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I was coming along fine in my physical therapy program for back pain. Then a new therapist saw me and added a program called graded exposure. He wanted me to start doing things that I'm afraid will increase my pain. Sure enough, I got much worse again. My regular therapist thinks there's some value in trying this new approach. Is she just covering for this other guy? I don't want to seem uncooperative, but I don't want to get worse either.
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New information on the role of psychological factors in chronic low back pain (LBP) is being reported and studied. One of the latest models for managing LBP is called the Fear-Avoidance Model (FAM). The idea is that fear of movement and fear of re-injury result in avoiding movement and eventually lead to loss of function and disability.
Studies show support for this idea. Pain-related fear affects how patients respond to their pain. Pain catastrophizing is a part of the problem. People who catastrophize tend to do three things. They think about their pain and can’t stop thinking about how much it hurts. They blow their pain out of proportion and are afraid that there might be something really serious wrong. And they feel helpless to change their pain, believing that there is nothing they can do to reduce their pain.
Two methods to reduce fear-avoidance behavior are being studied: graded exercise or graded exposure. Graded exercise starts by finding out how much exercise each patient can do before their pain stops them. This is referred to as exercising to pain tolerance. Then the patient is enrolled in a program that starts with that level of exercise or activity. The therapist guides the patient in building tolerance by slowly increasing duration, intensity, and frequency of the exercise or activity.
The graded exposure approach starts by looking at which activities patients are fearful of (e.g., lifting, carrying, twisting, bending). Each of those activities is then practiced under the supervision or guidance of the physical therapist. Patients start at a level that feels safe to them. They rate their fear before and after each activity. As their fear goes down, the frequency, intensity, and duration of the activity is increased. Then they are encouraged to start doing the same things at home on their own.
There is some evidence that this type of approach is beneficial for patients with low back pain. It may help keep you from progressing to a point that you have chronic low back pain. Or if you've had pain for more than six months, it can help you get back on track to increase function and reduce disability despite your pain.
Some patients just go too fast with this program. They may increase the frequency, intensity, or duration of an activity because it doesn't hurt. But later they experience an increase in painful symptoms. At that point, the therapist will help them back off and start again more slowly. That may be your situation. You may want to work with your therapist a little longer before giving up on this approach. It can be very successful in restoring more independent function over time.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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