In my first physical therapy session of the day, my patient sat slouched and dryly said:
“I’m not expecting much from this session. I’ve tried everything but I have disc degeneration and foraminal stenosis with severe arthritis.”
Those medical terms being parroted from past physician visits and late nights of internet research were shaping my patient’s perception of her physical capacity. For privacy, let’s call her Gina. Gina was reluctant to move because she feared piercing pain and didn’t trust her body to move like it used to. Her fears that ‘pain means damage' and ‘hurt means harm’ are common and very relatable. I asked Gina to show me where her back hurt. Her brows furrowed as she showed me an MRI image on her phone and she pointed out where her nerve was compressed.
Breaking the cycle of fear & pain
As we started stretching, I explained that a deformity on an MRI or x-ray can be misleading and may not necessarily be the reason someone may experience pain. For example, a research review article showed that among people with no back pain there are very high rates of "abnormalities" on MRI -- even among 20-year-olds, more than 1/3 have findings of disc degeneration, and the rate increases to 96% of 80-year-olds. I also shared that pain education - education about what pain is, where it comes from and what you can do about it - has been shown to reduce pain symptoms.
Gina was surprised that clinical research showed limited correlation between imaging and pain because she had always attributed 100% of the pain to her pinched nerve. Gina started to see how her condition went beyond what she could see on imaging, and that her persistent pain was far more complex.
While Gina’s doctors likely meant well, the words they used, combined with Gina’s ideas about pain and even herself, made Gina feel damaged. This caused her to move differently and even move less. By making sense of her pain, Gina’s expectation of what she was willing to try that day changed.
Exercise therapy offers significant benefits towards improving health, such as increasing strength and adapting your pain system, but for some, it can feel unsafe to start moving more without the right information to get going. Exercise therapy empowered by education and behavioral support are the 3 pillars of best practice care for persistent pain treatment because together they work to address the many contributors to pain.
If you’d like to see some of the recommendations I shared with Gina to help her relieve back pain from sitting at her desk, download the tip sheet below.
Brinjikji, W., et al. (2015). "Systematic literature review of imaging features of spinal degeneration in asymptomatic populations." AJNR Am J Neuroradiol 36(4): 811-816.