314- Helping Your Patients Self-Manage Low Back Pain

Welcome to the Evidence Based Chiropractor, where each week we deliver the latest chiropractic research and marketing strategies, all in the time it takes to get to your office. Now, here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. Happy holidays. Whatever you're celebrating out there, I know the holidays are coming up really at the end of this week. We're not going to miss a beat. So there will be Monday episodes of this podcast coming out each and every week, obviously including this one. And on today's episode, we're talking about Self Management at the Core of back pain care 10 key points for Clinicians this study just came out in the Brazilian Journal of Physical Therapy and there were some names that you'd probably recognize on the author list. So we're gonna break this down. There is a bunch of really, really good clinical pearls in this study, as well as thoughts on how to approach patient care that I think can improve outcomes and definitely improve the communication that you're having with your patients day in and day out. Now, before we get started, I'll say a few words about Novopulse. This is a technology where recovery meets performance. Learn more and check it all out. This reduces pain and inflammation while improving function to get your patients back to the activities they enjoy. If you pride yourself on having a performance center and you have not checked out Novopulse, you're doing yourself and your patients a disservice. Novo-pulse.com recovery novo-pulse.com recovery I'll drop that link down in the show notes, but as I said at the top of this episode, we're talking research. A brand new study, 2021, even though we're closing down at the end of the year, but Brazilian Journal of Physical Therapy I will drop a link down below, but it is titled Self Management at the Core of back pain care 10 key points for Clinicians so we know that this is a dance. When we have a patient that comes in with low back pain or with many different complaints that are musculoskeletal and neuromusculoskeletal by nature, that this is a dance between what we can provide for them and what they can do for themselves, I think about it in a very overly simplistic fashion. I say you spend 15 minutes in my practice in the other 23 hours and 45 minutes doing your own thing. We can only do so much in that 15 minutes. If the other 23, 45 you have bad habits, you're not doing the active care components. We're just gonna struggle to get those results. So a couple things here that are important are communication. And you'll hear me say this a few times throughout this episode, but this really, to me, is all about communication. Do people know what you're expecting of them do Then everybody that comes into your practice wants quick relief. As quick, you know, as fast as possible, as safely as possible, and as, you know, cost effectively as possible. People, you know, that's the gist, right? So how do you phrase it? So that when people come in, hey, here's what I'm recommending. Here's what we're gonna do in the practice, here's what you can do at home so that you can get the best results in the shortest amount of time. And get back to those things that you can't do today when you frame it positively. Now, it's not work or stuff they need to do. It is benefit, driven by their motivations and by what their goals are, right? So important concepts to keep in mind. So this study kind of cites and starts out by saying good health is increasingly understood as the ability to adapt to changing life circumstances and to self manage in the face of social, physical, and emotional challenges. We saw this basically as the definition of health, right? It goes beyond merely the absence of disease, but a total state of physical, mental wellbeing. And that's an important concept here because life is dynamic and low back pain has, you know, whether we like it or not, it doesn't really matter. Low back pain has a lot of psychological component to it. On one side, fear challenges, as we'll talk about in this study a little bit. On the other side, it has psychological challenges in terms of its links to depression, to chronic pain, et cetera. So here's the challenge. Most people are gonna deal with low back pain. We've said that almost every episode on this show. And most people who experience low back pain will have recurrent episodes that come and go over time. And even people that recover really well from an initial episode of low back pain are likely to experience new episodes. And up to 20% of people who have or seek care for low back pain have persistent back pain that they need to manage more or less continuously. So this is a couple important things, and I'm gonna go a little bit of clinical and a little bit of business here. One, you know, the fact that any chiropractor out there is struggling to attract, retain, and reactivate new patients is beyond me because clearly It's a communication issue. When we know that almost everybody has low back pain, we know that there is overwhelming, I'm going to say overwhelming support for what we do as chiropractors, as first line treatment. And for people that have persistent and consistent low back pain, periodic visits to chiropractors is evidence based, quote, unquote. So if you're struggling, you really have communication issues, probably more than anything else. And not that we are limited to low back pain. So an effective intervention for persistent conditions, chronic conditions, pain things, it's dual, it's bifurcated, right. It's influencing behaviors, it's influencing catastrophe type thoughts, fear and self efficacy. This is really about true patient empowerment. So clinical guidelines out there, we've seen these things change for the better, in my opinion, dramatically over the last five to 10 years. And we know clinical guidelines generally recommend stuff like advice, information, manual therapy, supervised exercise, all as treatments for persistent low back pain. So that's great. I mean, this tells us a lot of these individuals, borrowing red flags and all that jazz should be in our practices. So, okay, so how do we go about. This isn't about trapping somebody in your practice. This is about understanding how can we have a elegant dance here between when you need me, I'm here and you know, I'm gonna support you and help you get back on your feet. And, and at the same time understanding that our goal is to have you do as much as possible outside of these four walls and hopefully you're not coming in very often at all. And that is a delicate balance. And again, I think a lot of it comes down to communication. So this study cites the fact of, you know, we just talked about this a week or two ago on the podcast. But in terms of business, smart goals, but they cite that in terms of health as well, individual goal setting. So smart goals, if you remember correctly, smart, specific, measurable, achievable, realistic, time bound, this stuff applies to business and to life, can really help patients identify their motivations for change, increase their adherence to their plan, and help you as the provider, plan, interventions, treatments, care that support these goals. And this is really, really important. You know, I have a friend of mine who always says, you know, our care recommendations are gonna be based on all findings and your goals. And I think that's a really, really good way to put things. The second component to this is, is it specific smart goals? Right? Specific, measurable, achievable, realistic and time bound. This helps to again, as they say, identify their motivations for change. Remember, people don't Come into your practice because they're in pain. They come into your practice because the pain has gotten so bad they can't do something they'd like to do. Call that the life impact or the life effect. Something's changed in their life that's driven them into the practice. People. Cause you can ask people all day long, how long have you been dealing with this? 5 years, 10 years, 27 months, 6 months. People will deal with pain for a long time. It's only when it starts to change their quality of life again, we get down to communication. Communication, right. So planning and goal setting should really be, as they cite in this study, a shared decision making process between you and the patient. You know, your job is to keep them safe and not let them run amok, so to speak. You're the professional, you're the doctor, doctor. However, it also is about what their goals are and understanding that really helps shape a patient centered experience in your practice. That increases engagement, satisfaction and adherence, as they're calling it. I'm gonna call it active care retention. We talk about this with the smart chiropractor all the time because it's one of those three pillars that we focus on. New patients, improved retention and consistent reactivations. We do that through email, through social, through these communication channels. And I think a lot of this study ties directly in with that. A patient centered model is communicative first. A patient centered model has engagement, it has high satisfaction that leads to referrals, and clearly the patient has to get through their active care plan. You know, I get that some people will do so well that they accelerate out of it. But I'm talking about the other side of the coin. The 20 to 25% of people coming into your practice, which is a ridiculously significant loss, that don't complete their active care plan. Not because they did so well that they got beyond it, but they got confused, they got discouraged, they didn't know what to do. They might not have liked their experience. All of these things play a role and most of these things can be changed, eliminated, influenced by really, really good communication. So they cite a few different things in this study that I think are really, really important. They, they have sort of these circles, one on top of the other that show, you know, it's really about self care, self management and symptom management. Those are three different things. Self care, symptom management, and self management. Self care is healthy lifestyle behaviors. That's the biggest circle on the outside within that is self management. Managing the actual or potential impact of the problem, then within that there's symptom management actions to reduce the active symptoms. And, and then that's where your healthcare comes in. You know, you're helping them with symptom management, you're hopefully working with them, you know, to empower them on the self management side and you're providing them with those behaviors and activities of healthy lifestyles so they can do their own self care as they kind of get out of your practice and keep moving on. So these are all really, really key components and a lot of these change. You know, changing things around low back pain and behaviors is intimately involved with changing beliefs patients perceive. I had a friend here, I think I just brought this up maybe last month. I've a friend here in town that's been struggling with low back pain. It's relatively young, 40 years old, let's say. And people that have low back pain, they perceive it and believe me, I saw this firsthand. My dad's dealt with low back pain issues, et cetera. They think it's unpredictable, uncontrollable. They can't make sense of it and they just, they can't deal with it. They're scared. They're super scared it's going to come back. I can't bend forward, I can't bend back. You know, there's so much of this misinformation out there that really empowering your patients with how they can move safely, with the fact that hey, this might come and go a little bit. And again, the truth of whatever that patient's experience is and what you're finding, what their goals are, hey, to get back. Here's the realistic timeline of what that might look like. You might have some setbacks along the way. Don't worry, that's common with your condition. We're gonna stay on top of it. That's why every time I'm gonna ask you these questions is to ensure that I know exactly what you're dealing with so that each and every time you come into practice. And we can just fine tune and adjust that treatment plan to ensure that you are getting the best results as quickly as possible. Simple communication, but so, so powerful with patients that are coming in with low back pain. So bottom line is patients need a quote unquote toolbox for managing pain and related fears or other emotions. And this is breathing exercises, mindfulness techniques, walking, whatever it might be. When people go home and leave your practice, don't mistake the fact that they walked out feeling a bit better, which is awesome and super powerful. That that's gonna be the case 12 hours later before they come back into your practice. So, you know, they're gonna go back and sit at that desk, they're gonna go back to that assembly line, they're gonna go back lifting that shovel. If they're not out of work, they're going back to the same things that drew them to come India in the first place. And your 15 minutes, 30 minutes of care, you know, is super powerful. But you have to have a dance partner. They have to be, you know, takes two tatango, and everybody listening knows it. Your patients that are actively engaged, your patients that are doing the things that you've recommended at home, especially if you take pride and really go about that in a meaningful way, are gonna get far better results. They're gonna refer more people and be more happy. But at the bare minimum, what you can control, you can't control what they're gonna do at home. You can influence it, but you can't control it. But what you can control is, is how you communicate the benefits of them doing that so that they understand it. And people that have low back pain, where I was going with that is people that have low back pain, when they leave your practice, they might be feeling a little bit better, but when something starts to nip them again, when they feel that bit of pain, all of that fear is gonna come back. And fear of motion is one of the greatest challenges in my mind when we talk about low back pain. So the summary of key aspects of self management, I'm gonna go through these pretty quickly here, but I think they are important. The principles are people self manage most of the time, people that deal with low back pain, most people deal with it a lot, don't seek care at that time. So enable them to self manage well is important. Support patient autonomy, you know, act as a partner, be patient centered and avoid really strong clinical control. You want to help empower them along the way, Help patients develop self efficacy, provide and reinforce positive experiences. Hey, look at how much you move today in practice. That's great. You know, those sort of things are super powerful. It's not only about back pain, helping them manage it and maintain good physical and mental health. Staying upbeat, understanding that it's a process key. Working with self management requires the right setting, Trained clinicians, time for dialogue and room for confidentiality are prerequisites. That means, hey, you know, while we're helping you to do all these things at home, we're here for a reason and that's to be able to help you if you have questions if you have challenges, if you have a setback, if this thing comes back, be sure to start now. The sooner you start, the better off you will be. We see that time and time again here. Here's the clinical actions. Let patient value based goals guide your management. Help patients make sense of their symptoms, teach skills to solve everyday problems, provide tools for pain management and evaluate patient valued goals, action plans and patients understanding of back pain. Move the focus away from curing pain forever and more towards managing it. Here's a thing I saw time and time again in the orthopedic groups I worked in. Somebody would come in, they would be evaluated by the surgeon for surgery and whether or not they had surgery or not. I heard this so many times. It's important to bring up on this episode. I would say, well, we'd be going through the health history and they had seen a chiropractor. How'd that work? It was great for five years and now it's back and now they went right to the surgeon and this sounds nuts, but I'm telling you, we're living inside the bottle. If you get outside, this is what's happening with over 50% of individuals. They might have a great experience in your practice, but they think it's quote unquote forever. The irony being that surgery ain't forever either. And if anything's not forever, it's the surgery changing biomechanics, causing scar tissue. I could go on and on for that. I'll save us both from that. But the bottom line is people even have that great experience in your practice. But the communication wasn't refined enough. They thought it failed because the pain relief only quote unquote lasted five years and now they're off to the surgeon. Well, I guess I'm too far gone for chiropractic. So there are really great clinical tips in this study. Dive in, refine your communication. All of us as chiropractors can take a step back and refine our communication. And I can tell you as we get into 2022, if you are looking to build additional referral relationships with other healthcare providers to join the hundreds of docs that receive tens of thousands of referrals coming into the practices that we work with@the evidencebasedchiropractor.com I'd be super happy to work with you. Listening to the podcast on the other side of the coin. So that was B2B, right? Business to business on the B2C side, if you're looking to increase your number of new patients, if you're looking to improve your active care retention and you are looking to really systematically and consistently generate more reactivations in your practice. Head over to the smartchiropractor. Com. We are just wrapping up our last open enrollment period. That means it's the lowest price you're going to get. You know you can come on go monthly. Let us automate all your social Facebook, Instagram, Google Business, YouTube. Let us get out there with your email so that we can utilize all of the tools in our toolkit, streaming video, you name it. You can see all the tools over there. But the benefits are this new patients, better retention and more reactivations. That's over at the Smart Chiropractor. So have a fantastic holiday. I'll be back next week. Any questions about this study, hit me up jeff@the evidencebasedchiropractor.com if you have not left us a rating or review for this podcast that helps more and more docs find out about it. So if you're listening on your phone you can scroll on down on itunes, tap how many stars, provide some feedback. I would greatly, greatly appreciate. That'd be a great holiday gift to me is that if you have not left a rating or review, please do so. Thank you so much for tuning in. We are well over 300 episodes at this point in time. We'll be back next week. Have an awesome week in practice and I will talk to you soon.

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