Explore a comprehensive approach to treating lower back pain that incorporates physical, mental, and emotional well-being.

Low Back Pain & The Biopsychosocial Approach

In light of the recent Andrew Huberman Podcast released this past week on strategies to strengthen and "proof" your Low Back, I thought I might create this months blog post to to discuss another important factor when dealing with acute or low back pain: the psychosocial influences. 

Now, in order to understand psychosocial influences on the human pain experience, we need to review the "biopsychosocial" model of healthcare. The biopsychosocial model considers pain, health and illness as a result of interactions between biological, psychological, and social factors. Instead of focusing solely on biological factors like disc herniations or tissue damage, it recognizes the influence of psychological factors such as thoughts, emotions, and behaviors, as well as social factors like family dynamics, socioeconomic status, and cultural background. This holistic approach emphasizes the importance of addressing all these aspects to understand and treat health conditions effectively, promoting overall well-being.

Lower back pain can have various causes, and it is important to understand the root cause in order to develop an effective treatment plan. Causes of lower back pain can involve specific tissues (the BIO) such as muscles, discs, narrowing of the spinal canal (stenosis), and degenerative discs or joints in the spine. In the case of physical therapy, however sometimes the diagnosis does not greatly impact the treatment plan. For example, I might give very similar exercises to an individual dealing with radiating leg pain (radiculopathy) than to someone who has pain with bending over (flexion sensitivity). 

One of the key factors to consider when treating lower back pain is the role of psychosocial influences. Research has shown that psychological factors such as stress, anxiety, and depression can greatly contribute to the development and persistence of lower back pain. Additionally, social factors such as work-related stress, family dynamics, and social support can also impact the experience of pain. Therefore, a holistic approach that takes into account both physical and psychosocial aspects is crucial for effective management of lower back pain. This is also one of the primary reasons we focus on getting to know the individual in front of us during our intake process at GoalBound Physical Therapy and Performance.  Otherwise, it is easy to fall into the trap of focusing solely on the "biological" components to low back pain. 

Incorporating Physical Therapy and Exercise

Physical therapy and exercise play a vital role in the treatment of lower back pain. These interventions can help strengthen the muscles that support the spine and lower extremity, improve mobility, and promote proper body mechanics. A qualified physical therapist can develop an individualized exercise program that targets the specific needs of the patient. This may include a combination of stretching/mobility exercises, strengthening exercises, and aerobic activities.

In addition to addressing the physical aspect, physical therapy also incorporates education and behavioral interventions to promote long-term pain relief. Patients are taught proper body mechanics, ergonomics, and strategies to reduce the risk of future injury. By incorporating a guided and progressive exercise program into the treatment plan, individuals with lower back pain can experience improved function, reduced pain, and enhanced quality of life with needing imaging, injections or costly surgeries.

Addressing Mental and Emotional Well-being

The impact of mental and emotional well-being on lower back pain cannot be overlooked. Chronic pain can lead to psychological distress, which in turn can worsen the perception of pain. It is important to address any underlying mental health issues such as anxiety or depression in order to effectively manage lower back pain. For individuals dealing with  stress, anxiety or are having a hard time managing thoughts or feelings, I always recommend consulting with a behavioral health specialist or counselor for additional guidance. There has been a great deal of research that supports the use of cognitive behavioral therapy for the treatment of chronic and widespread pain. 

Various self-management strategies can be employed to address mental and emotional well-being in addition to speaking with a professional. This may include cognitive-behavioral therapy as mentioned above, relaxation techniques, mindfulness meditation, and stress management. By addressing these psychosocial factors, individuals with lower back pain can experience improved pain control, reduced disability, and enhanced overall well-being.

Creating a Lifestyle Plan for Long-Term Relief

In order to achieve long-term relief from lower back pain, it is important to create a lifestyle plan that incorporates healthy habits and self-care practices. This includes eating a well-balanced diet consisting of mostly whole foods, exercising regularly, avoiding prolonged sitting or standing, and prioritizing quality and quantity (7-9h/night) sleep. Many studies have demonstrated that insufficient sleep can exacerbate pain and reduce the body's ability to heal and actually lower your bodies sensitivity to pain (meaning it takes less for you to experience pain!). 

Additionally, stress management techniques such as relaxation exercises, and engaging in enjoyable activities can help reduce the impact of stress on lower back pain. 

By adopting and considering a holistic approach and addressing both the physical and psychosocial aspects of lower back pain, individuals can experience improved pain control, enhanced function, and a better overall quality of life.

To bring it full-circle, Dr. Huberman's recent podcast on Low Back Pain focuses mostly on the biological contributions of low back pain. In his defense, he does reference his episode with Dr. Sean Mackey on 1/15/24 in which they discuss the Science of Pain. If you haven't, feel free to check out that episode HERE.

As I eluded to in last month's blog post, it is important to understand that treating back pain is not a one-size fits all approach.  

If you feel this area of your treatment plan in physical therapy has been neglected, don't hesitate to reach out. I would be happy to help you get in touch with a provider who treats clients within a biopsychosocial framework. 

Thank you for taking the time to read and I hope you found the information helpful. If you enjoyed this post please feel free to share with anyone you think might benefit from reading and sign up for the GoalBound PT weekly newsletter!

Keep Moving!

-Doc Liam

*Disclaimer: The content provided in this blog post is for informational purposes only and should not be considered medical advice. It is not intended to replace professional medical diagnosis, treatment, or guidance. Always seek the advice of your physician or qualified healthcare provider before starting any new exercise program, making changes to your treatment plan, or if you have any questions regarding your medical condition. Reliance on any information provided in this blog post is solely at your own risk. The author and publisher of this blog disclaim any liability for any injury, loss, or damage incurred as a result of the use or misuse of the information provided herein.