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When Should You Worry About Protecting the Low Back?

The language we use and the narratives we support have dramatic influences on how people live their lives. The perpetual focus on posture, alignment, mechanics, and ergonomics in conjunction with biomedical healthcare that supports MRIs and other structural-focused assessments and treatments conveys the message that the body is a fragile machine. A person’s belief about movement and the fragility or robustness of their body will impact the way the move and confront pain. The researchers of this qualitative study assessed the relationship between one’s LBP and movement and posture.

All the participants noted their back feels ‘stiff, tight, tense, spasming, rigid and locked or seized up’ during painful movements and postures. Furthermore, they were constantly assessing their activity and body position, ensuring they remained cautious and careful. This conscious ‘protection’ encompassed common rules uttered by many healthcare professionals and ingrained in society such as sitting upright, lifting with a straight back and bent knees, or bracing the core. These beliefs, along with experiences of LBP, fueled the beliefs in spinal fragility.

It wasn’t until the participants completed a 12-week PT-led Cognitive Functional Therapy intervention that their beliefs changed. The training taught them the spine is robust and there is no ideal movement or posture. Restricting movement is often a protective mechanism that can worsen and prolong the pain experience. By learning to relax and freely move, patients experienced reductions in pain. Follow-up interviewers revealed the participants stopped believing in the structural models of pain, recognizing that their beliefs and activity patterns played a large role in the pain experience.

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