What is the best message with pain?

We often get patients that have been told by Consultants, G.P’s, osteopaths, Chiropractors and fellow Physiotherapists that they should be careful or even stop certain activities or sports following an injury. These words are very powerful and patients will more often than not stop their sport of choice and become more sedentary.

Commonly, I often find that this advice is given to runners who have had or are recovering from acute lower back pain, whatever the explanation given as to why the back is painful. They report that they are no longer running and have been told that this is bad for a disc or lower back problem due to the high impact. This is anecdotal and not based on any robust evidence.

The spine is a very well designed strong structure with significant ligament and muscle support but when someone suffers acute lower back pain this confidence in the spine is lost. Muscles naturally guard and protect us from this acute pain and in the initial stages this is normal. When the acute pain starts to resolve and normal movement returns then we start to think about a graded return to work and sports/activities.

Running is a normal activity that we have evolved to do and as long as we grade the return as well as observe any abnormalities and correct any compensations then there should be no reason to stop this activity.

In most instances the initial advice given may be not intentional or deemed as detrimental to the patient but we must be careful in how we give out information. Reducing the fear and installing confidence is paramount. Telling someone that running is bad for your back installs fear and cessation of that activity. Also we need to understand that any medical terminology can be misunderstood. For example degenerative disc disease sounds a lot worse to a patient than age related changes and disc bulges are normal and not a good indicator of lower back pain.

Matt Withycombe

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