What do we not say to patients?

Low back pain unlike other regions in the body is extremely complexed.

Professionals that claim that they know exactly what is going on in their patients back don't understand that most of the time, pain in the back is multidimensional and is rarely purely structural. MRIs on most backs may show some kind of anomaly (hernia, arthritis, scar tissues... ), but patients are generally asymptomatic. 

So how do you treat the back?

Well, it depends on many factors and we will explain this in another episode, but there is one thing you should definitely NOT do, fabricate catastrophizing stories!

One basic research studied how people understood their low back pain after an encounter with their health care professional. The author used a primarily qualitative survey design. 130 participants were asked to explain their pain and what caused the persistence of pain. Responses were then analysed: they found that many individuals explained persistent low back pain as

1) Due to something being broken

2) Damage being permanent/incorrigible/immutable

3) Very complex or negative

Most of them indicated that they learned these beliefs from their healthcare professional.

In NO way does this help with the patient's pain. Pain beliefs are important and catastrophizing thoughts which potentially leads to movement avoidance (kinesophobia) may hinder progression.

We, as healthcare professionals, really need to do better and err away from the biomechanical model as it is flawed and have been refuted by evidence-based research for the past decade! Pain is an experience and each experience is unique! The back does not go out of place. You cannot replace it like a Lego bloc. Your hands don't have divine abilities!

Remember, our words matter more than we may think and can worsen our client's pain experience!

Physio Summum Brossard

Reference: Jenny Setchell et al. BMC Musculoskeletal Disord.2017