Over the last few years, whenever I (or my colleagues) witness the sharing of erroneous or outdated information on television, in print or through various other media, we complain among ourselves about the power of the culture around us and how we have little influence in changing the perceptions of those not directly involved in our care. Worse still, the patient’s who do receive our care have often been inundated with nocebic information and have entrenched beliefs about their conditions that are challenging (if not impossible) to influence or change. Among the most egregious, in my estimation, is the continued reliance on postural and biomechanical models to explain the occurrence, prevention and treatment of acute and chronic low back pain (LBP).
While I admire Dr Richard Besser for many of his positive contributions on television and online (for instance, his engaging individuals on twitter this week regarding the safety and efficacy of vaccinations) I found the information being presented last week (specific to LBP on The View and LIVE with Kelly and Michael- links can be found at the bottom of this post) was difficult for me to watch. For instance, there was a graphic of a lumbar spine with the vertebrae outlined in blue with disks that were bright red – I understand the impact of seeing ‘red’ discs rather than white and how this engages different thoughts and emotions in the viewer. There was talk of the spine collapsing. The segment lacks information to inform the audience that disc bulging and degeneration are normal and part of the aging process – not necessarily painful. There was an over-emphasis on posture, and the ‘right’ or ‘perfect’ way of positioning one’s self, as if such things existed – allowing the viewer to blame themselves for their eventual/likely episode of LBP. I decided that this time, unlike all of the other times in the past, I would not sit back and complain in an echo chamber, but instead, try to make a difference.
Of course, I am an anonymous home care PT blogger with little influence or credibility – and I intend to remain that way. My hope is that a positive online response to the letter (if there is one) will lend it credibility. I have no interest in making a name for myself or engaging in an ongoing dialogue with people who disagree with the views expressed here for an extended period of time (although I will certainly do so for a while). I simply wish to respectfully share information that I have learned with another educator who may not be privy to the information in hopes that he might consider sharing it with a wider audience.
In regards to the segment on The View, I also wish to be clear that I have no previous knowledge or understanding of Ms. Goldberg’s complaints or her medical history. I acknowledge that there very well may be a primarily biological explanation for her painful complaints, and I am pleased to hear that she is recovering. However, the information that was provided on her television program (as well as LIVE with Kelly and Michael) was presented to a general audience and was not presented as being specific to Ms. Goldberg, per se; as a result, I found that much of the education surrounding the ’causes’ of LBP to be inaccurate and incomplete.
Insomuch as we understand that psychological and social factors play a significant role in the patient’s pain experience, and we understand that the brain often works via predictive modeling, it becomes increasingly important to change the narrative away from an incorrect view of LBP as a bio-mechanical and postural phenomenon and instead begin to have an honest conversation about the complexity of pain, rather than falling back on tired, outdated cultural memes…the letter linked below is my effort to try to push the narrative in the right direction. Without it, there will be more examples (similar to these) of people thinking their back hurts due to the absence, or incorrectly positioning, of a lumbar pillow.
I acknowledge that none of us are perfect; I do not expect perfection from Dr. Besser. As my letter reflects, I am pleased that he emphasized the importance of movement to manage and reduce LBP in both television segments. Additionally, he mentions red flags and when it is necessary to see a physician on his appearance on LIVE with Kelly and Michael. Unfortunately, however, I find the information on posture to be too potentially iatrogenic to remain quiet on the subject.
Please, if you think it is important to change the narrative – to shift the thinking, beliefs and how we discuss LBP in this country – I ask that consider tweeting/re-tweeting information pertaining to this letter and the television segments to colleagues and to Dr. Besser as appropriate. Open up your own bookmarks and share the data, resources and references that you have as well. I ask that you help in broadening the conversation to a wider audience and help add a little credibility to an anonymous home care PT who is trying to get the word out. #talkLBP