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Antifragile Clinicians make Antifragile Patients

Posted by Nicholas Dang on
Antifragile Clinicians make Antifragile Patients

‘Basically all I’ve kind of been told to do by physios is to work on my core...I’ve been tested by various different physios, and Pilates, and I’m apparently ridiculously weak.... I had an abortion because I didn’t think I could have a baby. I didn’t think I could handle it...carrying it, and having extra weight on my stomach.’ (32-year-old female with 9 years of persistent low back pain)1

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What’s heartbreaking here is that this common belief that ‘low back pain is caused by a weak core’ has never been backed by good science.

Your health practitioner powerfully influences your health beliefs and attitudes.1 You should be able to trust what they say because they should know more and they usually want to help you. However, good intentions don’t always coincide with good messages.

In a 2021 survey of 288 physiotherapists, the majority believed that:

  • ‘Good posture is important to protect your back’
  • ‘Lifting without bending the knees is not safe for your back’
  • ‘You could injure your back if you are not careful’.2

This is despite there being no compelling research to show that a single optimal posture exists,3,4 and research showing that manual handling training is practically ineffective in reducing back pain and injury. 5 Current understanding is that the back is a robust structure, and back pain often can’t be reduced to a single physical cause (biological, psychological and social stressors can all contribute).

Misconceptions about vulnerability and protection can drive fear related to pain and unhelpful behaviours to avoid pain. Such inaccurate and unhelpful beliefs can have enduring effects on people’s lives.

If your clinician believes your body is fragile and needs protection, you’re more likely to believe the same.

In contrast, if your clinician believes your body is strong and resilient, you’re more likely to believe the same.

Here at WPF, we are advocates of antifragility.

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References:

  1. Darlow et al. (2013) (PMID: 24218376)
  2. Christe et al. (2021) (PMID: 33915318)
  3. Slater et al. (2019) (PMID: 31366294)
  4. Swain et al. (2020) (PMID: 31451200)
  5. Martimo et al. (2008) (PMID: 18244957)

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