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Changing behaviour in low back pain

I use resistance training to alter movement patterns and recruitment strategies during low back pain rehabilitation and find it to be effective. However, outside of that training, helping to alter behaviours that you believe are contributing to a person’s pain is hugely important. These can be changes in thought process such as how someone responds to flare ups, or physical habits such as gait or posture.

I feel that it is important to provide education around why we feel the change should be made and the rationale behind it. If someone is able to understand the reasoning, and it makes sense to them, I think they are more likely to make changes. Once this understanding is in place, it is then possible to facilitate the development of an individual’s strategies and cues for how they may achieve the changes. 

Physical changes are often easier to make as it is possible to demonstrate to someone the difference in sensation in their back when, for example, they move from sitting in a very extended lumbar posture to a more relaxed neutral or central position. Encouraging people to label these positions and put reminders around their workstation or home to move into and out of these positions is then easy to do.

Depending on the change in thought process you are looking to help someone alter, and the individual themselves, this can be easier or harder to achieve. Something that seems basic like the lack of relationship between a patient’s MRI results and their back pain can be straight forward to explain, but will sometimes need constant revisiting in order to reinforce the message you are trying to get across. It can be easy to believe that just because a topic has been discussed that you have been successful in effecting a change. Regularly asking someone to talk you through what they feel to be the mechanisms behind their pain is important in order to understand whether you have been able to effect change. It is important to understand that sometimes these beliefs are very well embedded particularly if the message has been emphasised multiple times and/or by a person with high status to the individual. This can be the most challenging part of rehabilitation with some individuals.

Neil Welch

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