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LOWER BACK PAIN
“if someone is told there is something physically wrong with their back they may develop the belief that they need to avoid particular activities “
incapacity if it results in a return to pre-pain activities/ function as soon as possible.
At the heart of the biopsychosocial approach is the promotion of active coping strategies based on an internalised locus of control where the individual incorporates physical activity and exercise as part of an active approach to the management of their pain and as part of their acceptance of their own responsibility and role in this process.
Identifying psychosocial influences In identifying whether a client’s low back pain is being influenced by psychosocial factors, health and fitness professionals might consider the following: l Does the individual exhibit fear avoidant behaviour – are they avoiding particular activities, do they believe that activity could potentially cause further damage? l Do they exhibit negative or pessimistic beliefs about the nature of their pain and dysfunction and the likely outcome of any intervention, including exercise, or a tendency to always fear the worst outcome? l Do they exhibit any signs of over medicalisation - have they been X-rayed in the past or been told that they have a particular problem e.g. “wear and tear” in the spine or arthritis; do they use technical/medical jargon? l Do they exhibit any pain behaviours e.g. guarded movement or non-verbal/verbal expressions of pain? l Are friends and family reinforcing the behaviours of the individual e.g. an overly solicitous spouse who is taking roles and responsibilities (e.g. household chores) away from them because they believe this is helpful?
Health and fitness professionals are unlikely to achieve results with the low back pain sufferer unless they can
both assess and deal with any psychosocial influences and the underlying reasons for them.
The job in hand
In the case of fear avoidant behaviour, there must, through a progressive exercise programme in a safe environment, be a controlled exposure to the fear-inducing stimulus - exercise. If this is achieved it will help to desensitise the client and contribute to an increased functionality not only in the gym environment but also at home and work.
Many low back pain sufferers have an overly structurally- orientated view of back pain making them feel that they have a real problem that can only be resolved by medical
expertise, creating dependency and a certain amount of learned helplessness.
As health and fitness professionals we must recognise that the words we use are at least as important as our actions. While technical knowledge on exercise programming will play a part in the overall management of low back pain, the way in which clients are ‘managed’, the information that is given to them and how that information is communicated is hugely influential in determining outcomes.
Consider for a moment the psychosocial implications of telling someone that they have a weak ‘core’ or of prescribing specific exercises that focus on the back? Will this motivate or simply reinforce an existing over-focus on what is perceived as a problem area? When feeding back the results of a full postural assessment are you providing constructive advice or fuelling a deeply held structurally-orientated belief system that is at the route of their fear avoidant behaviour?