Physiotherapist David Rogers explains how a pioneering new strategy can help defeat persistent back pain…
David Rogers has more than 20 years’ experience helping people with musculoskeletal pain. A chartered physiotherapist currently based at the Royal Orthopaedic Hospital in Birmingham, he works closely with spinal surgeons and physicians to help people with persistent back pain find lasting relief. In his new book Back to Life, co-written with back specialist Dr Grahame Brown, he combines his expert knowledge of the spine with new insights into the psychology of pain. Less-Stress London finds out more…
Less-Stress London: In your book you say that attitudes towards the treatment of back pain are changing. How are they different now?
David Rogers: There is a growing consensus among researchers and clinicians that back pain isn’t as simple as we first thought. For years the idea has been promoted that back pain is solely due to physical factors, such as how much you lift, twist and bend, but there is widespread acceptance now that there is much more to it than this.
Exercise approaches such as yoga, tai-chi and meditation which focus on calming the body down, together with a new understanding of the science of pain, have helped us realise that we need to address physical, psychological and lifestyle factors to maximise people’s recovery when back pain presents.
We have moved a long way from the days when we believed a visit to a clinician could fix our back in one or two sessions. Whilst this can still be a helpful adjunct to treatment, there are many other things we can do address back pain.
L-SL: What are the most common triggers for back pain?
DR: Whilst it is common for back pain to be triggered by overdoing it in the garden or pushing ourselves too hard in the gym, our thinking around what triggers back pain has changed significantly. Remember pain is both a sensory and emotional experience. Many people find their back pain is triggered during a stressful time at work, where they have been overloaded with stressors or deadlines which they are struggling to meet. This can activate our body’s fight and flight response, making us feel threatened by events around us.
The over-bearing line manager, the demanding relative, a person’s tendency to want to provide for everyone else at their own expense, or the loss of a loved one (bereavement) will all impact negatively on our nervous system, raising nerve-muscle tension in our body and making pain output more likely.
Many people we see can relate the onset of their back pain during stressful periods of time such as these. Helping people to understand this, and giving them strategies to reduce the threats around them, can be a useful way at minimising triggers to back pain.
L-SL: What solutions can you suggest?
DR: It is helpful for people to understand that their own behaviour, and the way in which they respond to others around them, can have a direct effect on the pain they feel. This knowledge can be very empowering. Changing how they do things from day to day, learning strategies to calm down muscle tension (yoga, meditation, breathing exercises, taking time out for themselves) and taking a step back and looking at their own lives, rather than others’ lives, can all be useful solutions.
L-SL: You talk about ‘fear avoidance’ being a factor in preventing recovery. Can you explain this?
DR: Research has shown us that there is a clear link between fear and pain. Fear avoidance beliefs and behaviours, for example: ‘I’m worried if I do that activity I will damage my back,’ have been identified as an important factor in preventing recovery from back pain. Fear is a logical response to pain, and pain is part of our body’s danger alert system.
Pain is there to protect us from danger and our brain has to decide whether the pain we are feeling is due to something dangerous going on in our body. With back pain, although the pain can be excruciating and debilitating, it is uncommon that there is anything dangerous happening to our body. But if we don’t reassure people that it is more helpful to get moving again, safe in the knowledge that there is no serious damage in their back, fear avoidance can develop. This can then set up a cycle of avoidance, low mood, deconditioning and a feeling of helplessness. However, as can be seen in Back to Life, this can be reversed with the right approach.
L-SL: Can you briefly explain how the body processes pain?
DR: Pain is a useful warning signal to tell us there is something wrong. The brain has to decide whether these incoming signals are dangerous or not. It has to decide ‘What does this mean?’ and ‘What should I do about it?’ If it perceives the incoming signals are a threat to our survival, pain is produced. It does this in an instant, without us knowing it. We have very little conscious control over it.
L-SL: How can we use our mind to stop pain?
DR: It is really helpful to be aware that fear of movement often prevents people from recovering. Fear can be a powerful emotion in our mind and we can diminish fear by starting to do activities we had previously been fearful of doing. The best way to do this is to start simple – for example, if you are fearful of bending, start by doing small bends from a sitting position. You might feel worse to begin with, but as you repeat the activity it will become easier. You can then progress bending activities from there.
L-SL: How effective are painkillers in treating back pain?
DR: Painkillers (or anti-inflammatories) are best used in the acute stage of back pain to help you get going again. However, more importantly, keeping active, staying at work (even if you have to modify work activities for a short while), and pacing your activity are simple strategies to use to promote recovery.
L-SL: Do you think most people with chronic back pain can eventually ditch the painkillers?
DR: Current science is questioning the long-term benefit of painkillers. Learning new strategies to address pain and loss of function, such as those described in Back to Life, can help people with chronic back pain reduce their use of pain medication.
L-SL: If you could only give one piece of advice on how to prevent back pain what would it be?
DR: Keep moving and take up regular exercise — any exercise will do.
Back to Life, £12.99, published by Random House, available from Amazon (ISBN 9781785040740)