How Your Physio Can Help Prevent Your Back Pain Becoming Chronic
We all know by now that low back pain (LBP) is an important issue both in terms of the amount of pain and disability it can cause and in the economic costs it can impose on the individual and the state. The very large majority of back pain episodes cannot be pinned down to an anatomical source and are labelled as non-specific for that reason. A large number of people suffering a back pain episode on any one day are known to continue to have back pain problems a year later. So the search has gone on for the factors which might predict those patients who suffer chronic pain in the hope of being able to influence these factors and reduce the toll.
Many factors have been studied to try and tease out which ones are important and which are not, with many anatomical factors being of less relevance with two main sets of factors really becoming prominent in predicting how low back pain will go. These factors are a history of previous pain episodes and psychosocial aspects such as fear avoidance beliefs and depression. While these factors have been linked to some extent with a worse outcome, it is not clear how therapy can intervene to make a difference.
In acute (recent onset) back pain, interventions such as patient education have been shown to have an effect on their recovery and are cheap to administer. The physiotherapist is skilled at interpreting the signs and symptoms and giving the required educational input to suit the condition. Such education is unlikely to have effects on long term back pain. The advice to remain active may be important in reducing the tendency for some patients to do virtually nothing out of fear of what might happen to the back tissues. Your physio will help you adapt your normal daily activities so that you can still do many things without suffering too much pain.
If depression is present the patient can be encouraged by the physio to attend their GP to consider whether medication treatment is advisable. Depression reduces the will to be active and makes it more difficult for patients to remain motivated to take action to help themselves. Physios can work on specific fear avoidance behaviours by exposing patients to what they fear and showing them that nothing terrible occurs. Along with a graded exercise and functional programme the patient should be gently pushed towards resuming normal activity.
Author: Jonathan Blood-Smyth