It is estimated that between 70-90% of all people will suffer from an episode of back pain in their lifetime. It currently accounts for 40% of missed work days and costs the Australian governament approximately $8billion each year.
With such an impactful problem, why does it seem that we don't have a great solution?
These are some interesting facts to consider when dealing with a patient with back pain as a first contact practitioner.
- <1% of low back pain has a severe pathological cause i.e. cancer/tumours etc
- 5-10% of back pain has a clear patho-anatomical cause i.e. disc prolapse with nerve compression
- 85-90% of back pain, a definite patho-anatomical diagnosis cannot be made
- There is a high prevalence of ‘abnormal’ findings’ on MRI in pain-free populations.
- Disc generation – 91%
- Disc bulges – 56%
- Annular tears – 38%
- Disc protrusion – 32%
These statistics show us that following a structural or patho-anatomical model would be detrimental to the care of our patients. This is the model that is primarily used by first point practitioners in Australia...
The process usually looks like this:
Step 1: See a GP/specialist/physiotherapist
Step 2: Get a scan
Step 3: Medication and/or an injection, and most horribly - possible surgery.
However, we take a very different approach.
The research is evolving to include a more multi-dimensional model when it comes to our approach to treatment.
This evidence points to a bio-psycho-social model. This more updated model includes understanding patient’s beliefs and behaviours that drive their pain, understanding environmental factors that also affect their pain as well as always considering the biological factors that are present.
- Negative back pain beliefs and fear of pain and movement are more predictive of pain, more so than levels of pain intensity
- Depressed mood predicts future episodes of pain better than abnormal findings on an MRI film.
- High levels of stress are predictive of work absence due to back pain.
- Persistent back pain is associated with lower pain thresholds and altered pain processing, highlighting the involvement of the central nervous system.
- Trunk muscles of people with disabling low back pain demonstrate increased co-activation, rather than a lack of stability. It is not just a global system issue.
At Butel Health Services we are continually evolvng and updating our practice to incorporate the newest research findings. Namely, we are improving our categorisation and classification of each patient to improve outcomes.
Maladaptive patterns that patient’s have developed in order to unload an initial tissue injury, are now the most likely cause of their ongoing pain disorder. The patients are not only reinforcing their pain patterns through adaptive changes, but also creating new ones.
Treatment is derived from accurate classification of the patient’s back pain. As this research points out there is a small minority of patient’s with structural changes that need to managed medically, however, the majority of patient’s have minimal structural changes – more so maladaptive movement patterns that need to be identified and changed. Changing these movement patterns is usually the key to the resolution of their pain!
Reference: O’Sullivan, Peter. Diagnosis and classification of low back disorders: Mal-adaptive movement and motor control impairments as underlying mechanism. April, 2005.