Curtin School of Allied Health (Physiotherapy), Curtin University, Perth, Western Australia, Australia.
Physiotherapy Department, Royal Perth Hospital, Perth, Western Australia, Australia.
Eur J Pain. 2022 Nov;26(10):2097-2119. doi: 10.1002/ejp.2022. Epub 2022 Sep 5.
Movement and posture are commonly believed to relate to low back pain (LBP). Yet, we know little about how people make sense of the relationship between their LBP, movement and posture, particularly after recovery. We aimed to qualitatively explore this understanding, how it changes and how it relates to quantitative changes.
A mixed method study in the context of an existing single-case design involving 12 people with disabling non-specific LBP. Interviews were conducted before and after a 12-week physiotherapy-led Cognitive Functional Therapy intervention, and qualitative findings from these were integrated with individualized, quantitative measures of movement, posture, psychological factors, pain and activity limitation.
Strong beliefs about movement and posture were identified during the baseline interviews. Lived experiences of tension and stiffness characterized the embodiment of 'nonconscious protection', while healthcare and societal messages prompted pain-related fear and 'conscious protection'. Through varied journeys, most participants reported improvements over time with less protective movement and postural strategies. For some, being less protective required focused attention ('conscious non-protection'), but most returned to automatic, normal and fearless patterns ('nonconscious non-protection'), forgetting about their LBP. One participant reported no meaningful shift, remaining protective. Greater spinal range, faster movement, more relaxed postures and less back muscle EMG accompanied positive changes in self-report factors.
The findings offer a framework for understanding how people make sense of movement and posture during the process of recovery from persistent, disabling non-specific LBP. This involved a re-conceptualisation of movement and posture, from threatening, to therapeutic.
Findings from qualitative interviews before and after a Cognitive Functional Therapy intervention in 12 people with disabling low back pain highlighted an individualized recovery journey from conscious and nonconscious protection to conscious non-protection for some, and nonconscious non-protection for many. Pre and post-quantitative measures of movement, posture, psychological factors, pain and activity limitation integrated well with the qualitative findings. The findings suggest movement and posture may form part of a multidimensional pain schema.
运动和姿势通常被认为与下腰痛（LBP）有关。然而，我们对人们如何理解 LBP、运动和姿势之间的关系知之甚少，尤其是在康复之后。我们旨在定性地探讨这种理解，以及它是如何变化的，以及它与定量变化的关系。
在一项现有的单病例设计的背景下进行混合方法研究，涉及 12 名患有非特异性、致残性 LBP 的患者。在 12 周的物理治疗为主的认知功能治疗干预之前和之后进行了访谈，并将这些访谈的定性发现与个体化的运动、姿势、心理因素、疼痛和活动受限的定量测量相结合。
在基线访谈中确定了对运动和姿势的强烈信念。紧张和僵硬的生活经历体现了“非自觉保护”，而医疗保健和社会信息则引发了与疼痛相关的恐惧和“自觉保护”。通过不同的旅程，大多数参与者报告随着时间的推移有了改善，保护性的运动和姿势策略减少了。对于一些人来说，减少保护需要集中注意力（“自觉非保护”），但大多数人恢复了自动、正常和无畏的模式（“非自觉非保护”），忘记了他们的 LBP。一名参与者报告没有明显的转变，仍然保持保护状态。更大的脊柱活动范围、更快的运动、更放松的姿势和更少的背部肌肉 EMG 伴随着自我报告因素的积极变化。
这些发现为理解人们在从持续、致残性非特异性 LBP 中康复的过程中如何理解运动和姿势提供了一个框架。这涉及到对运动和姿势的重新概念化，从威胁到治疗。
对 12 名患有致残性低腰痛的患者进行认知功能治疗干预前后的定性访谈结果突出了从有意识和无意识保护到一些患者的有意识非保护，以及许多患者的无意识非保护的个体化康复过程。运动、姿势、心理因素、疼痛和活动限制的预定量和定量测量与定性发现很好地结合在一起。研究结果表明，运动和姿势可能是多维疼痛模式的一部分。
