Back pain: encouraging a self-management approach

Abstract

Physiotherapists use many different approaches to managing back pain but often aim to incorporate patient education. This paper explores how, based on a review of the relevant literature, patient education could more effectively encourage a self-management approach. In order to empower patients, individual perceptions and beliefs about their back pain need to be addressed. Fear and avoidance beliefs about physical activity are highlighted as potentially important barriers to recovery. The importance of the patient-therapist interaction and the need for an adult-to-adult relationship are emphasised. The value of devising an individual home programme and setting up positive support systems with the patient are described. Additional methods of encouraging self-management such as the Back Book and the Back to Fitness programme for those who are not improving at about six weeks are discussed. A brief review of the biomechanical literature reveals that the validity of several well-accepted pieces of advice often given to back pain patients is challenged by recent evidence. Studies carried out over the past decade suggest that sitting does not produce more strain on the back than standing, and that the squat lift should not be taught. Keeping heavy objects close to the body when lifting and changing position frequently are both pieces of advice that are supported by research findings.