You may have seen the recent media campaign by the UK Chartered Society Of Physiotherapists about challenging some of the common myths around back pain, if not you can read it here. This campaign was launched across multiple media channels including tv, radio, newspaper, and of course social media. It was aimed at educating the general public about some of the incorrect beliefs around back pain. It achieved a huge amount of coverage and attention and generated a lot of feedback from the both the healthcare profession and the general public. However, some of this feedback was rather negative and a recent editorial in the BJSM here discusses this and some now think the mythbusters have themselves been busted.
Following this editorial by Dr Chris McCarthy who along with eight others, including myself, was a member of the working group that helped develop and plan this campaign, there have been some rather disappointing comments and reactions on social media. So I thought I would have my say about this, and also put the record straight about a few things that appear to have been misinterpreted about Chris’s interview to the Daily Mail, his editorial, and the myth busting campaign in general.
In the BJSM editorial Chris explains his ‘bruising’ experiences of the direct, harsh, and annoyed comments left by the majority of the readers on the Daily Mails web site after an interview he originally gave to The Conversation about the myth busting campaign. He goes on to highlight four key areas that the Daily Mail readers comments fall into…
Physios are not qualified to diagnose and mange back pain
Doctors need to screen and scan all those with back pain before they start physio
There is a lack empathy for back pain by those who havent had it
Physios who advise those with back pain to exercise are trivialising the problem and saying its all in their heads
First I think its important that we recognise these issues and I think Chris has done a nice job in summarising them. However, I think it also should be recognised that this interview Chris gave that generated these negative comments about the myth busting campaign was done on his own, without the knowledge or approval of the CSP or the rest of the working group involved, and even before the campaign was officially launched. Why Chris decided to do this is beyond me, maybe eagerness, maybe self promotion, but I think he needs to accept that some of the negativity around this interview was of his own making and not just from the message in the campaign itself.
It was clear that this myth busting campaign to the public on a deeply personal and emotional topic like back pain would generate some kick back and ruffle a few feathers. Because of this the idea was for the campaign to be presented and promoted as a unified approach with a strategic launch that demonstrated to the public that these myth busters are not just the thoughts and ideas of one or a few physios, but rather as the profession as a whole. In my opinion Chris failed spectacularly at this with his premature and independent interview and personally this is why I think the negative reactions where so strong to his interview. No where did Chris mention these views where the work of the CSP working group, nor the vast majority of the physio profession as a whole, instead it appears that these are just his views, as an expert.
Now no one likes being spoken to or at by an ‘expert’, and no one likes to be told you’re doing it wrong… and again I think the wording of Chris’s interview doesn’t help to connect with the audience. Now of course this could be editorial licence by the media, I personally know they can turn and twist things around to make something you’ve said sound completely different, but in this interview Chris doesn’t demonstrate much understanding or empathy to the reader with back pain. For example in the first paragraph he talks about the cost and financial burden of back pain before mentioning the personal and emotional effects, and he even goes on to say “most people with back pain don’t manage it well…”. Now if I had back pain and I started to read that sentence I would be pissed off, so I can understand others being to.
However, aside from these issues I also think its important to point out the fact that challenging any deeply ingrained belief about anything is never going to be a simple walk in the park or a smooth ride. There will always be resistance, there will always be kick back, there will always be angst, rage, and some gnashing of teeth. This is normal human nature when anyone is confronted with different or opposing views and ideas, and it is nothing to be alarmed, deterred, or put off by.
But it does appear that this campaign and some of the negative reactions it has created has alarmed and deterred some physios, with some thinking we need to back off, or change our approach in how and when we question myths about back pain. I have even seen some physios using this negative feedback as a pathetic lame arsed excuse to justify how we should not rock the boat and how we should continue to do what we have always done.
This shit drives me crazy, nothing changes if nothing changes.
Physios need to understand and accept there will always be difficulties in challenging and confronting patients beliefs and expectations, especially around an emotional topic such as back pain. Lets face it back pain has been, and still is surrounded by decades of crappy treatments, rash promises of quick fixes, and shitty miracle cures. But just because its hard, just because its slow, just because its not readily or easily accepted by the public, it does not mean we should stop promoting the message of keep moving, hurt doesn’t mean harm, and you don’t need a scan for your low back pain. If we just give up at the first obstacle, if we just give patients what they want, then whats the point of us being an evidenced based profession?
I’ve said it before and I will say it again, the biggest dilemma with the physiotherapy profession as a whole is that most if not all things patients come to see us for can be managed easily and effectively with some simple advice and guidance and some small lifestyle and habit changes, yet perversely these are often the hardest things to address, accept, and affect, for both the patients and the physios.
Instead the easier option is to carry on with the back cracking, rib popping, pelvic thrusting, spine twisting, machine buzzing, needling stabbing, tape sticking, muscle rubbing, trigger pointing placebo treatments. Yes you could argue, and I’m sure some will, that there is some evidence for some benefits for all of these things, but so what!
Personally I think all of the above ‘treatments’ are nothing more than gimmicks, illusions, and distractions wasting time, resources and diverting attention away from the simple yet uncomfortable truth, that once it is clear that there is nothing serious as a cause of pain, then usually it will get better or it won’t regardless what we do! Yes that’s right, I said it will get better on its own, no rubs, no pokes, no cracks, no machines that go buzz buzz, just time, its called natural history, and physios don’t like to talk about it. Instead they feel an urge to do something, they feel the need to justify their existence, they feel the need to help, and this is admirable and I understand it, no one likes to see someone in pain, and if we could try to do something about it then why not?
Well maybe because you could be doing more harm than help. Maybe you are helping in the short term but hindering in long term. Maybe by rushing in and reducing a patients pain by a little bit for a short while you are not allowing them to find their own ways and means of coping, adapting and managing. Maybe if we didn’t help so quickly maybe patients would become more adaptable and tolerant to pain.
Sounds harsh doesn’t it, but its how I practice and manage all of my patients. Sure some patients don’t come back and I’m sure they go an find some other therapist who will rub and appease them, but that’s their choice and my failure for not connecting with the patient or explaining the process better. My goal and aim is to make every patient I see as reassured, as confident, and as in control of their own issues as quickly as I can. My job is to become redundant and surplus to the patients needs as quickly as possible. If I can do this in 1 visit or 10 it doesn’t matter, but the sooner the better.
This approach doesn’t sit well with many physios especially in the private sector, as often many use business reasoning over clinical reasoning. They feel threatened that if they tell a patient it will be alright and not to come back unless they need, they will loose money and run out of work, and everyone has bills to pay. And again I do understand this, but this is ridiculous thinking, just in case you haven’t heard back pain is a global epidemic and its growing, it is now the second highest cause of global disability, and there is no sign of it letting up soon.
To be frank I think modern healthcare as a whole is one of THE biggest reasons for the worsening rates of low back pain. The constant need to intervene and to reduce pain is why I think many people deal with back pain so poorly. Modern healthcare’s desire to immediately remove or reduce back pain, I believe reduces the populations exposure and tolerance to back pain. If more with back pain were educated and able to feel reassured and understand its ok, its safe, it doesn’t need treatment, it will get better, then I think we would finally start to see the cost and prevalence of back pain care go down.
Now of course I understand that there are many, many other socioeconomic factors for the growing rates of low back pain such as reducing general activity levels, increasing rates of obesity, and its not just as simple as telling patients with back pain to get on with it. Or is it? I do think we have to reflect and take a long hard and critical look at our roles as physiotherapists, and as a profession be better at getting the key messages across to patients more often, more consistently. I for one am extremely tired and frustrated of constantly trying to unpick fear inducing incorrect crapola out of my patients heads put in there by other some other healthcare professional.
So in summary I thought this myth busting campaign by the CSP was a good start in trying to change the public’s understanding about back pain, and I was extremely happy and honored to be involved and play a small part in its development and promotion. However I was disappointed at some reactions and comments after Chris’s editorial, and yes the negative comments were disappointing, but this is not surprising, nor the fault of the campaign, or the messages it contained. And this is most definitely not an excuse to continue to do what we’ve always done, or to stop trying to challenge and confront the many myths on back pain, amongst other things.
Long may the mythbusters continue!
As always thanks for reading
Adam
