Why are so many low back pain treatments ineffective?

Imagine you have two cars that won't start - one has a flat battery and the other has a broken starter motor.

Now imagine attempting to fix the cars by inflating their tyres.

I know nothing about cars, but even I know that this is the wrong repair strategy in both cases. It would clearly be a mistake to conclude that 'car repair' is a waste of time.

Yet, this is very similar to what happens in the world of low back pain.

Last year there was a huge scientific study that concluded that 90% of low back pain treatments don't work. It was a systematic review and meta-analysis of over 300 randomised controlled trials - the gold standard in scientific research.

The implication of this conclusion is that if you have low back pain, you might as well get used to it because there's not much you can do about it.

As you can imagine, the media loved this story. It ticked all the boxes of making people feel scared, anxious and hopeless, and it drew a lot of attention.

I've already written about how I was contacted by a journalist who was doing an article on the study for The Telegraph. I told him that the results were entirely predictable because not all low back pain is the same.

It's often complex and it can have many different causes. The problem with these studies is that they lump very different problems into one bucket called 'non-specific low back pain', and then wonder why people with different problems don't respond in the same way to the same treatments.

Some people get worse when they flex their spine. Others get better.

Same exercise. Opposite results.

So, if you get a diagnosis of 'non-specific low back pain' from your doctor, you should view it with the same skepticism as when your mechanic confidently concludes that your broken down car has a 'non-specific car problem'.

The information is too vague to be helpful. If you want to fix the problem you need more specific information.

You get this information by doing a thorough assessment to determine what your specific pain triggers are, and a personalised recovery plan based on what's found in the assessment.

This is key if you want long-term results. And it's the essence of The McGill Method that I use.

I teach my clients how to move in a way that doesn't stress their spines. When you learn how to avoid provoking your pain, you allow your spine to heal itself. The human body is very good at this if you give it the opportunity.

So, why don't all low back pain treatments focus on this? Well, there are a number of reasons, I'll give you what I believe are the 3 main ones:

1. Confusion about evidence, as I just described. Randomised controlled trials are great for testing drugs: you give one group of people the drug, another group a placebo, you compare the results. But they're not the best tool in the toolbox for low back pain - because it's so individualised. It's like trying to use a hammer to cut a piece of wood in half - a hammer may be a great tool, but it's the wrong tool for the job.
2. Economic incentives: The low back pain assessment that I guide my clients through takes 3 hours to complete. That's how long it takes to cover everything. For obvious reasons of cost and time this doesn't fit well into a healthcare system that is essentially a business. There's a reason why a lot of low back pain rehab involves passive treatments where you lie on a table attached to a TENS machine or under a heat lamp, or doing exercises, unsupervised. This allows the clinic to allocate several patients to each therapist simultaneously. Many of my clients report having experienced this type of 'treatment'.
3. Human nature: human beings are notoriously bad at behaviour change. The World Health Organisation reported that roughly 50% of patients with chronic diseases don't take their medications as prescribed. From the doctors' perspective, if someone can't put a pill in their mouth once a day to prevent them having a heart attack, it's highly unlikely they'll do an exercise program for their back pain (a sobering fact that highlights the utility of a coach for accountability).

I hope this makes it clear that, despite what some studies say, a diagnosis of low back pain isn't as hopeless as it sounds.

If you can see past the confusing evidence, the economic incentives of the healthcare system and our fallible human nature, you can find a solution for your pain.

This requires a thorough assessment, not a random treatment that may give you some temporary relief of your symptoms. This is the starting point of the McGill Method that I use with my clients.

The next time your physical therapist asks you to lie on a table under a heat lamp, remember that this is the equivalent of expecting your broken-down car to start when you pump up its tyres.

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