Back pain affects 8 out of 10 people at some stage in their lives, with a proportion of these experiencing severe or persistent symptoms. Yet a recent series of articles published in the Lancet delivered the message back pain has been poorly treated for decades. We now know that prescribing copious amounts of painkillers, using scans to look for structural damage and trying to fix things with injections and surgery has, on the whole, been ineffective.
The Old Way.. “Doing more Harm than Good”
The use of MRI scans is worth focusing on. Historically, when someone had intense back pain, an MRI scan may have been ordered as routine, and the results sent to the GP. The GP would then read this out in full to the patient at a return visit.
After 20 years of scanning, we now know…
1. Many of the findings commonly found on MRI scans, such as disc degeneration, bulges, and protrusions, are actually ‘normal’ findings and commonly found in people who have no pain. This is why treatment of these scan findings with injections and surgery have now been found to offer short lived benefit. Even more unhelpfully, without this understanding, the findings from scans have been ‘over medicalised’ and lead to treatment of the scan and not the patient.
2. Information from scan reports has often been poorly explained, leading to increases in patient fear or anxiety. Fear is well known to change our behaviour, and can heighten our awareness of pain, altering the way we move, only compounding the problem. This negative effect caused by the medical professional is sometimes called an ‘iatrogenic’ problem. i.e. One in which the medical process actually makes the problem worse.
Take Home Messages from The Latest Research
Things need to change. So here are the key messages from the latest research:
- Severe back pain is NOT an indication of a serious problem.
- Most severe back pain, including Sciatica, is NOT dangerous.
- Rest is NOT good for most forms of back pain.
- Expensive scans, injections and surgery will NOT help most forms of severe back pain in the long term.
As physiotherapists, this is something we’ve been preaching for some time. In fact, the Chartered Society of Physiotherapy (CSP) launched a campaign to publicise this message a few years ago. On social media the hashtag #backmyths was used to get the message out there. You can read the BBC article on the campaign here, and look at the more detailed CSP article with links to research papers supporting this argument here.
The New Approach. What we need to do differently
- Keep active. Don’t listen to anyone who tells you bed rest is best! Try to get moving as soon as possible. Little and often is a good general strategy .
- Don’t be fearful of bending, take your time when moving, moving as much as you feel you comfortably can.
- Try to get a good night’s sleep. Sleep is essential for the body’s recovery and repair, and often overlooked.
- Discuss pain with a professional. Pain doesn’t always equal damage, even if its the most intense pain you’ve ever felt. Pain intensity is often NOT a good measure of severity of damage. 9/10 episodes of back pain do not require surgery or more specialist intervention.
- Give things time. If you’ve got high levels of pain, it can take a substantial amount of time to improve. As much as a quick fix would be great, looking for medical procedures to give a ‘quick fix cure’ rarely leads to better outcomes.
Severe back pain can be frightening and the prospect of following the advice above is likely to be rather daunting.
This is where physiotherapy comes in.
Treating back pain effectively involves having a trusted advisor. A physiotherapist you can rely on. Your Physiotherapist can analyse your pain history, how it started, how it feels through the day, sleep, what makes it worse, what you do for your work, your hobbies and interests, and even your own beliefs about your pain. This information, together with an assessment of how you move, gives your physiotherapist information about how to tailor your treatment. Modern treatment of back pain will always try to find ways to get you moving again, in a way that you can tolerate and progress over time.
Medical evidence is now clear…the best way to manage back pain is with guided exercise.
Determining what you CAN do rather than what you can’t, and helping you build confidence in manageable and realistic recovery steps takes the focus away from the pain and misery, puts YOU in control of your recovery. It’s a paradigm shift.
This new approach is something we take seriously here at Bridge4Health. We help people all the way from the early stages of injury, back to fun, safe activity and exercise that they can continue long after the memory of the pain has faded.
Feedback from our members who’ve struggled with back pain has been overwhelmingly positive. The more people we can help, the happier we’ll be. It’s optimistic, but hopefully in a decade’s time, we’ll be able to say we’ve played a part in changing the story of back pain to one that is more positive!