Does your low back hurt? Is it so bad that you are thinking about seeking help? If so, you are not alone, which you are probably already aware of. Low back pain, also known as lumbar spine pain, occurs at any age and is one of the most common reasons why people seek medical treatment.
It can be reassuring to know that this is usually a benign condition. Typically, you feel better for a period, maybe quite well, and then the problems reoccur after you have done something that has affected your back negatively.
“Very few people with back problems have a serious illness. It’s usually said that in 80–90 per cent of cases you can’t find an exact structure in the back that hurts, but the person has what’s called non-specific back problems,” says Karin Schröder, physiotherapist and associate professor at the Department of Health, Medicine and Caring Sciences, HMV.
Worry can make it worse
In addition to pain, it is common for the affected person to be limited in their movements. The pain causes many people to be afraid to move, which negatively affects the whole body.
“There’s a lot of concern linked to back problems and pain, so it’s important for us to be able to explain that it’s benign and that it’s not good to just stay in bed,” says Karin Schröder.
In her work as a physiotherapist, she and her colleagues focus on how the person is affected by their back problems and how the symptoms can be managed.
“We treat restrictions in mobility with adapted movement,” says Allan Abbott, physiotherapist and professor of physiotherapy at HMV.
In recent years, intensive efforts have been made in Östergötland to develop a physiotherapy care programme for back problems.
Several keys to success
It all started in 2016. Rehabilitation care managers in Region Östergötland saw a need for a joint approach in the treatment of low back problems and in ensuring evidence-based care. Birgitta Öberg, professor of physiotherapy, was one of those who took on the challenge of developing a research plan for the care programme that was named BetterBack. A few years later, they were joined by another professor of physiotherapy, Allan Abbott.
The researchers believe that an important factor behind the success of the programme is that physiotherapists within the healthcare system’s rehabilitation organisation have been involved throughout the development and implementation of the programme.
“It’s very important that those who will use the research in their clinical work are involved from the start and are committed to designing, implementing and evaluating the care programme,” says Allan Abbott.
The support from managers has also been crucial. They were the ones who came up with the idea and the managers of the various operational units have supported the work all the way.
The work resulted in evidence-based recommendations for how primary care should take care of patients with low back pain. The recommendations include support tools, a training programme with exercises that are easy to use and can be adapted to the user’s abilities.
Since those suffering from back pain also often seek information about their condition and what they can do, BetterBack includes a brochure and an educational initiative.
“For us, it was important that the education would not only consist of healthcare professionals giving lectures but also include discussions where patients can talk about what pain is and how to manage their own back problems. The idea is to provide a toolbox that patients can use when their back feels worse and allowing them to find an optimal level of activity,” says Karin Schröder.
Important to see the whole picture
Many people might think that back pain is simply about muscles, joints and vertebrae – the biological machinery, so to speak. But according to research, other aspects are also important, such as stress and worry, fear of moving if it hurts, the individual’s experience of their condition and depression. Therefore, part of the model of care involves the treating physiotherapist broadening their perspective to consider the whole picture of the patients’ well-being.
So far, the work has resulted in eight research articles and two doctoral theses. Studies by the LiU researchers have shown that patients treated by physiotherapists following the model of care recommendations experience reduced symptoms and an improved quality of life.
International recognition
The success does not end there. In the autumn of 2024, a group of Portuguese researchers reviewed the research evidence for various care programmes for low back pain. They found that, so far, BetterBack is the only programme in the world that has been evaluated in a structured way in research studies based on effects at the caregiver, patient and organisational levels, and that the strategies for introducing the care programme were based on accepted strategies and theories.
BetterBack is also an important part of the national care process for low back problems that has been developed recently and is now being introduced in healthcare across the country.
“BetterBack is a cornerstone of the national care process, which makes it clear that in the case of low back pain, treatments based on movement should be exhausted before medication or surgery,” says Allan Abbott, who has chaired the national working group that has developed the care process.
Empowers people to help themselves
He thinks that a major advantage of using activity and movement to treat problems that limit the individual's movements is that the person does not become dependent on the health care system.
“They have the power. For me, it’s very rewarding to see people gaining an increased ability to handle their own conditions. I help them find the tools, so that they can then use them independently,” says Allan Abbott.
Karin Schröder agrees:
“Yes, it’s important that patients can manage their own conditions, as back pain often recurs throughout life.”
This article is also published in LiU Magazine (in Swedish)
