The Challenge of Low Back Pain
This week’s Clinical Insight engages with the recent piece written by Dr. Neil Langridge in the September Frontline publication (1), published by the Chartered Society of Physiotherapy, outlining the challenge of low back pain through the lens of celebrating World Physiotherapy day.
We explore the ways in which physiotherapy can have an impact on this challenge and suggest a change in focus can be helpful here.
Impact of Physiotherapy
When thinking about impact, physiotherapists can consider the resultant pain, loss of movement, or adaptation to function as the key physical areas for interest.
They will also acknowledge the emotional impact of injury and life changes that low back pain can bring.
Whilst doing so, it is perhaps the next step for any clinician to ensure that the wider components are considered and addressed (if possible). These include cardio-vascular health, smoking, weight, alcohol consumption, general mental and emotional well-being, general strength and health awareness.
As the literature around the impact of practice upon pain is limited, and pain being a multi-factorial construct that is not necessarily modulated by singular events, then the physiotherapist needs to think wider for impact.
Shifting from Pain to Function
Would it be reasonable to shift the focus from pain to function?
Pain over function may be an easier model for patients and clinicians to follow. Goal setting, and maintaining function whilst pain naturally (in most cases) resolves may be more fruitful, and less complicated?
Secondly, the clinicians need to consider not only their impact on the functional loss of low back pain, but also on the other key areas of human wellness.
By focusing on work, function, social challenges and giving advice on wellness for the future, the clinician is potentially driving a greater more improved locus of control.
By focusing on the pain, and trying to impact this even as natural history occurs, does this link the patient’s belief to pain reduction to therapy, when in reality time plus context may be more powerful allies?
Giving Patients Control
If patients gain greater control not only over their return after injury, but also maybe over small negative health issues through the interaction, then therapy in its broadest sense creates impact.
Moving forward in addressing this challenge may require a change in the narrative; replacing referrals for “pain” with functional loss and wellness improvements. Is this something to consider?
