One of the concerns from new patients in for chiropractic care centers around movements and activities that could make the condition worse.
Quite frankly, it’s rare that the typical low back pain patient will be made worse in the long run by activities that they may do, provided that the activity wouldn’t produce low back pain in a patient who does not have low back pain. In other words, lifting and twisting while carrying a 100 pound object is not a good idea whether you have low back pain or never have in your life.
A large chunk of patients who come in with a new episode of low back pain don’t recall doing anything to bring about the episode. Sometimes the aggravating event is not as obvious (new shoes, side sleeping without a pillow between the knees, new chair, etc…) and sometimes, the patient is in my office, not because of what they did, but because of what they are NOT doing. As in moving around.
It is very common for the mere act of being a couch potato to create low back pain. So, when the new patient comes into my office and is concerned that movement may make his or her back pain worse, I reassure them that movement is a good thing. Sacroiliac conditions, for example, do way better when the patient is moving around and keeping the joint “lubricated.”
A frustrating aspect of practice for me is how often chronic low back pain patients, or those who have a tendency to “throw out” their backs, have been told to “take it easy” and limit activity by an orthopedic doctor, family practice doctor, physical therapist or even my own colleagues.
Fear of movement. It’s never a good thing.
This particular study drives this point home. Researchers looked across 17 clinical studies to see how much of an effect fear avoidance behaviors (as measured by the Fear Avoidance Beliefs Questionnaire (FABQ) or the Tampa Scale of Kinesiophobia (TSK)) had on whether or not treatment was effective. Here’s what they found:
• In patients who had up to 6 months’ duration of low back pain, high fear avoidance beliefs were associated with more pain and / or disability and a lower likelihood of returning to work.
• However, if patients were able to show a decrease in fear avoidance beliefs during treatment there was less pain and disability.
• Interventions that addressed fear avoidance beliefs led to better outcomes.
• The results were not as strong in chronic patients.
I had recently been asked to participate in a chronic pain panel for the Arizona Corporation Commission. This involved looking at case studies of chronic pain patients to see how guidelines could be effectively applied for treatment. However, I had such a hard time being non-biased looking at these studies because so many of the cases of chronic pain are actually failed cases of acute pain.
And in Arizona, very few patients ever make it into chiropractic offices in the early stages, when manipulation can be the most powerful. Most end up medicated and / or put into physical therapy. Considering that the cost of going into physical therapy treatment for non-surgical spinal conditions first here in Arizona is almost TRIPLE the cost of chiropractic care, it may be that fear avoidance behaviors are addressed intuitively by chiropractors, lowering the chance of a condition becoming chronic.
Of course, this also means that, should you come across a chiropractor who uses fear (i.e. subluxation kills and without adjusting your nervous system can’t flow) to sell you on more care, it may be time to work on your short burst activity and run the other way.