Typical belief of a patient
✅ “I thought fixing my back would be as straightforward as fixing a broken wrist. I’d find a surgeon and get it done”
The medication problem
✅ “It is a struggle for patients and clinicians everywhere to resist pain medication that is incredibly effective in the short term, even if it is incredibly harmful in the long term.”
The imaging problem
✅ “There is a very poor relationship between changes on MRI scans and the presence or absence of low back pain.”
✅ “While people with low back pain are more likely to have disc degeneration show up on an MRI, so will a large number of people without back pain.”
✅ “If you get into the business of treating disc degeneration because it’s shown up on an MRI, the likelihood is that, in most of those people, it is not contributing to their back pain.”
✅ “MRI scans probably do more harm than good.”
✅ “A scan can change a patient’s behaviour, because they’re told there’s some wear-and-tear damage in their back; but most people have wear-and-tear damage in their back and when you get to my age, I’m sure everybody does.”
✅ “It also changes clinicians’ behaviour: “They’re more likely to offer invasive procedures if they can see something on an MRI scan that they can treat,”
The problem of low-value interventionist treatments
✅ “The case against invasive treatments such as injections and surgery is even more shocking… facet joint injections, a mix of anaesthetic and steroid injected into the small linking joints of the spine, are very widely used (yet) There is no evidence to support their use, but nevertheless the numbers… go up year on year.”
✅ “At best, spine surgeons define success as a 38% improvement in pain and function,” says Ramin, “but if a hip or a knee surgeon had a 38% success rate, that physician would no longer do that surgery. And 38%? I think that’s really optimistic.”
Why does pain persist & become disabling?
✅”The fear-avoidance model illustrates this well.
– “You find it hurts when you move,” ➡️
– “so you don’t move, you don’t do things, you get deconditioned, ➡️
– so your back pain gets worse, ➡️
– so you become even more frightened of moving ➡️
– you get into a negative cycle
What can you do?
1) Reactivation: Safe & Effective Movement to Gain Resilence
✅ Dr Stuart McGill’s Big Three exercises for stabilising the core – the modified curl-up, side bridge and quadruped bird dog
✅ exercises that the professor of biomechanics at the University of Waterloo in Ontario, Canada, says “spare the spine, enhance the muscle challenge, and enhance the motor control system to ensure that spine stability is maintained in all other activities”.
✅ They should be performed every day
2) Gain Reassurance, Hope & an Achievable Plan for Sustainability
✅ “the most helpful thing we can do is challenge the assumption that, if our back hurts, there is a pain generator in there somewhere that can be scanned, identified, injected or surgically removed, and fixed.
✅“That whole notion is erroneous,” says Ramin. “The truth is that low back pain is a many-faceted problem, emerging from your life situation, the state of your body and the social factors surrounding you.”
✅ “Rather than trying to find a doctor who can make the pain disappear, we need to be aware that to a certain degree, it is a part of life and the best approach is to keep physically active in the right way, to find a strategy to manage stress and to keep on with normal activities.
✅ ”Like all complicated pain, avoiding it, trying to use a substance to blot it out, investing in one person the belief that he or she can cure you: that all makes it worse.”