Testing, Graded Exposure, And Reassurance For Low Back Pain
Over the past couple of weeks, we have been looking at and discussing the clinical guidelines for treating low back pain.
We have covered how important reassuring our patients their tissues are safe is a crucial component in their recovery from pain as well as building our therapeutic relationship with them.
We also discussed how important using graded exposure as part of that reassurance is, along with its importance in getting them moving again. So, this week we’ll cover how you can do some simple and effective graded exposure right in your massage therapy treatment room.
But first, we’ll have a look at the orthopedic test that was commonly recommended throughout those clinical guidelines and how to do it. There is a bit of controversy between papers as to how effective this test is, but it is the one that was most commonly recommended, so we felt it important to review.
Here is how to do an SLR (straight leg raise).
Even though the more common use of an SLR for low back pain is to look for a disc issue if you get a positive it is still important to reassure your patient they are okay. Use terms like “it just shows us the area is sensitized right now, so we just need to calm it down”. Try not to alarm them or instill any fear around there being a damaged disc or tissue.
Quite often when patients with low back pain come in, there will be some movements they are fearful of doing. Commonly forward flexion is the one I’ve seen in practice that most people have an issue with, so we’ll look at how we can do some graded exposure to help with that.
If you have a hydraulic table here are some simple things you can do to not only reassure the patient movement is okay, but also to help build up their trust in you:
If you don’t have a hydraulic table, here’s how you can do the same thing with some of the furniture most of us have in our treatment rooms.
The biggest takeaways:
- Provide reassurance to the patient that they are not “damaged”.
- Make them feel safe with the movements.
- Gradually expose them to an increased range of movement.
- Encourage, encourage, encourage your patients!
