Don't we need to know what is wrong with my back before it will get better?

Q. The physiotherapist I am seeing right now doesn't seem very interested in finding out what's wrong with my back. She just wants to analyze my movements and come up with a plan of activities and movements that won't cause pain. That doesn't really get down to the bottom of what's wrong with me. Should I go shopping for a different therapist. If yes, what should I look for?

A. Based on the results of many studies over the last 10 years, physiotherapists are trying to categorize low back patients into subgroups. These groups are based on patient characteristics and recognition of certain pain patterns and movement patterns.

They don't necessarily use the specific location of pain or other symptoms to identify the underlying problem. They don't always try to identify the soft tissues or anatomic structures involved, or diagnose the underlying pathology. Instead, they look for patients who have pain that is constant versus intermittent (comes and goes). They use movement patterns that make the pain better or worse as another way to classify patients.

Of course, treatment should always include education about posture and exercise. The difference is the way exercise is prescribed now. It's no longer one-size-fits-all. Patients identified as falling into one of the classification groups are given exercise strategies specifically designed to find movement patterns that reduce pain while at the same time avoiding movements that bring the pain on or make the pain worse.

If your pain is not caused by a medical problem (e.g., cancer, fracture, infection), then this approach is most likely to work well for you -- and it doesn't require knowing exactly what went wrong. Most of the time, patients with mechanical pain (that's pain brought on by certain movements or postures) doesn't show up as anything recognizable on an X-ray, CT scan, or MRI anyway.

Hamilton Hall, MD, FRCSC, et al. Effectiveness of a Low Back Pain Classification System. In The Spine Journal. August 2009. Vol. 9. No. 8. Pp. 648-657.

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