Unhelpful beliefs | Messages delivered during the BSc-2 module |
---|---|
Back pain is due to structural damage | • Degenerative changes are frequent in asymptomatic population [2, 34] • Little association between degenerative changes and the level of pain and disability [35, 36] |
LBP is a serious condition | |
Biomedical or biomechanical factors are the major cause of LBP | |
It is necessary to find the source of pain to treat LBP | • It is difficult/impossible to accurately determine the tissue source of LBP [2] • Identifying the source of pain does not lead to better outcomes [2, 41] |
LBP is due to “something” out of place that needs to be corrected | • LBP is not due to “something” out of place [2, 42, 43] • Manual therapy has short term effect and works as a pain modulating technique (no structural changes following manual therapy) [18, 44] • Guidelines recommend active exercises as first line treatment [18, 45] |
Bending/lifting with round back is dangerous for the back | • Biomechanical studies do not consistently support that lifting with a straight back is better [46, 47] • Epidemiological studies do not support flexion as an independent risk factor for LBP disability [48] • Manual handling training (doing less flexion) has no effect on LBP [51, 52] • Patients with LBP move with a more rigid spine (less flexion and more muscle activity) [53,54,55] • Psychological factors are associated with a more rigid movement [16] |
There is right and wrong ways to move | • Movement is very variable and there is no right or wrong way to move [54, 58, 59] • Confidence to move seems more important than how you move [13] • If a movement is painful, you can temporarily adapt it. But in the long term, all movements should be promoted and trained (improving tolerance) [60] |
The back is vulnerable and needs to be protected | • Loading has positive effects on the back [61, 62] • Disuse has negative effects on the back [63] • The back can positively adapt to load [64] |
Bad postures (particularly slumped postures) cause back pain | • There is no right or wrong posture [65, 66] • Posture is very variable [67] • Lumbar spine posture is not an independent risk factor for LBP [68] • Patients with LBP often show a hyperactivity of trunk muscles [55, 69] |
Core stabilisation exercises are important to treat LBP | • Patients with LBP move with a more rigid spine (and naturally adopt more “neutral” postures) [53] • There is no association between transversus abdominus or lumbar multifidus activation and clinical outcomes [70, 71] • Stabilisation exercises are not more effective than other types of exercises [72, 73] • The idea that the back needs to be stabilized may elevate fear avoidance beliefs [11, 72] |
Important factors that need to be modified during physiotherapy treatment are muscle strength and mobility (physical factors) | • Improvement in physical factors alone do not explain improvement in disability [74] • Self-efficacy, pain-related fear and psychological distress are important to address [75, 76] • Physiotherapy intervention can improve psychological factors through education and active treatment (e.g. gradual exposure, promoting self-efficacy) [78] |