific program following the specific program at the end of it you get results well if you get results and they’re good results so it wasn’t something that was done to you it was more like a coach who could take you through that exactly right so things you can do yourself yes right so um i go back to a couple of times practitioners have said to me you need to rest and that seems to be a common thing look sounds like rest for sleep is good yeah rest for sleep and and sometimes when the sciatic pain is so bad i will go i would say to my husband i’m going to bed for a couple of hours i get the heat pack and that’s the rest that i have but not for days and days and days because you get stiff and useless then you become fearful of doing anything so are you fearful of the future in terms of age in terms of how do you see your future then because it sounds like the last three years you feel like you’re doing more you’ve got more strategies to control it sounds like you’ve got better control over your pain you’ve got tools yes yeah yes what was the question so so how does the next 10 years look like for you well i’m a realist i know i’m not going to be trying to climb everest but i’m absolutely convinced that i’m going to be going to the gym on a regular basis i’m absolutely convinced that i’m going to be doing the things that i want to do having a social network going out eating on various things the future the future is day by day i don’t want to project predict what i’ll be doing in three years time because i absolutely don’t know but i can’t imagine that anything is going to exacerbate the pain to the degree that i can’t deal with it right so you feel in control of it oh totally right did you three years ago no did you 10 years ago no 20 years ago no right so that’s a new thing it’s a new thing and the other thing is um you uh you are always mindful of how it has been and i i give myself i’m much kinder to myself and i give myself much better self-talk i go now jan you know you can get through this it’s not as bad as you think now what did you do the last time right you i i i actually so your own you’re your own coach talk to myself yeah your own coach if you put it that way yes yeah i talk to myself and i go in a kind way it’s yes it’s not that bad come on you can do this i have had suicidal thoughts once just once how long ago was that 2014 i was in france uh the itinerary that we had looked very doable but i was on planes in cars on beds that i didn’t know staying up late at night all those things and all these factors conspired that i could hardly walk i went to a gp who gave me all sorts of opioid drugs and whatever have you didn’t work i had a nurse coming home twice a day to give me injections how i got back to australia is all a blur [Music] and i thought i’m never going to that place again but while i was there one day my husband had to go went off to do some research and i went into the bathroom i looked at my wrists and i thought i’ll make a mess of this and just as i was at the bathroom mirror looking at my wrist the owner of the apartment who never came to the front door knocked on the door and said i saw bob go off this morning um i know he’s gone out for the day would you like to come and have a cup of tea with me i thought well that was opportunity wasn’t it that saved me doing something i didn’t so you were feeling very desperate i was feeling totally desperate for no strategy to control yourself no do you ever think that’ll happen again no never right okay no never never okay because if you think about it logically what is that going to solve it’s not going to solve anything no no no no and i have a coach for which i am very thankful now i must tell you that at one time i was fearful of it’s a it’s a health practitioner uh at one time and i spoke to him about it i was very fearful of relying too much on my practitioner but i was assured that he was only my coach and guide and i was asked when i thought another appointment would be appropriate choice practitioners do not give choice right are you reliant on that practitioner now no i like to see him i like to i like to see him to be i’m not reliant but i like the assurance that i’m still on the straight and narrow that i’m still on the right path how often do you do that uh well i’ve had a little episode lately i’ve had a little episode lately where i was moving moving moving moving so i was up for a walk and i fell over and broke my arm right okay so i’ve seen him a little bit more frequently than than i i was gradually being weaned off so what does wayne look like now for you frequency-wise a win looks like for me now six weeks two months but i’m offered the choice now when do you think you’d like to come back whereas normally practitioners will say i need to see you in two weeks after the reception is for an appointment so that’s that’s nice it puts you in control again yeah yeah have you got questions yeah i just wanted to we might explore the shoulder pain in a little bit but i just wanted to get a really clear idea of your trajectory in terms of your quality of life around your back pain and your function around your back pain so started when you were 19 and then was it a slippery downhill slide from then or was it no it was still menopause and that’s when it kicked off uh no it was um i lifted uh there’s a lot of psychological stuff around the episode that i can put my finger on [Music] i was a careers advisor which meant that i went out and promoted the place that i was the college that i was working for on this this particular evening um i had taken my display board with me which weighed 16 kilos and i had two bags of briefcase and a bag in this hand it was 10 o’clock at night it was very cold it was very wet and i slipped because i had this some great big display board which um broke down into sections but i had 16 kilos hanging around my neck and these two things here and i slept so when when was that how old were you 1980s um yeah about 1983 that was sure so that was 40. big spark in terms of your big spike and then it’s kind of how you’ve had episodes since yes and in the last three years has actually got better yes now that’s quite abnormal for the typical trajectory of back pain you know and maybe you know from the research perspective maybe pete you can talk about what is the normal trajectory for back pain so it’s a good question kev um we’ve done lots of epidemiological research to go what in a population when does it begin so and typically it’s very unusual to get back pain before the age of ten very unusual but around the age of 16 14 to 16 a lot of young people start saying oh i’ve got a bit of a sore back around the ages 17 up around one and five will be reporting significant back pain around the age of 20 um then that’s up and around 30 he’ll be reporting back pain where it starts impacting on aspects of their life is that related to technology no so there are lots of factors that can influence back pain some of it’s lifestyle factors some as a stress related factors some of it’s you know you know how much activity you engage in or not so lots of things can influence that um but we do know that if you track across time most people see it that if you’ve got an early age that’s it for you now there are some people where back pain becomes something that is a fluctuating others it’s it’s it can get worse and part of that can be some of the things that you describe to us around getting told scary message or not being informed or not having a clear understanding so the mind runs wild when you don’t have a clear understanding of what’s going on not having tools in your toolkit that allow you to have control over it you know get on with your life keep active engage you know strategies to dampen down your nervous system rather than wind it up and unfortunately that then can escalate over time for some people and i think you were someone who was probably caught in that cycle where your system was so wound up um and you were so guarded and protective you took nothing to fire you up and it sounds like your journey has been quite a different one of like de-escalation of relaxing and moving and confidence and having control over your body that often if you don’t get that the trajectory just carries on basically but what we know from the research is that um often you’ll see a peak around the mid 40s and for many people it towers off and as to why we don’t really know why but we certainly don’t see we what we do know is that there is a group of people going into older life when they’re not doing well they become dependent on opioids become very fearful avoidant they stop exercising and moving and that’s a terrible situation because it can have major impact on other issues around their health the key thing with aging is aging well yes and that’s aging fit strong active in control all the things that you’ve pretty much told us um but that’s not a common thing that people believe because if we ask people in the population what do they think about backbone they think oh my god if it’s like this at 30 or 40 what the hell am i going to be like when i’m 60 or 70 because that’s the common belief out there and the key thing that we say to people is back pain is manageable at any age and i think that’s the key at any age it’s manageable but the best things you can do for back pain are the things you can do yourself and sometimes you need a coach to help you when you got stuck into a bad cycle that makes sense um i i i just feel with the opioids um my ex i have a very low drug tolerance and i’ve had hallucinations oh the amount of drugs oh oh this is the vogue this is what seems to be the one that people take you know so you take it and you’re either a screaming lunatic or you’re crying all the time so that was another reason for me that was another reason for me searching out something for me that gelled for me which didn’t introduce chemical right the other thing that this kind of taps into is this idea that we degenerate over age and we know our structures change the way they look with tongues a bit like gray hair or wrinkles or whatever it’s a normal part of just getting older that’s not something now that concerns you i’m hearing no no no so you’re kind of i don’t need my gray hair you’ve embraced it but day by day yeah but that’s the other thing that we know does change so if you take a scanner someone’s back at the age of 45 eighty percent have so-called degeneration that’s like changes within the disk so you lose water content it’s a very normal thing but that can be a really scary thing for people because the word itself degeneration is like i’m degenerating i’m kind of falling apart i’m my body’s not as trustworthy and so that’s something that has a strong connotation with aging that people start thinking oh my god i’m now getting older and i’m gonna you know that’s the wheelchair the end point of that is i’m no longer about to function um and that’s not something that you’re now you’re you’re functioning better but you’re older yeah but i also think um there’s a certain level of curiosity um some people don’t want to know what they some there are people who you suggest something to them with the good help and they they do it once for instance exercises you know so i i have been so fortunate to have been given specific exercises which i have found do i didn’t even think i could do the jolly things but i found that i could do them and they and they work but you’ve got to keep at it you’ve got to be committed you’ve got to have goals you’ve got to measure the goals um some people they go like they get a prescription and they take they take something once or they do the exercises once [Applause] yeah and like my father was a military man and we had planted it right so you learned that so i’m hearing that that discipline is is some something you’d advise someone that maybe a colleague of yours who is coming to you and said you know i’ve been struggling with my back pain or i’ve got some dis degeneration or my doctor said i’ve got this degeneration or some bulging discs and and that discipline is something that you’d advise them to what other advice would you give those sorts of people if they’re coming to you saying you know my back’s just wearing and tearing it’s it’s going to get worn out as i get older um because those were the messages that you were given right yeah and and you you didn’t go down that path yeah so what advice would you give to you i would i was very fortunate that i happened to hear about some research that had been done and i was able to evaluate it in terms of my own back pain so what i would say to people is be curious don’t believe all that dr google says there’s a lot of anecdotal stuff out there but if you want and you’ve got to be careful about joining self-help groups because we can all whinge together but someone you you respect um talk to them about it what did they find helpful talk to a practitioner talk to a practitioner who doesn’t want to keep poking and prodding you talk to a practitioner who can give you some evidence so that’s about demanding evidence from your practitioners yes and demanding management yes skills yeah skills you know what do i do i remember my husband used to go away a lot overseas why do you think my back pain was worse then but i also um started waking up in the middle of the night and shaking i had no idea what it was but it was frightening anyway i went to the doctor i said this is unusual he gave me a little book he said look i’d like you to take this home i’d like to come back and see me in a week so i read the book avidly took it back and he said to me did you relate to any of those symptoms in there i said the whole book form he said you’re having panic attacks so to me that was just so helpful but i realized that with back pain there isn’t one everyone is a different case everyone is different everyone is an individual what aggravates me might not aggravate someone else so it’s going to be tailored for you yeah but i think you touch on another thing that’s really important and that’s around trusted sources of information and we know there are some really really trustworthy websites out there like pain health and i’m really happy to push that so the pain health website is government-funded west australian government funded and it puts up evidence-based only evidence-based health information and that’s a really important resource because what there was a study done recently that looked at the accuracy of a lot of the back pain information on the website and it’s not a lot of most of it’s not accurate and so the website on this channel yeah on the general internet if you google back pain you look it up you’ll hear some scary stuff around your back’s worn out but you know google number one i think is you know back pain is caused by degeneration the disc and it’s going to wear out with time well that’s the very thing we’re talking about today um and unfortunately it perpetuates the myth uh yes i think you’ve touched on something that i thought about which was education okay i want to buy a new tv set do i just go in and see that one in a box and just say well i’ll take that one no i go what size can i have in my lounge what what does it do how easy is it i do some research well my health is the i can’t replace it it’s the one thing that i have that i need to have some control over i can i can do the exercise and all that but be curious educate yourself about it and that’s what this podcast is for actually is to take you know people like us who work in the research world and to try and make it sensible logical understandable for people who live in the real world yes yes i’m really passionate about it because um i would never want anyone to go through all the pushing and prodding and cranking and pushing um that i and all the drugs and treatments and oh it’s endless it’s fatiguing we know it’s not life-threatening it’s fatiguing it’s time-consuming it’s inconvenient and it’s expensive good summary that’s a really good one absolutely thank you so much jan for sharing your story it’s a real pleasure so there you have it the end of another episode thanks again for tuning in and if you want more information please head to the show notes page for episode 12 which is www.bodylogic.physio forward slash podcast now as you heard the topic of suicide did come up in this conversation if you’re having suicidal thoughts please remember you’re not alone and help is available we implore you to tell someone you trust and if you’re in australia lifeline’s number is 131114 next time which as we mentioned will be in two weeks as we move to fortnightly releases we tackle back pain myth number three now we’re incredibly excited to bring you a conversation with professor rachelle bookbinder she’s a rheumatologist in melbourne and is one of the authors behind the infamous lancet series on low back pain she is truly a world world-leading authority and we had a really insightful conversation which we cannot wait to bring you but until then remember to ask is there more to pain than damage 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 theme music generously provided by ferven and cash