How Patients' Low Back Pain Turned A Bruising Pain to England Physiotherapists: A Sting Awakens Us from Delusion
Lower back pain is the greatest source of global disability, ahead of nearly 300 other conditions, leading to huge levels of healthcare costs and suffering (McCarthy CJ, 2016; Bailly F et al, 2021).
When Agonized Souls Visit Clinicians
When an agonized, frustrated & disabled soul with LBP cannot even put his or her socks on or get dressed, clinicians say: Pain is in your mind, don't stop enjoying exercise, instead, keep twisting & bending!
Such scenario happened on August 23, 2016, when a short article about lower back pain management was published in the Daily Mail Online, which conveyed the messages from the British J of Sports Medicine (BJSM) and the Chartered Society of Physiotherapy of UK. The article was authored by Dr Christophe McCarthy, PhD, a physiotherapist at Manchester Metropolitan University.
Don't Stop Enjoying Exercise, PT Doctors Say
The message of that Daily Mail article was aimed at people who suffer from low back pain, to convince those sufferers that:
1. you need keep doing twisting and bending of your back, because your muscles are in spasm due to pain, so twisting and bending will relax the spasm.
“Do not fear twisting and bending. It is essential to keep moving. Muscles that are in spasm, due to pain, relax when gently moved and stretched. Gradually increase how much you are doing, and stay on the move.”
2. You should continue ENJOY exercise or regular activities, even while you are in pain (excruciating pain or minor pain regardless).
“Back pain should not stop you enjoying (emphasis added) exercise or regular activities. In fact, studies have found continuing with these can help you get better sooner – including weight training.”
3. Your pain is in your mind - your unconscious and conscious interpretation. Physical damage rarely causes pain.
“Level of pain has very little relationship to damage to the spine and more to do with your unconscious and conscious interpretation of the level of threat the pain represents to the sufferer.? Cultural influences, work, stress, past experience and duration of symptoms have a stronger relationship with pain than the number of normal age-related changes you have on your scan.”
Patients' Response: A Storm of Rage
The article was accessed over 29?000 times with 125 reader comments being posted in the following 2?weeks (McCarthy CJ, 2017). It was quickly engulfed by a storm of rage from not only all over England but also across the oceans sweeping America, Australia, Canada, Finland ..., absolute majority of the comments coming from angry patients in miserable agony:
Jk63 , London, United Kingdom:
Yes yes ... Bloody nonsense. Back pain is my life. Two slipped discs, surgery and still in pain! Live on painkillers and anti inflammatory drugs- yeah it's in the mind is it ?
Ron , Daghenam, United Kingdom:
A 70kg deadlift: that should sort it!
razorsharpe , Manchester, United Kingdom:
Sciatica isn't a myth. What a stupid article!
HappySmile , Leicester, United Kingdom:
very stupid article, I had severe back pain, I was taken to A & E nothing showed up on the XRay I had difficulty passing urine and altered sensation in my leg. Told me to exercise as this was a normal part of the aging process. The pain carried on and on, in the end we went to a private Consultant he test my reflexes which were absent in my legs and ordered and immediate MRI scan. This showed a severe sequestration of the L5 disc which has set in the spinal nerves and the damage is irreversible. He said had they taken notice and did an MRI scan at the time i wouldn't have reduced mobility. He said the sequestration was so large it looked like a tumour. Aging shouldn't cause pain, stiffness and slowing maybe down but not pain.
frankie2112 , Hawaii, United States:
This is a dangerous article. If you have something wrong with your back it could be serious and no you shouldn't move furniture to make it feel better.
Britannia , Worcester, United Kingdom:
These articles are so dangerous
glendyson1956 , Warrington, United Kingdom:
Depends on the problem. A very dangerous stupid article
Mark , Woodbridge, United States:
I've had back pain so bad that I seriously considered ending it all if I faced the prospect of living with it forever. I couldn't sleep, I could barely walk, and I could only lay in one exact position that gave a little relief. Don't tell me it's a perception, that pain was something I wouldn't wish on an enemy.
Bessex , Brentwood, United Kingdom:
Caused me huge damage and awful long-term pain by exercising with undiagnosed prolapsed discs on a friend's advice as the doctor refused to visit me and I couldn't get to the surgery for the pain. This man's article is very dangerous and I hope nobody follows his advice without a proper diagnosis first.
Wolfinstien , Rio Rancho, United States:
I think this guy doesn't know what he is talking about. Pain can be the result of something physically wrong with the spine. Pinched nerves because of shifting vertebra causes incredible levels of pain. How do I know? Four back operations. Physical exercise can make the situation with pinched nerves in the spine worse by aggravating the situation. There are far more things that can cause pain in the lower back other than just pulled muscles and some of those things require surgery. If you have a situation where you actually need a spinal fusion you will not have to be convinced to seek help very soon as if you don't you may end up an invalid as was the case with me for two years while I was put threw many tests over time until finally having the forth back operation which did not return me to having a normal back but did relieve the pain to the point I can get around and not be house bound. The point is to check out all your options then decide what you want to do.
eagleeye , harlow, United Kingdom:
He (Dr McCarthy) has a Theory about people with a painful back, that they need to keep moving etc. Alas when you cannot even put your socks on or get dressed, how the hell are you meant to trot off down the gym for a solid workout ?
His idea is called Combined Movement Theory, and its just that, an idea from someone that doesnt suffer from a painful condition. He is not a GP, or a Surgeon, he is a knowledgeable fellow, but that doesnt mean he is right when everyone with a back condition calls him wrong. It is well known that in general, it is better to keep active than static when your back plays up, but thats not the same as going to the gym etc.
Dcmm75 , Inverness:
I wonder if doc McCarthy has ever experienced the living hell of back pain?!
flakey2015 , Leicester, United Kingdom
The person who as done this study is topical of people who have never had severe lower back pain , you should still exercise is a joke when you can't stand up straight although you do need to move as you will still need the loo .
DMH84 , Andover:
He should try my back pain. Several operations for pressure on the spinal cord and damage from neurological Auto Immune desease means pain all the time. I had physio for it years ago and then was told "I won't touch you again as something is very wrong with your back". There was. At least that physio told the truth. 16 years later it affects my legs so making walking very painful let alone do exercises, This article could be dangerous
What is it all about , Geordie land:
Dead right, the person writing this obviously hasn't had it or a serious back condition. I had both for 18 months & it's very painful & wears you down.
Sam Smith , Swindon, UK:
There's always some stupid article about back pain. Until you suffer day in day out then you know what makes it worse or what helps for while. My spine is partly fused the rest has damaged disks, it's only a matter of time before I can't walk. I'm fed up of these stupid articles.
KasKas , Perth, Australia:
It looks to me that the article has been written by somebody that doesn't have back pain and therefore not qualified to tell those with compression fractures, trapped nerves and the like.
What we used to call an ignorant quack. Go home to Mummy.
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Ewanhoosearmy , South Coast:
Well Mr Physiotherapist, would you classify Cauda Equina as harmless pain?
jules , outerspace, ?land Islands, Finland:
Isn't it amazing how all these people make a living out of telling people who deal with pain daily that its all because they are lazy!!!
Mark , Woodbridge, United States:
I've had back pain so bad that I seriously considered ending it all if I faced the prospect of living with it forever. I couldn't sleep, I could barely walk, and I could only lay in one exact position that gave a little relief.
Don't tell me it's a perception, that pain was something I wouldn't wish on an enemy.
Traaveller1 , South Yorkshire, United Kingdom:
In the UK they tell people to take paracetamol for back pain. Absolutely useless, doesn't help at all, doesn't provide any pain relief whatsoever.
... with the dysfunctional NHS I am unable to carry on a normal life for several weeks. English doctors seem to have a belief that pain is GOOD for their patients.
Useless numbskulls!
Tiny , South East:
I have no faith in our so called highly educated experts, given my experience with these stupid dumb idiots
Lozzie , Winnipeg, Canada:
Except when the pain does mean damage, and you literally can't move without yelling due to the agony of a herniated disc, let alone think of exercising.
This article is way too generalized and ridiculous - it could mislead a lot of people to damage themselves further, if in fact, they have slipped a disc. Get any back pain checked out for a real doctor, before listening to Dr. Daily Mail.
geo p , york, United Kingdom:
This is perhaps good advice for simple mechanical lower back pain that is low grade but for anything more severe short term rest is advised as most patients are immobilised.
Vicomtedelomagne , Donzac:
"Dr" Physiotherapist, even if you have a PhD at a non-Russell group university, to use Dr in these circumstances is misleading, and all 5 of your statements are controversial, to say the least.
onlyme99 , UK:
What do physiotherapist know about back pain? They should stick to what they know which is rehabilitation... I.e getting somebody mobile again after an operation, learning people to pick up objects after they've suffered a stroke etc. They do nothing for neck, back or shoulder pain and never will. Exercises they prescribe after waiting 4 months for a 10 minute appointment (including treatment) can be found on the Internet. The sooner people realise this the better.
Clinician's Intellectual humility
Having reviewed those patients' biting comments, Dr McCarthy with one of his colleague published a responding article on Br J Sports Med (2017). The two PT experts recognized the following:
"The readers' comments suggested that;
A Bruising Pain to Clinicians: Stings, But Awaken Us from Delusion
Dr McCarthy et al further acknowledged:
“While reviewing the comments was a personally bruising experience, it has been valuable in reminding us of the challenges ahead. The anonymity of the comments in this forum certainly allowed for some personally insulting comments to be posted; however, the themes that emerged may reflect an unfettered reflection of a discord between back pain sufferers' expectations of the healthcare system and the healthcare they receive."
Clearly, We Still Have A Way to Go...
Dr McCarthy continued: “The comments from Daily Mail Online readers highlighted to us the need to reflect on the perceptions of sufferers of back pain and to use stakeholder perceptions to adapt our methods of communication. ...
“Clearly, we still have a way to go ....”
Deep Thinking
Lets start from a plain logic. As a clinician, ask ourselves: when our loved ones (spouse, kids, parents ...) have LBP but they feel they do not need to discontinue ENJOYing yoga, dancing, twisting and bending and performing their daily activities, do you think you need to recommend your loved ones to take half day off to visit a musuloskeletal doctor for LBP management (get prescribed an extra exercise program), or you need to design a workout plan by yourself specifically for them?
Do such similar people with minor low back pain need to see a doctor at all? Do we need at all to elaborate an article posted online, in the first place, to tell these people no need to stop enjoying their workout?
On the other hand, the disabling and debilitating low back pain has been there for at latest since the birth of modern medicine in 1800s. Millions and millions are suffering and desperately looking for a fast, reliable and effective medical treatment for their LBP, but not just a better-than nothing twisting and bending so-called exercise therapy.
Why do we need to elaborate an unnecessary message by completely ignoring or trivializing those true sufferers who are urgently in needs? Why do we do something so stupid which is so self-destructive to our reputation?
Intellectual humility involves recognizing our intellectual limitations in the service of pursuing deeper knowledge, truth, and professional development.
In the last two century, the advance of science is astonishing, except specifically pain science and largely medicine in general. We humankind today can send a man, a human body, intact and safely from the earth to the moon with 3 days. The moon is about 390,000 kilometers away from us, which is a distance around 10 times the circumference of the Earth. With today's science and technology, we can place a spacecraft exactly on the lunar orbit and place a human body on a spot on the surface of the moon as we calculated in our planning.
In musculoskeletal medicine, we clinicians have been touching a less than one third portion of the human body called low back with our hands for at least 200 years in clinical practice: palpating, rubbing, kneading, icing, heating, taping, twisting, bending, stretching, strengthening, compressing, spinal cracking, joint mobilizing it every day, but we still do not have any clue about how to quickly and consistently shut down the pain from that portion of human body yet.
While the knowledge of a high school student about nerves and brain would be enough to convince us about the possibility that the pain can be shut down in seconds. Not just for low back pain.
We are stuck somewhere... is there a way to get out? We need to know where our limitations reside.
References
Bailly F et al, Clinical guidelines and care pathway for management of low back pain with or without radicular pain. Joint Bone Spine. 2021
McCarthy CJ, Yeowell G. Newspaper response to the back pain myth busting advice: bruising but helpful. Br J Sports Med. 2017 May;51(9):758.
Mccarthy CJ, Daily Mail.com 23 August 2016. https://www.dailymail.co.uk/health/article
#lowbackpain #painmanagement #painscience #physiotherapy #exercise
#criticalthinking #intellectualhumility
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3 个月Wow this is really interesting. Thanks for sharing!