Many terms come in and out of fashion for a variety of different things. That’s normal. And let’s face it, there are some things that fall out of fashion for good reason. But, as with all things, there will always be those who choose not to move on with more modern language and choose to continue using older terminology. I must confess, I still occasionally refer to John Lewis as ‘Bonds’ (it’s likely only readers over the age of 30 will understand that reference). That’s fine, it’s the individual’s choice – they’re not harming anyone!
Except in this case of using the phrase ‘Mechanical Low Back Pain’. To use this term is not only to squeeze back into your flared trousers and tuck into a plate of duck a l’orange, it’s actually misleading in the vast majority of low back pain cases and I’m going to explain why.
I’m not going to try to argue that when someone has back pain that there are not mechanical issues because that would be untrue. For instance, we know that when people have on going low back pain they tend to have over-recruitment of their core musculature. That’s a mechanical issue, it can be a reason why people experience on going problems and improvement of it can help a patient to have a lower risk of back pain in the future.
However, the word ‘mechanical’ leads patients to believe that the fundamental problem with their spine is coming exclusively from mechanical issues and this is wholly untrue.
Around 90% of back pain cases do not have a specific cause. Rather, there are a number of different risk factors present that predispose the patient to the pain. For example, we know that if you do not exercise enough or do not sleep very well then you are at a higher risk of getting back pain. We also know that the people most at risk of getting back pain are those who have had an episode of back pain before (particularly within the last year) and those who have a physically demanding job.
Neither of these higher risk groups can be explained using the phrase ‘Mechanical Low Back Pain’. To say that other lifestyle factors are not relevant is untrue based on the research that we have, but it is also untrue to say that mechanical factors are also not relevant. So what term should you be using?
The official term that we now use is ‘Non-Specific Low Back Pain’. I sometimes call it ‘multi factorial low back pain’ because I feel this tends to make more sense to patients when i’m explaining their issues. The key here is that both of these terms reinforce to the patient what we know about the majority of back pain cases; that they are caused by the interplay of numerous other factors, many of which do not fit in the category of ‘mechanical’.
I’m not trying to make the case that mechanical low back pain doesn’t exist. What I’m saying is that it is part of a much broader issue. To simply refer to the most common form of back pain as ‘mechanical’ is like looking at the topic with your blinkers on – you are missing the bigger picture.
Not looking at the big picture could lead a patient to receive insufficient or ineffective treatment. For example, if a major reason why a patient has been experiencing low back pain is because their stress levels are too high and not well managed, then simply focussing on the mechanical issues at play is a “down stream”, narrow sighted way of looking at their problem. Not adequately addressing this patient’s high stress levels could lead to this patient not fully recovering.
To some, it may feel like i’m being pedantic. To be completely honest, I believe that being pedantic on this issue is not only justified, but it’s important. Getting a clear understanding of the issue allows you to build a clear recovery programme. Without fully understanding the problem, the nuances required in order to make a full and lasting recovery will be very hard to grasp.
So yes, whilst I often enjoy the nostalgia and obscurity of using older terminology (even though doing so often makes me feel much older than i actually am) this is an instance where I insist that I, my chiropractors, patients and even other health care professionals, must use the correct and modern terminology. It’s not about what we want, it’s about creating true and lasting recovery for our patients.
To read Rob Bailey’s latest column in the Diss Express please click here.
