The following article was written by Natasha Nicolai, DPT.
It is typical human behavior to have a protective reaction to painful stimulus; it is also becoming increasingly clear that people have a similar response to physical movements which we perceive are associated with pain. The Fear Avoidance Model of musculoskeletal pain has been thoroughly researched over the last ten years and is applied to many joints including the knee, shoulder, neck and low back. The theory behind the model states that “pain related fear is a response comprised of psychophysiological, behavioral, and cognitive elements in which fear emerges in response to a pain-related stimulus that is perceived as a threat (Lentz, 2009).”
Specifically, in the case of low back pain, research has demonstrated that fear of movement and work related tasks will lead to decreased movement and participation in normal daily activity. This inactivity, or fear avoidance, is often the culprit in acute cases which can eventually become chronic states. Back pain responds best to exercise, including both aerobic stimulus and core strengthening. In fact, deep core weakness, fear of movement and the inability to work or participate in activities of daily living are more accurate predictors for patients likely to suffer from chronic low back pain. Surprisingly, the imaging studies done, such as MRI’s demonstrating disc pathology, are less likely to predict chronic low back pain than examinations involving fear avoidance and core weakness. New research also demonstrates tissue quality change occurring within spinal muscles related to pain inhibition. Likewise, trauma and muscle disuse lead to fatty deposition within the muscle belly, demonstrating dysfunction and pathology.
For the average woman or man suffering from back pain, this new research and real life theory is meaningful. Various triggers can cause biomechanical changes in the spine which lead to pain, poor postural control, and aberrant movement patterns which results in compensation. This is a result of muscles turned off by the brain, in response to pain or injury. It can be difficult to feel these changes occur as they may be subtle at first and worsen over time as muscle quality deteriorates. Decreased activity can exaggerate weakness leading to overall fatigue, instability and poor pain inhibition. Physical therapists have a good understanding of this vicious cycle as well as the tools to correct it and help people move forward. An appropriate and tailored bout of physical therapy including core stabilization, general exercise and manual therapy is typically enough to help individuals get back to normal living.
Both the physical and psychological components of back pain need to be addressed to avoid further injury and progression of acute pain to chronic pain or disability. Comprehensive understanding of injured structures, postural imbalance and strength deficits are all key components to taking control of pain and moving away from fear. Individuals having any hesitation surrounding participation in recreational activity, work related tasks or general exercise, especially those pertaining to fear of pain, should take a further took at getting the specific help they need.
