Episode 4 – Ten scientific facts about low back pain
Back pain is the most disabling health condition on the planet and costs more than cancer and diabetes combined. In this week’s episode, we discuss the 10 scientific facts every person should know about back pain, the origins of the popular research paper published in the prestigious British Journal of Sports Medicine (BJSM)( http://dx.doi.org/10.1136/bjsports-2019-101611 ), as well as why a strong core or lifting with a straight back might not be as important for back pain as we first thought… plus much more.
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Episode Show Notes:
Ten scientific facts about low back pain:
Video’s of the facts presented by patients available here:
Nic Saraceni’s paper about bending your back during lifting here:
Welcome to episode 4 of the Empowered Beyond Pain podcast, proudly brought to you by Body Logic Physiotherapy. I’m Kevin Wernli, a physiotherapist and PhD researcher, and each week I’m joined by world leading physiotherapy specialists* and clinical researchers Professor Peter O’Sullivan and Dr JP Caneiro as co-hosts with a simple goal… to help you make sense of science, bring evidence to your eardrums, and empower you to better health, and empower clinicians to provide the best care for people with pain.
In this week’s episode we start by playing audio from a brand new resource we put together with the help of some prominent global patient advocates to summarise a very popular research article titled: “Back to Basics: 10 facts every person should know about back pain”. This scientific paper was published in the prestigious medical journal: the British Journal of Sports Medicine a few months ago and today we discuss some of the key concepts raised in the paper. Professor Peter O’Sullivan led the paper which was also co-authored by Dr JP Caneiro and myself, as well as Dr Kieran O’Sullivan, Dr Ivan Lin, Dr Sam Bunzli and Dr Mary O’Keeffe. Next week we hear the stories behind the patient advocates that presented the facts, as well as talk to Joletta Belton who presented low back pain fact number one and is the patient-partnership lead on the Journal of Orthopaedic and Sports Physical therapy (JOSPT)’s editorial board discussing her journey with persistent pain.
As always, show notes, including resources, references and transcript, as well as video of the conversation, can be found at www.bodylogic.physio/podcast. We hope you enjoy this episode of the Empowered Beyond Pain podcast, and remember to ask, is there more to pain than damage.
[Music] persistent back pain can be scary but it’s rarely dangerous assistant back pain can be distressing and disabling but it’s rarely life-threatening and you’re very unlikely to end up in a wheelchair 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 persistent back pain is rarely associated with any serious tissue damage lacks a strop if you have had an injury tissue healing occurs within three months so if pain persists past this time usually means there are other contributing factors a lot of back pain begins with no injury or with simple everyday movement these occasions may have contributions with stress tension fatigue in activity or unaccustomed activity which can make the BAC sensitive to movement and loading sounds rarely show the cause of back pain scans are important but only for a minority of people lots of scary-sounding fields can be reported on skin such as disc bulges degeneration protrusions arthritis and so on unfortunately the reports don’t say that these findings are very common in people without back pain and that they don’t predict how much pain you feel or how disabled you are scans also often change with most discs prolapses shrinking over time pain with exercise movement doesn’t mean you’re doing harm when paper cysts is common that the spine and surrounding muscles become really sensitive to touch and with movement importantly the pain you feel during movement and activities reflects how sensitive your structures are not how damaged you are so it’s safe and normal to feel some pain when you start to move in exercise this usually settles down with time as you get more active in fact exercise and movement are one of the most effective ways to treat back pain and having a health professional coach you through the process can be helpful that pain is not placed before question how we sit stand and bend has not been shown to cause back back even though these activities may be painful a variety of postures are healthy for the back and it’s safe to relax during everyday tasks such as sitting bending and lifting with around back in fact it can be more efficient back pain is not caused by a weak or weak core muscles do not cause back back in fact people with back pain often tense their core as a protective response this is like clenching your fists after you sprained your wrist being strong is important when you need the muscles to switch on but being tense all the time isn’t healthy learning to relax their core muscles during everyday tasks can be helpful backs do not wear out with every day loading and bending a same way lifting weights makes muscles stronger moving and loading like the back stronger and healthier so activities like running twisting bending and lifting our safe if you start gradually and practice regularly pain flares don’t mean you’re damaging yourself while painful ups can be very painful and scary they are not usually related to DC damage the common triggers are things like poor sleep stress tension worries low mood in activity or unaccustomed actively controlling these factors can help prevent exacerbations and if you do have a pain flare up instead of treating it like an injury try to stay calm relax and keep moving injections surgery and strong drugs are usually not a cure spine injections surgery and strong drugs like opioids usually aren’t very effective for persistent back pain in the long term they come with risks and can have unhealthy side effects so finding low-risk ways to put you in control of your pain is the key to read the full paper for free search back pain facts be jsm if you’d like to watch the patient stories behind the facts click the link in the description so we’ve just heard the video the audio of the video for the back facts video that we has been published by BJ’s and I wanted to get a bit of an insight into the behind the scenes of that paper that paper has been it’s kind of blown up in in this journal space journal article space it’s a really popular article and I think you know this story behind that the article will kind of help explain or partly explain why it’s been so popular and it also gives a nicely decided to where all these facts and myths come from so can you kind of Pete you you were the lead author of that paper okay I’ll give us a bit of a backstory yeah so we’ve been involved in a research trial in Australia and part of that trial we were involved in sitting and watching other clinicians work with people with disabling back pain and so part of part of our job was to sit there and watch and listen to people’s stories essentially so we probably had about 80 to 90 patients who are all profoundly disabled with back pain paying for a long period of time who taught this story and so part of this was mentoring in feedback to the physios who were working with them and so I was typing up their stories and it became very clear that there were the these very clear beliefs that these people had that were given to them through societal messages given them to them through family given them through messages from health care practitioners which were not evidence-based but these facts were things that massively impacted on their life that influenced the way they care for the back that influenced their lack of hope that they’re sensitive spare the levels of the stress and that these facts these these kind of beliefs were not evidence informed and so as I went through this process of writing this up I realized that actually there were some consistent themes that kept emerging and all these people and so I essentially wrote them up and then we I remember having this conversation as saying we actually need to write this these facts and myths up to give us a hand out to patients because they need to know this stuff because this is kind of like common stuff that if you hand us I’ll go I believe that God I believe that and so it’s actually the kind of thing you can share with someone and so I went through this process of writing them up and then I flicked the you were involved in the infographic and then I flicked it to VGSOM and said look I know you guys running for graphics and we think this would be a great interest to the readers of the British Journal of Sports Medicine and though I like going yeah we really like that would you like to write it up as an editorial so that was how that whole process began and that’s where it ended up and the cool thing is is that that then infographic and that knowledge is now being translated into posters that are running in the National Health Service in the United Kingdom for example so it’s actually been disseminated it’s been put into different languages it’s been rolled out into like it’s through the world that’s just gold in my mind and I and why is that being so interesting and I’m thinking because it finally hits our core okay that’s what I believe and so when something hits your core it’s something you want to know about well so that’s the story behind the paper that is a fantastic segue to my next question which is around the core right so one of the myths that comes from the paper is that you know core strength is important you know you have to brace your core if you mean anything you have to brace your core when you you know sitting down like we’re talking here after brace a call when you’re washing the dishes yeah all the time yeah and we see this in not just our profession but you know personal trainers and Manu Hanley occupational therapy so what’s the go with the core yeah so I suppose a simple way of talking about it might be usually we use the analogy of the wrist so what’s a healthy functioning wrist well your risk and it’s got this amazing capacity limo three dimensions like the back it’s got an ability to define motor control stuff like you know writing writing or playing a musical instrument where you want you your muscles around the wrist to be relatively relaxed I can move but it also has this amazing ability to grip hard so that you can create stiffness to open something up or if you’re you know a boxer the box on or whatever but actually what’s not healthy for the risk would be to walk around clenching it all day not relaxing it so in the same way were the core of the bag you got a whole bunch of muscles around the spine that are involved with controlling the spine in three dimensions right and those and those muscles are not meant to be doing much when you’re sitting and standing and moving in a normal way and they should allow you to facilitate movement in three dimensions if you’re doing normal activities of daily living but I forgot lifting a monstrously heavy weight than those muscles all get together and they tense up for a very short period of time to an hour you to generate power and stiffness the problem with pain is that we start doing the clinching thing sitting standing can either be chair picking up a sock and ho-jon getting off the loom that is not all and a fortunately we’ve taken something that is a good thing that is to be very strong and powerful and controlled in the body and we translated it to kind of adopting these bizarre guarded protective movements in a way that is not normal for the human body and in fact it’s not helpful so what we know about clenching your fists is it creates a lot of compressive load through the structure in the same way that over contracting the core does for the bank is there any danger with that no but if you do it all the time those muscles will fatigue and you’re putting compressive load on structures that might be sensitive and you’re not allowing those structures to move in a normal way and we know the human spine needs movement and psychical loading for us health so fundamentally we’re teaching the people to do things that are not normal and not healthy if they’re engaging those core muscles all the time awesome and unfortunately that principle became almost part of a management approach where we developed this idea in a back in the day of creating water control around creating stability around the joint because a stable joint is a healthier joint and it was translated to patients and as you said for personal trainers for their clients that you have to stabilize your body to be able to do an activity and that become they get themselves trained into tensing up so when you are in pain and naturally your body tenses up now if on top of that you’ve been told to hold your body strong and suck your quarry and keep your spine in a neutral position that creates a lot of stiffness and unfortunately we see a lot of patients that come into the practice they have been told that same message across several clinicians that I’ve seen they could be medical doctors they could be surgeons there could be fissures they could be personal trainers that reinforce that message and in fact when you get them to sit in the way for instance that if you’re comfortable when it’s their preference it feels better but they say well I don’t do this because that’s wrong isn’t that bad for you isn’t allowing your back to relax bad for you and so those messages are really strongly put in in society and if we look at something like the common sense model which is something that we we use as a framework to to understand patience and also as part of research you know where the way you understand the problem comes from messages that are from your family from your friends that are ingrained in society and that shapes how you understand the problem and based on that you act to resolve that problem so it shapes your behaviors now if that’s effective your emotional response is positive and it makes sense and your goal would like – doesn’t make sense your emotional responses to become feet frightened and distressed and more worried about that body part because in fact you’re following the rules and you’re not getting the benefit that you should be doing so you kind of get better at following those rules because if they are the rules that should work for you yeah absolutely yeah you know I think the thing to clarify here is that then strongly you Korra’s guru it’s a good thing so if you’re involved like you know we met by for example well you’d want to hit you want strong back muscles that you want strong muscles to go over a jump and – but you don’t want to have those muscles all the time because you’ll fatigue rapidly and you need a strong core if you’re like to get a twisting or if you’re pushing or you’re tackling or if you’re engaging in some heavy loaded activity you need a strong core but you don’t need them on all the time you only knit use enough for the time skin effect what we know about motor learning is that you as you get better at something you’ll get more efficient and often this whole idea of rehabilitation is you need more because it’s better actually most what we know about motor learning and certainly people have pain as they get better they use less not more and so learning to move better doesn’t engage more motor activity often it engages less yeah yeah and we see that with some of the studies that have come out that look at people with and without pain those with pain young weakly tense their core more and doing it directly they they’re it’s a social then getting barriers associated with dancing they call this you know all their back wheels let’s exactly and that probably highlights they’re not protecting their body part as much yeah exactly we’re hearing the word protection the core and the spine you know this idea that maybe you know the core comes from this idea that the spine is unstable and I kind of that tends to drive this narrative that your backs fragile and you have to be careful with it it’s vulnerable so of course you’d protect your core and race’ core when you when you’re back to vulnerable but is that true is the spine vulnerable um so I suppose you could come back a question and say a human beings vulnerable to back pain absolutely yes absolutely as we know it’s like one of the most as corners the cold it’s really really prevalent Society and it can really disable you is this human spine vulnerable to injury yeah it can be so we see that there’s a group of people at vulnerable side to disc prolapse or to straining their back then what are the factors that leave those people vulnerable that’s the next question and so that things that are actually really interesting so we know that if you look at what predicts an episode of back pain it can be a bunch of factors so if you’re really sedentary and your job and your deconditioned and do you go out and you start digging ditches that’s to me a bit like sitting around all day and then running a half marathon are you likely to get a sore knee if you run a half marathon if you’re sitting around a bag yeah you’re probably well because that loads legs aren’t conditioned to running a heart marathon so so is the back vulnerable yeah it is vulnerable if you don’t keep it healthy and so that that’s consistent with lots of things and in the human body you know it’s your heart model yeah so if you smoke and if you don’t eat and you eat it and there you do if you don’t um exercise and you’ve gotta have you got a risk factor for cardiovascular disease that’s might be genetic then yeah you’re vulnerable your heart is vulnerable but if you keep active keep healthy keep moving have a good diet you you know goods like all a military mental health then your risk for your heart is significantly less and I see them the back is a bit like the heart then if you what do we know about back sale the mo that loves to be active it hates to be sedentary it loves to be strong it loves to be engage in physical activity that needs sufficient rest and sleep and benefits from people with social engagement and mental health for all of those factors and not too much body fat all of those factors influence the health of the back so yeah we have vulnerability in our backs and you know having had episodes of back pain in my life myself I’ve been certain events some have been trauma exposed to forces that are beyond my strength in my body structure others are being too much tension and stress and other factors that have influenced that it’s vulnerable what it means and what we do about is another question just say it’s more vulnerable than any other body structure I think it for some reason vulnerable to pain probably yeah so vulnerable to damage probably not does that make sense so vulnerable pain yeah definitely we know it’s a really really common cause of pain so it is a vulnerable region of the body that when when this when at homeostasis or our in our world environment is threatened for some reason pain emerges in our body and often it goes through the neck and the back or the pelvis for some reason that’s probably partly linked to our whole nervous system has operated but is it structurally vulnerable for some people there would be evidence that yeah that they may have to care for their backs more than others but I don’t see that it’s different than say for some people they go to care for their cardiovascular health way more than others and I see it with an understanding where your vulnerabilities are and then optimizing the things you can change around that and then understanding it is also adaptable yeah exactly and I think that’s really important yeah you know you know stuck with your feet yeah you know and I think you know we have this kind of dichotomous view of like it’s a structure where it’s not structured well actually very often back pain is led to structure most often it is but is it I think the point you raised here is that is that you’re damned with that no like what can you do to manage that structure to keep it healthy and it’s a bit like the story of the save knee arthritis hmm it’s a bit like you know how do you manage that to keep that region as healthy as you can that’s the question and the other thing too is we talk about the back being vulnerable but when we listen to patient stories we often find that they had a period of their type of time of their life that they are vulnerable to pay so they can be under stressed under under exercise eating crap so a period like Kobe in 19 isn’t classic for that we had a lot of people that change significantly lifestyle and they had a emergent or they became highly distressed and they had pain so it’s an expression of your of your health system so looking for a vulnerability around a period of time in their life may explain this story better and a lot of those factors may be modifiable yeah yeah absolutely so you’re kind of mentioned before that a lot of times pain is related to structure then surely with their advances in their medical technologies and we have seen this historically that you know we’ve been hunting for the reason to explain the pain in hunting looking for on a skin so that’s probably opened up this you know whole rabbit hole of maybe an efficient care can you talk to when is a scan important but probably more important what’s what’s the go with scans and background yeah so a lot of people think we’re anti scan and for me personally I’ve had a number of scans a lot yes for other health issues and those scans have been really helpful they’ve diagnosed twats him a leg and clots in my lungs which is probably saved my life so scanning for certain things that was really really important potentially like life-saving in terms of the back I can think of patients in the last year who I’ve referred for scans and if I kind of think of them young girl in tumor and a spine where is referred for a scan that was really important because she could have lost she could become a paraplegic basically another lady who I saw who had a massive dis prolapse who had lost blower bowel and bladder function had lost neurological deficit and I I she’d had she’d had a skin and I rang the surgeon so that scam was really important for her she had surgery that night I had other other patients recently who have had a neurological deficit so we lost power on sensation and their legs they needed a scan because that was progressive so not quite a require but progressive I’ve had a guy who had a acute injury in the surf and he wasn’t getting better and he had a fracture so he had fractured his his spine and he just needed that scan to know they had to back off because his guy who was just wasn’t going to back off so even though you probably would have got better with the passage of time he was not giving his spine of the chance to heal I’ve had other clients who’ve had scan where they’re being so motor changes or inflate edema or swelling or inflammation around the the discs the bony structures around the disk and that we know it can be a source of pain and so it’s we’ve modified the management plan for that person in an in response to that so I think it’s not why there’s nothing you don’t ignore what’s on a scan the one thing that’s tricky about a scan is that as we get older our scan results change and so we know that it looks like this ik what is emerging evidence that at a young age significant changes like dis changing the scan look like they’ve got a higher association with bone but we know that as you get older ever or all of us have changes on the skin that are normal age-related changes and the problem is that gets all messed up and then the messages we give people about their scans get messed up as well so people for example the public think if I’ve had a dispro Laxus there for life well we see it’s like an acute event that reabsorbs rapidly usually over a period of months so those things are not forever those momentary event and modifiable we we know that degenerate you can have a degenerate disc and function at a high level you can have a disc bulge in function at a high level so we know a lot of these things that we think of pathology a present and highly active athlete so using their body every day so we know that there are certain things that are important that we need to identify that we need to address with the scan but there’s lots of stuff on a scan like you know moderate degenerative change for example fissures bulges prolapses in the absence of neurological deficits that may not be there may be chance findings that are part of your normal picture that we shouldn’t be giving too much attention to it which certainly shouldn’t be protecting so it’s a tricky role as a clinician it is to marry the story of the patient with the picture on the scan and say is this relevant and important for you in this context are those things modifiable can we manage this in a different way yeah and it’s even harder for the patient when they get old these messages around yeah these are episodes and you’ve raised some really nice examples of when people should get skills but you know in the broader ecosystem of the health system that may be well the data suggests that it’s not happening that well that’s probably a bit scan happy yeah I’m sending for too many scans and to be fair it’s only about 5% of the population where what you see in the skin is probably really a you know significant in terms of that problem and all of that improve that may be only a momentary thing anyway there’s a modifiable yeah and I think that’s really important to highlight is that people can have to fold your scan that much I mean you can get read on yeah but nothing no that’s kind of can be unrelated to whether they paying it but it exactly they might have known yeah and the belief they need to protect that body part if you do have a final illness can actually can preclude you from working on things that would facilitate the process so if we have a dispro maps with you know with a with nerve compression and it is quite an inflamed the structure you want to take an anti-inflammatory approach which you include you know working asleep managing stress keeping you active getting you movement in a graduated manner in a non provocative manner and that can actually increase the health and facility that your body to heal that and reabsorb that in your laps so this idea that you need to protect when the risk pathology is true to an extent you need to protect from highly provocative from activities but the management actually should facilitate the healing of the body yeah yeah and that’s kind of paradoxical in a sense because if you have been told that you’ve got a disc bulge and the common narrative sort of the false belief that there is that when you bend over you’re gonna shoot you discount the back while it’s just kind of like a virus soaked with this yeah really long so that really unhelpful most you’re gonna protect intent you’re not gonna go out and get that not a healthy movement you’re gonna be stressing because you can’t work what you can’t laughter yeah and that’s gonna impact your sleep so you can really easily see how you ever get down this road yeah and there was a lovely paper that just got published looking at people who are active versus people inactive and track them over time and showing that the people were active had healthier looking spines and those were enacted so we know there are lots of factors around lifestyle obesity engaging in physical activity etc that are really important for healthy spine and unfortunately we’ve got a a growing number of netcommunity who are more and more vulnerable because of their lifestyles to developing problems with the structure of this one yeah yeah okay final question now this is a controversial one so controversial that there’s a PhD student doing a hot topic on it um Nick sy Rossini so this comes out a lot of this question should we lift with a straight back so this is a surrogate well I was just gonna say let’s talk broadly about yeah lifting in background yeah so so Nick’s projects have a really interesting project in that it looked at the looks at the evidence so we have this incredibly common view in society that lifting with around back increases your risk of injury and let’s come out of a couple so really only studies looking at putting you know measuring pressure within the spine and looking at different postures and like if you hold a fork their posture there’s more load on the distant if your stroke there was a kind of view than that oh my god there’s more pressure on the structure it means it’s a greater risk of injury so we have this view that I’d cheat loading something increase its risk of injury where actual fact we know that loading something makes it stronger that’s a major problem with that extrapolation straight up the second thing around that is that those studies never actually measured the angle of the spine those were measured Trump inclination that was followed up with other studies that put pigs this or spinal segments in vices and repetitively bent them and found that if you pedal at Leben a disco overtime would actually what fraction was the endplate yeah not the disc itself and it’s kind of make sense because if you get a any structure and you do this to it and advise is going to break the question of the thing is that was never ever tested well it’s never been confirmed in real people like me living tissue so the next study looked at all the evidence available in the literature to say is there any evidence to say that actually bending with around back or flexing your spine when you’re engaged in lifting is a risk factor for back pain and the answer is that actually there were what was there about eleven twelve studies I think somewhere at least some were a pretty crappy quality but there was no evidence at all so that raises a question so we have this economic industry or menu handling industry that says lift with a stroke bag cuz you’ll protect your back there’s actually no evidence for it so if you look at the literature that has instituted those recommendation so has introduced the episodes of back pain at all so while it hasn’t worked in – it’s not evidence-based so the question then is what is everyone’s back and that’s a tricky thing because actually the evidence is pretty limited at the moment in that space now if you take a broader view ago what’s healthy for the human body what’s healthy for the human body is actually moving in a variety of ways it’s good for us then v beta is good for us so if you’re engaged in a manual job and you’re gonna lift off the ground this it’s it will be impossible to lift with a straight back so you have to bend to do that job so you want to be fit and strong to bend to do that job so the question then is what’s best to do it and I would say you’re best to learn to get fit for task you’re best to be conditioned for task and to keep all those other factors that are important for your health in check to minimize your risk so there is also some evidence to suggest that you’re more efficient if you’re lifting off the ground with a round back than it with a straight back that’s not to say you should live in the strike back but it may mean that if you’re repetitively lifting with a round back that you can do it fell longer because it’s more efficient you can get away with it for long we’re straight about you know fatigue more so there is the the jury is out actually around what is best but based on current evidence we’ve got to take a sensible view to say actually there’s probably a variety of ways you could lift and having adaptability if you’re engaged in a manual job to do it in a whole bunch of way so that you’re fit and conditioned and confident to do it when you’re caught out that’s probably smart but make your job most efficient for you that means engage your legs it means that use your body efficiently that to me is where the evidence sits right now and what’s best for you might not be what’s best for me it’s everybody different every body shape is different and and that’s the bit that we don’t really know what we know everyone’s are different yeah and whether some people have more vulnerability than others around different ways that’s something that will emerge I think in the future when we you know do more research on this space hmm but I think what it does tip into some of your words okay that actually we have a lot of fear around bending and lifting that probably tips you into what your work has shown yeah and one of the things that we know is that it’s a fairly commonly reported situation and what people say that was a trigger for their back I just bent over to pick up my shoe and I had back pain well I went to lift a box and I had back pay and it’s always linked just to that task as opposed to context in which they happen or if you actually fit for the task and during my PhD we we had a an opportunity of evaluating patients that had high levels of fear around bending and lifting and then you can see the consequence of some of these myths that are in society where people became completely unable to bend and they’re very frightened to bend and they create structures or even using a picker-upper to pick something from the floor because they have this really strong belief that if they’ve been forward something bad will happen with their back and that kind of got us thinking about you know you can ask someone about their beliefs around bending and lifting and they may say to you that no it’s okay to bend your back and it’s safe so we kind of designed this we use this this test called an implicit association test which was designed at Harvard University and we adapted to ask the question you know is bending and lifting with a round versus a straight back he’s a safer dangerous and the way that the test is is set up is it kind of depicts your your poor believes you don’t have much time to consciously think about your answers and we looked at people with back pain that had high levels of fear of any and people that had reportedly no fear of bending and when we look at their implicit beliefs they had a very clear bias that Romney your back when you’re bending and lifting is dangerous for you and that got us thinking sorry if if regardless of what you saying you have this implicit bias this is something that potentially is spread in society so we looked at and investigated people that had no back pain whatsoever and the same bias is present so despite that they reportedly say that it’s okay it’s ingrained in their memory that is not a cat to bend lift it around back so then we looked at how about we ask people that treat patients with backpack so we’ve got a better physiotherapist working with muscle pain and we asked them and the same bias is present interestingly a vast majority of the features were saying that Benjamin around back is okay but when it came to the implicit test they showed the same bias so what that demonstrates to us is that the test is picking up on quick associations you can make in your brain and if we think of the context that we will look at based on that manual handling industry everywhere you go you see a picture of someone they’re nearly feeling around back with a cross and someone lifting with a straight back with postures that maybe you and I cannot achieve with a big tick so it’s ingrained in our society that that’s the way you should do it and some people they can achieve that and they struggling they’re trying to achieve it they put it there boy putting their body under stress trying to achieve something that they may not be able to achieve and actually feel much more comfortable doing in a different way so this this kind of reflects the extent to which a myth can be spread in society and the consequences that can have in someone’s in someone’s life you know I saw two patients today that would refuse to bend and pick something on the floor around their back when they’re trying to get by with their life in doing that and the debilitated by it and that’s basically from the belief that running their back would should destroy the back like I said so I have this boat and therefore I cannot bend forward so it’s really interesting looking back at that seminar any initial work of Alfred mechanism which you know developed this idea of the identified high pressure in the discs and stuff if you follow his work his later work ten twelve years later which not many people know about he was actually saying look I’ve done all these studies and look at the mechanics of the back but what I’m finding is that some people are not satisfied at work so people more stress some people are not physically conditioned so it looks like back pain is a little bit beyond what happens with the structure of the disk but those papers didn’t get as much attention and we keep going back to the initial ones because they fit the buyers of training and I think just on from that JP then is the problem with that belief as you highlight is that when people become in pain they revert back to believe and so you know you might be doing your job and getting away with it and very little people work probably most people ignore you know the strike back idea but once I get back pain I like what do I know about back find you that’s when they start straightening out they start doing this and invariably we see this and the clinic always work I would say almost invariably we see people squatting to pick up a pen sitting to pick up this shoe doing this stuff completely avoiding a bit in the back and often once we get them relaxing and bending they feel so much better and whether that’s a reduction and fear or whether it’s because they get to relax their body and start to moving painful structures probably lots of reasons why they benefit from it but fundamentally is I think it’s incredibly unhelpful but to change that narrative amongst the ergonomic or menu handling will I think will be a massive massive challenge because it is so embedded and there is so much fear around backpack because it is such a prevalent problem and it’s really easy just to pin it on something simple like your back straight it’s interesting because some of the patients will come back and say yeah look I see all those posters but I never really took care of my back now I know I should and that’s when they start you know protecting me and the other thing too is that when you have pain clerks and as you said you know you may come in to the physio the physical change or narrative change your mindset things are going well and then you have a flare-up and a lot of people get really scared of that flare up and clinicians don’t really like to you know know a patient that was doing one who had a flare-up but actually those great opportunities for learning from the patient because they may have had a flare-up those beliefs come back those behaviors come back and they rattled because almost like that fear memory never goes why it just becomes suppressed with a safe stronger memory but once you have a flare of that fear memory emerges and then the clinician has an opportunity to modify that belief in you know shut down their fear memory and strengthen the safe memory and as we see along the journey is that as people continue getting some of these pain flare-ups they learn to manage and this becomes more of a you know safe the safe memories tend to tend to win over time notice the safe memories don’t feed the fear memories exhibit all right the wrong I just want to bring it back to a really clinical example as we finish so say for example we’ve got a listener who does have back pain or a hypothetical patient has a back pain and you know we’re hearing this stuff which for us is you know we talk about this stuff a lot but actually for some lots of people hearing it’s like hang on a second I mean that’s completely the opposite to what I’ve been told and what society knows that doesn’t really like sit with me but you know like so I’m gonna go I’m gonna go around my back I mean I’m gonna go Bend in time I shoot and and then they have a pain flare with that so can you kind of talk to why they might still have pain even though their pathology my chances are you know 80% of these prolapses here within the first couple of months yeah why have they still got time in their Bend yep so I suppose the first question is is why did suppose the head pain so it’s a bit like Ward I have pain in my name in a run light of day name a rug she’s a week on that leg I’m so when she’s loading that leg it doesn’t have sufficient support so it starts putting stress than the joint and she’s thinking my knees arthritic well it’s just weak so so there’s lots of reasons why you might have pain and I think that’s the first important thing so I always say to people if it’s not broken don’t protect it that’s number one it’s not broken so how do you know if you get a broken bone well you probably will remember that you’ve had some kind of major trauma if you if you’ve got pain raging down your leg in people go I’ve got none less well grab a needle stick it in your skin if you can’t feel it then you need to go and see some medical care because that means that you’ve lost some of the messages that come through down to your leg you can’t pay that’s important if you’ve got a history of cancer and you’ve developed this onset of pain that’s like I’m significant and there’s no real pattern to it then you need to go and see your doctor so there are lots of reasons when you should get sick here all right so it’s not something that but if you’re you know look at the context like JP’s if you’re tired run down estrellas or you done nothing and you’ve gone and you know done crazy stuff in the garden or whatever get back pain don’t freak out because that’s likely that and you often feel your muscles clench when you do it relax your body engage with the moment keep doing normal stuff don’t go straight back and dig your ditch again because that’s just like not very clever and the body will in good chance the majority of back pain over a period of the four weeks will get better no matter what you do we do know that 30 percent of people are vulnerable they’re not getting better and they’re the ones who need to seek in so in that first couple weeks if the pain is significant and distressing and is limiting you and it’s not getting better then seek here but seek the right here so sick here where someone’s not gonna just leave you passive and do stuff to you I saw a lady this way who went to see a clinician who told them they needed to be said three times a week for 10 weeks they spent all this money and there were no different they were given no soft care strategies so seek here that puts you in charge of your back that gives you an understanding and gives you strategies to put you in control that’s the kind of care you look for empower people right yeah that’s why it’s the name of the podcast exactly I’m perhaps asked the question to the clinician is there more to my opinion than just my back yeah are there other things that I can do what else to help and sometimes it’s probably important to also note that sometimes you need some help with that yeah yeah and look there is a role in some cases for just strategies to reduce your pain you know it might be a heat packet when you’re really cutting your muscles are really changed it may be some hands-on work that just gives you a window to get moving although a lot of the time we think it’s important an actual fact you know there are strategies like breathing and movement and gentle exercises I can just do that job beautifully well yeah and it’s cool because we’ve seen that before and we’ve experienced it ourselves yeah yeah so we know that there are other options out there yeah just the tools that we’ve been absolutely us of it in our own way having had lots of back pain of my life I’ve never had treatment it’s because I know how to care for it what’s that option awesome thanks for their chat again guys good thank you pleasure
So there you have it, episode 4 of the podcast – Jam-packed full of facts. We’ve received lots of great feedback about this resource and with almost all of us knowing someone who’s life is impacted by back pain, why not share this video with them – it may provide some insights or maybe even some hope that they can get back to living. We look forward to having you again as company next time, when we delve into some of the stories behind the patients who presented the back pain facts, including a discussion with Joletta Belton, patient advocate extraordinaire, blogger and just an all round good human, but until then, remember to ask, is there more to pain than damage.