Low back pain is much more like clouds than like clocks.
I imagine that you probably had to read that sentence twice because it’s a bit of an odd thing to say. Generally speaking, clocks and clouds couldn’t be more different, but that’s exactly the point.
Something I’ve always found so frustrating is that despite the wealth of scientific research available, many therapists continue to employ a model of healthcare called The Biomedical Model – thinking about the body like a clock. This model of care purports that the cause of all musculoskeletal pain or injury can be accounted for by looking at someone’s tissues – much like when a clock stops working. They look for the ‘thing’ that is wrong instead of looking at the patient as a whole person.
Examples of this model would be to say that your back pain is caused by having one leg longer than the other, or that your glutes aren’t activating or that you have a weak core.
None of these examples have research to support them – in fact, there is plenty of research going back to the 1980’s that has found no relation between those examples and the onset of low back pain.
Multiple causes
A research-backed way to think about low back pain is to think about it like a cloud. For a cloud to rain there are many different conditions that are necessary; you need enough water, the upward movement of air, and appropriate levels of warming and cooling (to name a few).
This is much more akin to the formation of low back pain. Most episodes of low back pain fall under the diagnosis of ‘Non-Specific Low Back Pain’. This means that there are multiple different factors that need to interact together for someone to experience an episode of pain. This includes a patient’s overall exercise level, their mental health, their beliefs around their pain, and even job satisfaction.
This model of healthcare is known as The Biopsychosocial Model. It states that the causes of musculoskeletal pain come from biological, psychological and social factors. This falls much more in line with the research base and the gold standard level of treatment. A study by Schmerz from 2001 found that psychological and social factors were bigger predictors of experiencing long term pain than biological factors (another nail in the coffin of the Biomedical Model).
I’m not making the case that there isn’t anything wrong with someone’s tissues – core muscles that are too active and intervertebral disc degeneration are found more commonly in people with back pain than people without back pain. But, to purely look at the body as a simple mechanical structure and not factor in psychological or social factors would be the wrong way to go about treating the patient.
Rethinking your back pain
Whenever I treat patients, if they’ve been to see another health professional before, I always ask plenty of questions about what they were told the issue was and what treatment they had. This allows me to get a full picture of whether they received treatment under a Biomedical or Biopsychosocial framework.
If they have received treatment in a biomedical framework, I spend a lot of time talking with the patient to reshape how they think about back pain – we get them thinking about back pain as a cloud and not a clock.
The reason that I get so frustrated when I see clinicians working from the Biomedical Model is because it leads to the patient receiving incorrect explanations and treatment for their problems. Whilst this can lead to short term improvement, it invariably leads to more problems over the long term.
The onset of back pain is a complex multifactorial experience. Back pain is not a purely mechanical issue that needs a clinician to find the faulty part. It is best explained by comparison to clouds, not clocks.
To read Rob Bailey’s latest column in the Diss Express please click here.
