Education & Problem Framing

Arguably the most important component of any treatment program for an injury or pain problem is the explanatory narrative offered by the treatment provider. As a treating Physio, it’s my job to ensure that you have the correct understanding of your back pain’s cause and prognosis. This is important, because one of the strong predictors of a progression from acute, manageable back pain to chronic, unmanageable back pain is a skewed or erroneous understanding of the causes of back pain and a belief that one’s symptoms cannot improve.

Proper framing of a back pain problem starts with a few facts:

  • back pain is not only a product of the degree of injury to structures in your spine. We also have to consider how sensitive the nerve endings that are plugged into your back’s discs, joints, muscles and tendons have become. When the sensitivity is ramped up, your back will hurt more. If the sensitivity is reduced, pain will reduce.
  • 95% of cases of acute, sudden onset low back pain resolve 100%. The numbers are well stacked in your favour.
  • People with no back pain often have structural changes to their spine such as disc bulges, disc herniation, spondylitis etc. So a nasty looking x-ray or MRI does not mean you are destined for a life of back pain. x-rays and MRIs are a poor predictor of who will suffer long term back pain.
  • If there is serious damage to your spine, we are good at identifying such damage with clinical questioning and testing.

Proper framing of a back pain problem should also include information about the anticipated trajectory of recovery and overall prognosis. For most acute, sudden onset episodes of back pain, where there has been no major trauma associated with the onset of symptoms, the episode of back pain usually last a few weeks. The first week or so is normally very painful, and movement is often very limited. Rising from sitting is often very difficult. Bending forward very difficult. Putting shoes on often impossible.

The severe pain and movement limitations are not an indicator of severe injury… they are an indicator of very strong protective responses from your body to what is most likely a fairly minor strain or sprain to a structure within your spine. Over a 2-3 week period, I would estimate that over 90% of patients I see like this have recovered to 80% of normal function. After 4-6 weeks most are back to normal. There are exceptions of course. If the onset of back pain was traumatic, we would expect symptoms to last longer, especially if there has been significant structural injury from the trauma. If a person has a long history of previous back pain, a recent onset of back pain might take more time to settle down.

The key though is that the “bark” of back pain is nearly always worse than it’s “bite”. Reducing the sensitivity of the nerve pathways and nerve endings within and around your back will expedite the resolution of your symptoms. You can read more about the various treatment options that serve this purpose below.

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