What a pain in the back: How personalized approaches to care can help people with low back pain

One of the hallmarks of getting older is the onset of lower back pain. One day, you wake up on the wrong side of the bed or sneeze the wrong way and something goes “pop.” And suddenly, the thought of moving and aggravating the pain becomes agonizing.

Typically, when something hurts, we instinctively do not want to move for fear of causing more pain. But this could be doing a disservice to the healing process. What if there was a way to make certain movements easier when dealing with low back pain?

Dr. Stephen Brown and PhD candidate Cathrine Feier in the Department of Human Health and Nutritional Sciences found that using visual cues — such as looking high or low — can be an effective strategy to help reduce the difficulty of standing up.

“Sit-to-stand transitions are important to daily life but can be both painful and difficult when you have low back pain,” says Feier.

As a trained chiropractor, Feier is familiar with people who struggle with low back pain. She often noticed how patients with low back pain would get up from their waiting room chairs in different ways. Some got up slowly, some leaned far forward.

This got Feier wondering if there might be a way to make simple movements, like getting up from a chair, more comfortable for the patient.

 “We need to take a wholistic approach — it’s not just whack and crack, it’s also about movement,” says Feier.

But what is low back pain? It’s a tougher question to answer than you might think.

“We don’t know what causes low back pain or exactly what low back pain is,” explains Feier.

Adds Brown, “Low back pain is a complex issue. Diagnosing a specific cause is very difficult because most people with chronic low back pain have no clear diagnostic structures or indicators.”

Back in the lab, Feier asked study participants to look at a visual cue placed on the wall as they transitioned from sitting to standing. The cue was placed at an exaggeratedly high height, eye level and at a low height because our heads tend to follow where our eyes are pointing. Placing the cues at different heights shifted participants’ head and neck position, which in turn altered the position and movement of their spine. Feier used motion capture imaging to “map out” how each person’s spine moved as they stood up and assessed if there was any impact on the level of discomfort experienced by participants with low back pain.

Using visual cues did indeed make standing less difficult, but to Feier’s surprise, there was no single approach that worked for everyone. Some individuals preferred having the low visual cue, while others preferred the high visual cue.

“People are very different and have different problems,” explains Feier.

It is what makes managing back pain a challenge. Pain is subjective, as it is based on the patient’s experience with it, as is the root cause of the pain. This is why more and more research points towards using a personalized, wholistic approach.

Both Brown and Feier share the same sentiment when it comes to adjusting to a life with low back pain.

“Listen to your body,” advises Brown. “If you notice something off, try to find the issue and what triggers it, and adjust your movement strategies to minimize movement that causes the pain. We don’t want people to be fearful of movement, it often takes time, but it is important to keep moving.”

To paraphrase the wise Dory from Finding Nemo, “Just keeping moving, moving, moving. What do we do? We move, move.”

Read this study in Musculoskeletal Science and Practice.

Read about other CBS Research Highlights.