Delving into the myths and truths of low back pain, the podcast covers appropriate imaging guidelines, the impact of education on pain perception, and the importance of tailored rehab plans. It explores the complexities of online health information, sleep positions, and squat form variations. Additionally, it discusses the multifactorial nature of pain perception and controversies in low back pain management, while highlighting the benefits of acceptance and commitment therapy.
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Quick takeaways
Educate patients on the natural history of low back pain and debunk myths to empower proactive management.
Screen for psychosocial factors like fear and anxiety to tailor treatment plans and improve outcomes.
Encourage physical activity and movement to challenge negative beliefs and improve self-confidence in pain management.
Focus on gradual progress and functional improvements, rather than immediate relief, for sustainable pain management.
Avoid viewing persistent pain bleakly; seek guidance, set functional goals, and expect gradual improvements over time.
Individual responses to pain management methodologies vary; focus on patient needs rather than a specific framework.
Deep dives
Importance of Language in Educating Patients
Education plays a crucial role in informing patients about the prognosis of low back pain, debunking myths, and preparing them for potential recurrences. Framing conversations through a relatable lens, such as personal beliefs and experiences, can significantly impact a patient's understanding and response to treatment.
Addressing Psychosocial Factors in Low Back Pain
Screening for psychosocial factors like fear, catastrophizing, anxiety, depression, and kinesiophobia is essential in identifying contributors to persistent low back pain. Understanding a patient's beliefs, emotional responses, and context around pain can help tailor treatment plans and improve long-term outcomes.
Normalizing Low Back Pain and its Recurrence
Educating patients on the natural history of low back pain, its tendency to improve, and the likelihood of reoccurrence can help normalize their experience and empower them to manage future episodes proactively. Providing them with coping strategies and a supportive approach can enhance their self-efficacy and overall well-being.
Screening for Yellow Flags and Understanding Beliefs
Identifying yellow flags such as fear, catastrophizing, and learned helplessness, and delving into patients' beliefs and emotional responses can uncover crucial psychosocial factors influencing low back pain. Engaging in open dialogue, addressing anxieties, and fostering a supportive environment are vital in facilitating patient recovery and promoting self-management.
Benefits of Physical Activity and Strength Training
Encouraging patients to engage in physical activity, strength training, and movement can help challenge negative beliefs and increase self-confidence in managing low back pain. By focusing on functional improvements and gradual progression, individuals can develop resilience and autonomy in their journey towards pain management and recovery.
Resolution of Persistent Pain
Expecting immediate resolution of persistent pain may not be realistic. Progress and improvement over time, rather than immediate cessation of pain, should be the focus. Managing symptoms, acceptance, and commitment therapy can help in the journey towards reducing disabilities and improving function.
Emotional Influence on Pain
Dr. John Sarno's hypotheses emphasize the impact of emotions on pain. While emotions can influence pain experiences, it's crucial not to oversimplify pain as solely emotional and consider the multifactorial nature of chronic pain.
Heuristic Approach in Pain Management
Having a methodical approach like McGill's system can provide structure and self-ownership in pain management. However, no single system is superior, and individual responses to different methodologies vary. It's essential to focus on the patient's needs and goals rather than relying solely on a specific framework.
Importance of Seeking Professional Help
When dealing with persistent pain for years, seeking guidance from a trusted healthcare professional is crucial. Personalized care, coping mechanisms, and building a supportive therapeutic relationship can be instrumental in managing long-term pain and working towards goals.
Diverse Approaches to Low Back Pain
Low back pain presents different perspectives, such as McGill's methodology and the McKenzie method, each with varying levels of evidence and applicability. While adopting specific approaches can provide structure, it's essential to consider individual needs and not rely on any single method as a definitive solution.
Expectations in Pain Management
Expecting complete resolution of persistent pain may not always be realistic. Instead of aiming for immediate relief, focusing on gradual progress, acceptance, and functional improvements can lead to a more sustainable and holistic approach to managing pain.
Influence of Weight on Spinal Stability
Contrary to assertions that adding body weight enhances spinal stability, gaining weight does not inherently stabilize the spine. Simple exercises, rather than solely relying on biomechanical principles, may be more beneficial in promoting overall spinal health.
Symptom Modification and Pain Management
Symptom modification should not be the sole focus of early rehabilitation efforts. While addressing symptoms can be important, a holistic approach that considers individual needs, coping strategies, and functional improvements is imperative for long-term pain management.
Variability in Movement Quality
Variability in movement qualities, such as twists during squats, does not necessarily indicate weaknesses or instabilities in the spine or muscles. Understanding individual movement patterns and addressing symptoms without overemphasizing biomechanics can lead to more tailored and effective treatment approaches.
Long-Term Perspective in Pain Management
When persistent pain continues over years, it's essential to avoid viewing the situation bleakly. Expecting gradual improvements, seeking guidance from healthcare professionals, and focusing on functional goals rather than immediate relief can lead to more effective pain management strategies.
Papers:
2018 Lancet Low Back Series
https://www.thelancet.com/series/low-back-pain
How we frame the problem
https://www.ncbi.nlm.nih.gov/pubmed/12923482
Appropriate vs Inappropriate Imaging
https://link.springer.com/article/10.1007/s00586-019-05918-1
https://www.ncbi.nlm.nih.gov/pubmed/30760458
Myths of Low Back Pain
https://www.ncbi.nlm.nih.gov/pubmed/9674171
Do medical students believe the back pain myths?
https://www.ncbi.nlm.nih.gov/pubmed/31248406
Prevention and Treatment of Low Back Pain
https://www.ncbi.nlm.nih.gov/pubmed/29573872
Education and Low Back Pain
https://www.ncbi.nlm.nih.gov/pubmed/30737200
Gurus and Low Back Pain
https://bjsm.bmj.com/content/50/4/198?fbclid=IwAR3R-PCN6ll7eGa9JTOdciJp4udW4JRV7D_zhsg1tESyko92u6cUIvOqF14
Outline:
Introduction
Defining Low Back Pain -
A symptom NOT a disease
Defined by location
HIstory of how we’ve examined the supposed problem
Unsurprisingly, we tend to prefer organic, visible diagnosis, and place our trust in technical diagnostic results more than our own clinical judgement.
“Almost all graphs show the same pattern. They all rise in the 20s and 30s, decline in the fourth, fifth and sixth decade to almost zero or totally disappear in the 70s/80s, and mostly reappear towards the end of the century. Only the disc category shows a different pattern: it rises rapidly in the 30s and 40s to become the reigning theory in the second half of the century. It is the only etiology that keeps an 80% share within all etiologies for 4 decades.”
Normalizing the problem based on prevalence
The global point-prevalence for activity-limiting low back pain was 7.3% in 2015, which means there are about 540 million people dealing with this issue at any one time.(See Hartvigsen 2018)
Appropriate vs Inappropriate Utilization of Imaging
Downie 2018 - rates are increasing for complex imaging
Lemmers 2019 - increased healthcare cost and utilization
Negative impact of clinician words (Setchell and Darlow)
Rare cases warranting imaging (1-4%)
Non-specific nature of LBP - doesn’t mean we have no idea what’s going on BUT rather shouldn’t unnecessarily worry ourselves and our patients about the supposed “cause”.
What should we be doing with the majority of LBP cases?
Education - BUT is education alone enough
Natural History / Re-occurance
Psychosocial correlates to be considered
When should we consider a goal directed activity intervention guided by a clinician
Guruism and Low Back Pain
Final 10 minutes of Q&A
What does science tell us about the effect of different sleeping positions and LBP? - Ron_Swanson_super_Stache
How do you know when to suck it up and train as programmed vs modify or take a deload? - Pull_sumo.taste_the_rainbow
What do popping and crunching sounds when I move my low back mean? - Bangarangbarbell
Is a small twist on the ascent of the squat related to weak low back? Or glute medius to stabilize? - Vanhanen_One more question?
I want you to discuss te hypotheses of Dr. John Sarno, and how, if at all, tey comport with the - Unoriginalfit
End range loading/MckEnzie, why it works, what the lit says, if you use it in practice - Geronimo10
Does adding bodyweight make the spine more ‘stable’, as Rippertoe asserts in his latest video? - Willdavies_fitness
What happens when LBP doesn’t get better after years of pain - Blakelosangeles
Exploring different schools of though around LBP i.e. McGill, Mckenzie, etc (loved the first 2 eps). - Davinbyrne1
Is it unrelastic to expect resolution to persistent pain? - Thedrzo
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