So, back pain!
Around 70% of you have or will have a bout of it at some point in your life. It can be super painful or not too bad, but interestingly enough only 1-2% of back pains can be attributed to a structural cause. So keeping this in mind, how important is getting a scan…?
Here’s the kicker, studies have shown time and time again (also at most other joints in the body) the huge number of “abnormalities” on peoples scans that have ZERO back pain. Rajaswaren (2014) found that 96% of athletes under 22 years had “abnormalities” on a scan, with another study finding that 37% of 20 year olds have degeneration in their spine, and 30% have disc bulges (Brinjikji 2015). Again, those people didn’t have back pain, so what on earth can we achieve with getting a scan once the red flags have been cleared?
What the heck is a NOCEBO?!
“A nocebo effect is said to occur when negative expectations of the patient regarding a treatment cause the treatment to have a more negative effect than it otherwise would have. For example, when a patient anticipates a side effect of a medication, they can suffer that effect even if the “medication” is actually an inert substance”. Thanks Wikipedia (https://en.wikipedia.org/wiki/Nocebo).
Aside from ruling out anything sinister, nocebo! Everyone’s heard of Placebo where basically “if you believe a treatment works, it works”, however Nocebo is the total opposite and scans for back pain can be the perfect example of it live in action. If someone with clinical power (ie, a GP, a physio, chiro, specialist etc.) tells you ” you have a disc bulge at L3/4 and mild-moderate degeneration throughout your Lumbar spine”, of course you will freak out and likely your pain will rise and you certainly won’t want to bend over and touch your toes in a hurry. We know now that using scans in the wrong context can actually lead to worse outcomes in the individual (still case by case scenario).
So our plan is always to clear the red flags (such as unknown rapid weight loss, numbness in the saddle area or even a drop foot), reassure people their body knows what it’s doing and the pain will eventually ease, and continue to move and be active as much as the pain allows without any fear of harm. Backs are mega strong and robust so be reassured that in over 98% of cases there is nothing structurally wrong to fear, they are just massive pains in the butt!
I’ll sneak up a post soon on what are the key influences/risk factors on back pain, and that’s where it starts getting interesting, and even a bit hairy! Watch this space, and head to https://www.facebook.com/Benjonesphysiotherapy and give that thumbs up a click to hear more back stories!