Low Back Pain – The Problem with Self-Management 14 October

The cost of LBP is on the rise. To help control costs, clinicians often withhold or delay physiotherapy. Instead, they may give patients advice and send them home to self-manage their rehab. The problem with the advice strategy is that it doesn’t work. It promotes future problems and ends up costing more to patients and payors.

Low Back Pain is Not an Injury

To understand the problem with self-management, we have to first understand that LBP is not an injury. People often think of some harmless activity causing their LBP. For instance, perhaps they were reaching up, or maybe they were picking up a piece of paper from the floor – and SNAP! Back pain. Those simple activities performed in moderation do not injure the back. They are more coincidences than injuries. The muscles of the back are very thick and strong. Healthy back muscles can support the body while you reach up with no weight or while you pick up a sheet of paper.

LBP results from some element of deconditioning. The condition flares up and settles down intermittently over the span of months and years. Why does this matter? When we think of LBP as an injury, we also think of it as “healed” when the pain settles down. But the deconditioning is still there – waiting to cause another flare-up in the future. Effective LBP management shortens the current episode and prevents future disability.  

Self-Care for LBP Doesn’t Work

Studies have measured the effect of self-care programs for LBP. These have been very good programs. Patients received excellent instructions from qualified professionals along with nicely prepared teaching sheets. It didn’t matter. Long-term results of such programs have been found insignificant.^1,2

Professional Guidance Makes Low Back Pain Rehab Work

Seeing a healthcare professional for exercise supervision makes patients more likely to reduce pain significantly and less likely to have flare-ups in the future.² A full physiotherapy assessment can determine what deficit is contributing to the back pain and where to begin rehab. Continued supervision helps people make sure they are performing exercises correctly and helps people advance the difficulty of their exercises efficiently. Physiotherapists also keep patients motivated to work as long as needed, even when the pain has been overcome. In fact, up to a certain point, the more physiotherapy visits a patient receives, the better the outcomes.

 

References:

1. Ammar T. A randomized comparison of supervised clinical exercise versus a home exercise program in patients with chronic low back pain. Physical Therapy and Rehabilitation. 2017 Aug; 4( 1): 7. 
2. Ford J, Hahne A, Surkitt L, et al. Individualised physiotherapy as an adjunct to guideline-based advice for low back disorders in primary care: a randomised controlled trial. Br J Sports Med. 2016; 50: 237-245.