419- Why Do People Believe They Have 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 Langman.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are back with a fantastic research study titled what do People Believe to be the cause of Low Back Pain? This is a scoping review. Lots of great clinical pearls as we wrap up the year, believe it or not on this podcast and look forward to hitting it strong in 2024. A lot of clinical pearls from this one. We're going to dive in in just a moment, but before I do, I want to say a few words about the Smart Chiropractor and the Evidence Based Chiropractor. Both of my flagship services have their best offers of the year going on right now. So if you've been interested in generating more patient reactivations, you want to check out the smart chiropractor@thesmartchiropractor.com Additionally through some of the emails, if you're on a list that we've been sending, if you're interested in building better referral relationships, this is a massive opportunity for some. So many docs out there, this is our best price of the year, month to month to get started with our MD referral program at the Evidence Based Chiropractor. Again, if you're on our email list, you can check that out. If you have any questions, feel free to hit me up. Jeff, the evidencebasedchiropractor.com happy to hook you up with links to give you the best offer of the year. Make it as easy as possible to hit the ground running in 2024. But as I said at the top on today's episode, we're talking research. This was a Brazilian Journal of Physical Therapy article came out in 2023. Brand new article. I'll repeat the title again. What do people Believe to be the cause of Low Back Pain? This is a scoping review and I'll be sure to drop a link down in the show notes if you wanna link over and check it out. And this was an interesting study because I'll probably say this a couple times during the podcast, but understanding what people believe to be the cause of their pain is, is absolutely critical in my opinion to helping them overcome that pain because the perception is reality and that's really the key takeaway. But let's dive into some of the specifics we Know that the way people understand their pain or what they believe to be the cause can influence both their conscious and actually their unconscious response to it as well. So their perception of pain is a really big deal and it can impact fear, avoidance behavior, disability type ratings, or pain related to disability. All of those things tie into the perception of that pain. And an easy example of this outside of cause, but just the perception. We've all had patients come in and they are, you know, they can barely move and you're like, where are you at on 0 to 10 about a 3 today, right? You're like, oh my gosh, as they say that through gritted teeth. And on the other token, you see somebody like, you know, jump up and tap the top of the roof on their way in and skip in and drop keys and bend down and pick them up without hesitation. You're like, where are you at? And they're like, oof. Nine out of 10 today, we've all had that happen. So the perception is really, really key. And this is important for a few different reasons. One, there are different belief domains as they outline in this study. One of them is, what is this pain? What's the. It's an identity belief, as they call it. What caused this pain? That's a causal belief. We're going to focus most today. What will this pain mean to me? Really big one consequence beliefs, how can I control this pain? Control beliefs and how long will it last? Timeline beliefs. Now here's a spoiler alert. If you really want to put together a ridiculously patient centric, powerful report of findings, answer those questions to the best of your ability, right? When you're answering the questions of what is this pain, what caused this pain? What will it mean to me, how do I control it, and how long will it last? I don't expect anybody to have perfect answers, but using your clinical judgment and best evidence and experience, when you can start to frame that conversation, wow, that is a powerful report of findings. That's a powerful way to communicate with your patients because you're speaking and leaning in to what their questions are, which in many cases are far more important than what your questions are. So in low back pain, there's been qualitative research indicating that causal beliefs do have a really big impact on people's lives and how they manage their pain. So if you believe that the pain. And we've all seen this, this is just such a great example they highlight in this study, which is we've all had people who believe that low back pain is caused by damage or their spine being weak. And what does that lead to every single time? Overprotective behavior and avoiding, you know, fear, avoidance behavior. And that often can be some of the most challenging things to overcome. Even when, and this is the powerful aspect of this, even when they're feeling better, they will still avoid that because they are overprotective and terrified that they're going to, quote, unquote, cause the pain again because they are weak, because their spine is damaged. Those are really, really impactful understandings. I'm going to say that you need to have, as a clinician so that you can as quickly as possible confront those beliefs and guide the correct beliefs in your patients, because otherwise it is gonna be an uphill battle. So in this study, they were looking to examine a few different objectives. What questions and questionnaires have been used to measure causal beliefs for nonspecific low back pain? What types of causal beliefs about low back pain have been identified, and how many studies have identified those beliefs? And in what types of studies and contexts do causal beliefs, where have they been measured? And finally, what outcomes have been investigated for an association between causal beliefs in cross sectional and longitudinal design? So they took a look at 308 unique belief items. So that's a lot. And there is 15 distinct categories. And out of those causal beliefs. So let me rephrase that a slightly different way to make it super, super clear. When they looked at what people believe the cause of low back pain to be, there were over 308 different responses. So a couple things are important there. One, you know, 15 categories makes a lot more sense, I guess, cutting to the chase, which is there are very common categories as far as what's going on and what are the causes of pain that people come in believing. So here are some of those categories. And be warned, some of these are gonna sound very familiar, right? So number one, lifting and bending. What caused your pain? Lifting and bending. Number two, physical activities and sports. I overdid it. Right. Three, loading, movement and physical capacity. Four, work demands, physical work demands. Five, other work demands. Six, posture and position. Seven, structural injury or impairment. Then we get into genetics, trauma, mental or psychological issues, general health and lifestyle, external environments, spiritual beliefs. And then there are unknown and other. So as you can see, as we went through that list, probably you'll hear less about spiritual causes of low back pain. However, you probably hear a lot around lifting and bending, around sports, around loading, movement, physical capacity, what work demands. These are common things that we hear all day, every day. But it's really, really important to identify what are those patient beliefs? Why do they think that they were hurt? Because why they believe they are hurt is going to directly contribute to how they believe they can get better. And that can either accelerate that progress or it can completely impede that progress. So while this is probably a question that I believe we ask in the context of our over examination. Right. Hey, what, you know, what, what happened? Right. Ultimately, what caused the pain might be a more interesting question to ask just to see what the responses are. Especially now, as you've heard these categories, you'll probably start to pick up on. Yep, yep, yep, just falling into these categories. And once you know the category again, this gives you the opportunity now to speak into that. So if somebody believes that they were hurt for lifting and bending, and believe me, sometimes they believe that they were hurt lifting and bending, and they were hurt lifting and bending. So when I say cause causal and when I say beliefs, sometimes these things are 100% accurate, sometimes they're not accurate. That's not, I'm gonna put that aside for a moment and say perception is reality. So understanding what they believe to cause the pain, whether it did or didn't, many times it did, is really, really important. So if they believe that lifting and bending cause their pain, they, those might be activities you want to incorporate, of course into some of the rehab in the practice so they don't have fear avoidance when they get out of the practice. If they believe, you know, loading and movement, again, what were those movements? Maybe you can use that almost that test that diagnostic as the rehab, so to speak. If it's a physical work demand, well, what does that entail at work? Are there items that you can do or guide them on that help them overcome? I'm gonna again specifically focus on the fear avoidance behaviors because that's really, really, really a big component of this. So if we stratified these, there is slight differences than, than how they read them. So in terms of the most popular, so to speak, from a research perspective, down to the least popular in terms of research perspective. So the cause that's been researched the most is the structural injury or impairment, as you can imagine. Second in terms of research, lifting and bending. Third, mental or psychological, which is really interesting to see that that high, it's actually above posture and positioning and above physical activity in sports. And then they kind of go down the line there. So really taking a look and understanding that. So what did they find? Based on the current evidence, they say it's not really feasible due to the large variation in measuring causal Beliefs and the lack of studies designed to investigate causal beliefs to determine a longitudinal association between beliefs and outcomes. So basically what they're, what they're saying is, hey, there's so many different categories, 308 different items, there's 15 different broad categories. We can't really tell you based upon what somebody believes caused their pain, how that impacts the outcome. But as we've dove into on this episode, there's some clear things we can take outside of the research realm and just from a clinical boots on the ground perspective and say, okay, we've seen this pattern before. Now, we might not be able to predict what their ultimate outcome is, but we certainly can help them get to their ultimate outcome, wherever that may be be based upon understanding where they're at today, why they believe they're in that position, AKA the cause and belief and then the third component, which is really what we do, which is helping guide them towards a better day. So I found this study to be absolutely fascinating because it was able to highlight so many different aspects of what we see all day, every day and probably overlook. Again, I speak on stage and I typically ask, who here believes low back pain's boring and every hand goes up? Because it's something we see and we take care of at such a high level all the time. But sometimes that can be. We almost become blinded to the fact of it's still a really big deal. And especially just that's at a, that's at a epidemiological level, it's a really big deal. With billions of people struggling with back pain, there is no shortage of individuals struggling with back pain in any way, shape or form. And then at an individual level, the psychological components to it, as I've said before, you know, somebody hurts their wrist, there's not really a psychological component which, whereas spine has such a deep rooted psychological component to it that we need to be, when we look at a biopsychosocial model of care, for example, we need to be mindful of. It doesn't mean we need to be psychologists, but it does mean we need to be in tune with where our patients are at. I like to think about it like, think like a beginner when you're speaking, when you're guiding, taking one step at a time. Because trying to have somebody take four steps at a time, it just never works. Whether you're selling a product or service, whether you're helping somebody get well, you can't skip steps, right? Every process takes time. So being sure that you're clearly articulating to that individual. Here's where you're at today. I believe we can help you. Here's what you need to know and here's how we're going to get you to be the best. You moving forward is really impactful and important. And again, helping them overcome those psychological components, the belief of the cause, whether true or untrue, helping them overcome that so that they can knock on wood, not only get back to where they were before they came into your practice, but hopefully be performing just at a human level, even better. But that takes a carefully threaded skill set of clinical skills, speech and communication skills and understanding skills and guidance. And when you put all those things together, you're going to have a lot of patients that really love the care that they get. You're going to have tremendous outcomes and those people are going to want to refer their friends because so many doctors, as I've talked about this, it's like, well, this is what we do as chiropractors and that's true. But so many other healthcare providers and we can always be better individually, but so many other providers outside of chiropractic, this is a foreign concept. So that's a huge advantage that we have being able to accurately communicate and guide patients. But it starts with understanding what their beliefs are around causes. So I found this study awesome. Again, I'll drop a link down below and as we wrap up, I want to say a few words about pillows and a few words about Shockwave. Align of sleep. It's the pillow we use in my house. If you have pillows in your practice and you have not checked out alignasleep.com, i can't recommend it enough. 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Go stemwave.com the evidencebasedchiropractor I'll drop those links down in the show notes as well. Both of these companies will roll out the red carpet for you because they appreciate you listening to this podcast and I do as well. And if you have not left a rating or review, I would love to hear from you. Otherwise, I hope you have an awesome holiday. Hope you have a fantastic new year and I'll talk to you in 2024. Have an awesome day and I'll talk to you soon.

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