As it is the Halloween season, I thought I’d write a bit on the role of FEAR in persistent lower back pain. Most of us don’t like to admit being AFRAID of something, especially pain. We like to show ourselves as robust, ‘hard-as-nails’ and ‘just getting on with it’. Most patients I see will tell me (usually very early in the consultation) that they have a high pain tolerance. This doesn't matter! Regardless of how much pain someone thinks they can handle, pain itself (and more importantly FEAR of pain) changes people’s behaviour.
Picture this scenario:
It’s a normal day. You bend forward to put your socks on/empty the dishwasher/pick up a child etc, etc... You experience a searing, creasing, spasming pain in your lower back and need to drop to the floor. You ‘know’ this is serious - somewhere on a scale between childbirth and ‘man-flu’ (obviously an escalating scale!). Your lower back is complaining big-time for some reason. If it’s any consolation, you are not alone. Welcome to the 80% club! A staggering 80% of people have an episode of lower back pain in their lifetime. More importantly, 80% of club members will go on to have repeated episodes of back pain. One significant reason for this is FEAR!
Thankfully you survived your first episode! Your pain settles over a few days/weeks and you cautiously get back to normal BUT you avoid bending because of what ‘IT’ did to you. You put your socks on while sitting, you pick things up from the ground with bent knees and butt out, ‘core’ switched on all the time - robotic. In essence, you change your movement behaviour due to FEAR of pain. Avoiding movement leads to a decreased ability to make that movement in the future – you become deconditioned. Then, when you next need to make the movement, it is beyond what your body can comfortably perform and you get pain. This reinforces the FEAR that the movement is ‘bad’ for you. This is the vicious cycle we see and hear in clinic over and over again.
" THE FEARS WE DON’T FACE BECOME OUR LIMITS "
In this case, FEAR is driven by your initial pain experience. However, there is another surprising source of FEAR which will increase your chances of having persistent, ongoing lower back pain...
...The Healthcare Professional Treating You.
Yes!!!! - The very person you trust to help you through an episode of back pain can promote FEAR. This could be your GP, Surgeon, Physio, Osteopath, Chiropractor etc… and here’s how it works:
We say things like: ‘Your spine is out of alignment’ | ‘You’ve got a vertebra out of place | ‘Your sacro-iliac joint (SIJ) has rotated’ | ‘You’ve got a slipped disc’ | Your spine is ‘crumbling’ | ‘Your spine is unstable | ‘Don’t move without tightening your core’
Comments like this reinforce FEAR – You believe that your spine is vulnerable so you give up/limit some activities, lose mobility, become deconditioned - again a vicious cycle!
In truth, for more than 95% of back pain sufferers, these statements are untrue. ‘Perfect’ alignment is not normal (in fact there is no ‘normal’ - everyone is different). Indeed, alignment and posture have never been shown to have a link to back pain. The spine itself is an extremely strong structure. For a vertebra to go ‘out of place’ you would need huge trauma – and you wouldn’t be on a therapist’s table!
Comments like these can also create reliance on a clinician to ‘pop that back in for you’ or ‘realign your spine’. There is evidence that spinal manipulation can give some pain relief in the early stages of low back pain and all good clinicians across disciplines will be able to provide this. However, it doesn’t ‘realign’ or ‘pop anything back in’ and is only short-term at best.
If you have persistent lower back pain and need help:
See a clinician who –
- spends time listening to you to understand your problem from your point of view.
- explains your problem in a way you understand without FEAR -mongering.
- helps improve your quality and range of movement.
- progresses your treatment to achieve pain-free, confident movement.
- promotes your independence, not dependence on them.