Saturday the 16th of October marks annual world spine day, a day used to highlight the burden of spinal pain and disability around the world. This year’s theme is back2back.
The theme ‘back2back’ focuses on the fact that the way we think about back pain needs to be readjusted. Low back pain in particular is one of the leading causes of disability worldwide and is often associated with costly, unhelpful and sometimes harmful care.
Part of the challenge rehabilitation professionals face is the uphill battle against the mountain of misinformation and stigma associated with all types of back pain. This challenge isn’t unique to low or middle income countries as access to quality spine care and rehabilitation is a common challenge for us all. However, lower income countries face additional barriers in the resilience of health systems and their ability to adapt to growing rehabilitation needs – something the ReLAB-HS project is working hard to address, which should see improvements in care for those with back pain in the future.
In higher income settings there is over reliance on medical imaging despite there being decades of evidence highlighting the poor correlation between imaging and diagnosis. Spines often look worse than they are when you put them through a scanner meaning ‘red herring’ diagnoses are often made, which reinforces bad habits and raises false alarms. Rather than striving to follow suit, lower income settings may need to question how limited resources should best be spent to optimise patient outcomes – recent research in this area, which addresses the additional challenges resulting from the COVID-19 pandemic with evidence-based solutions, should be at the forefront.
“More than half of slipped discs get better on their own”
Think of it this way – spinal pain is extremely personal and multi-factorial, meaning there are lots of muscles, bones and nerves which contribute to pain, as well as other psychological and social factors, and it’s often too difficult to know which and how many factors are specifically causing the pain. Current best practice in pain acknowledges the important role that a whole variety of stressors play in all pain presentations. X-rays and MRI scans are great at looking at part of the picture in detail but often not the whole picture. Meaning a light is shone on part of the spine which could be contributing to the problem but we interpret this as the sole problem, rather than taking a holistic approach.
Simply put – many ‘obvious’ problems that scans reveal aren’t actually problems. This is demonstrated by the fact that not only do more than half of ‘slipped discs’ get better on their own without intervention – but it’s the worse ones which are more likely to get better on their own. Persistent pain is rarely related to serious tissue damage, but instead may be influenced by any number of factors such as stress, mood and changes in activity.
This appears paradoxical and is inherently difficult to explain to people when they are in the midst of an episode of severe back pain. It’s no surprise that people find it hard to understand when they are told exercise and movement is the best approach when it’s movement and exercise which hurts them the most. This is particularly challenging if support with rehabilitation is not available, and puts the focus on public health advice to improve quality of life.
Spinal Pain Myth Buster – a guide for everyone
The theme back2back reminds me of an excellent editorial published in British Journal of Sports Medicine in 2020 titled Back to Basics: 10 Facts Every Person Should Know About Back Pain.
The article is a must read for all rehabilitation professionals and an important tool in communicating evidence-based messages to our patients. If you are going to do one thing on world spine day it should be to read this myth buster and reflect on your back pain beliefs.
- LBP is not a serious life-threatening medical condition.
- Most episodes of LBP improve and LBP does not get worse as we age.
- A negative mindset, fear-avoidance behaviour, negative recovery expectations, and poor pain coping behaviours are more strongly associated with persistent pain than is tissue damage.
- Scans do not determine prognosis of the current episode of LBP, the likelihood of future LBP disability, and do not improve LBP clinical outcomes.
- Graduated exercise and movement in all directions is safe and healthy for the spine.
- Spine posture during sitting, standing and lifting does not predict LBP or its persistence.
- A weak core does not cause LBP, and some people with LBP tend to overtense their ‘core’ muscles. While it is good to keep the trunk muscles strong, it is also helpful to relax them when they aren’t needed.
- Spine movement and loading is safe and builds structural resilience when it is graded.
- Pain flare-ups are more related to changes in activity, stress and mood rather than structural damage.
- Effective care for LBP is relatively cheap and safe. This includes: education that is patient-centred and fosters a positive mindset, and coaching people to optimise their physical and mental health (such as engaging in physical activity and exercise, social activities, healthy sleep habits and body weight, and remaining in employment).
Other Things You Can Do On World Spine Day
If you are interested in learning more about back health why not check out these top resources.
- Learn more about low back pain
- If you’re a clinician learn how to safely assess the neck before treatment
- Check out these clinical guidelines for back pain
- Use these easy to use low back pain fact sheets
- The Lancet series on back pain
- The Global Spine Care Initiative – Clinical Guide and Patient Guide