Lunch with Ben Cormack
Ben Cormack is an internationally recognized powerhouse in sports therapy, rehabilitation, pain science and movement. Ben recently shared his wisdom with our Tall Tree staff via an in-house Lunch & Learn presentation. Here’s what we learned in JUST ONE HOUR with Ben…
Complexity is Inherent to Low Back Pain
When we viewed the literature, it was clear there are many different things that are associated with back pain such as genetics, context, psychology, social factors, etc and so it makes sense that a prescriptive or a one-size-fits-all treatment approach may NOT be a good path forward.
2. The Solution - Patient Centred Care
To move forward, we need to work with our patient, really listen in, deeply understand their needs and values to find solutions. Patient centred care allows us to connect with the human experiencing pain and helps us do two critical things: (1) Develop a narrative that is relevant and makes sense to the person in front of us and (2) provides patients with information that is relevant to their story that helps them learn to control and manage their symptoms (i.e build pain self-efficacy).
3. Embrace Uncertainty!
Because the road to recovery is neither prescriptive nor linear, we are forced to embrace and flourish in the uncertainty. HOW? Use a process/iterative-based approach. This iteration comes from listening completely, making shared decisions on a line of inquiry (i.e exercise) and seeing what happens.
4. Exercise Seems to be Helpful. WHY?
Ben spoke to the steady signal in the literature that exercise is helpful in regards to reducing pain, reducing disability and improving function for many people with acute and chronic low back pain. He then posed the question: how might exercise be mediating the experience of pain?
He referred to eight possible mechanisms: changes in inflammatory markers (TNF-alpha, IL-6, CRP, etc), changes in biomechanics, beliefs, biomotor abilities, blood flow/oxygen, self-efficacy, descending inhibition, and expectations.
Photo Credit: Ben Cormack
5. Pain is Weird!
Ben highlighted a recent systematic review with meta-analysis showing that if strength and fitness outcomes improve, pain does NOT reliably improve and that when we see reductions in pain we do NOT see changes in strength and fitness measures. Yup…pain is weird! One mechanism mentioned that does seem to show more reliable and favourable improvements in pain, disability, and function is building PAIN SELF-EFFICACY.
6. Is Movement Safe?
Now luckily, about 1% of back pain is from serious pathology (cancer, cauda equina, spondyloarthropathy, infection, fractures). This means it’s highly likely it’s safe to move if someone has back pain.
7. But What Exercise is Best?
Data seems to point to the one that gets done - any exercise could 'work'. The one that gets done is often in line with what the patient is already doing, their values or what they want to do, not the one the therapist thinks is best. This is key for intrinsic motivation and getting patients engaged in the plan - it’s all about behaviour change. What I love about this narrative is that it means that we can be creative in our solutions and that not everyone in pain needs to go to gym to reach their goals (patient’s almost always have a sigh of relief when I mention this).
8. Exercise for Pain is DIFFERENT than Exercise for Fitness
Knowing our patient’s stage of recovery (acute / chronic), level of symptom irritability, and values are just some of things we can use to help guide our clinical reasoning on where to get things started. We shouldn’t just send someone blindly to the next yoga class or the gym in an effort to help. The main point here was that we want to help people find movement/exercise they will and want to do which means they move/exercise more regularly, and will be afforded more opportunities to engage with their issue, learn how it behaves, and learn what is uniquely helpful for them. They essentially build self-efficacy and are more likely to reach their goals.
9. What is an Enactive-Biopsychosocial Approach?
Ben has recently written a paper discussing the history of the BPS model, how it’s been misinterpreted and how we should move forward. Moving forward looks like using an enactive-BPS approach. In the clinic, this means treating someone like you would treat a family member or friend, adopting a humanistic approach and considering how the person's environment shapes behaviours. By thinking and interacting in this way, Ben argues we can make people feel safer to move which is important and congruent with an active approach. These types of interactions that involve listening to people’s concerns and co-constructing a plan with them is key for building therapeutic alliance and facilitating behaviour change. This is not a medical transaction, it’s all about changing behaviour. If we don’t build an alliance we may not get the information needed to help make effective change.
There was just too much to cover in this session so I will leave you with one final quote.
So let’s give the person and not the pain some agency! If this is what we got by just sitting down for lunch with Ben, imagine what you will get from his 2 day course!
This course will help you to thrive in the complexity. For low back pain and beyond, you will master your assessment, practice with greater ease, and change your clients’ outcomes and lives for the better! Click the button below to visit the course home page where you can learn more about the details of the 2-day master class and sign up!
