Two and two is not always four. Four is one of the many possible hypothesis.
On Manual Therapy 15 (2010) 382-87, Cormac G. Ryan’s group from Glasgow Caledoniam University published a study that should make an impact, although I’m afraid that it will remain unnoticed.
I usually don’t make entries about articles but I think the occasion deserves it.
The authors studied the effectiveness of teaching about the biology of pain and exercise in low back pain-sufferers.
One group was only given education, words. A course of two and half hours on basic concepts of neurons, fear of movement, pain does not mean damage, live a normal life… following Butler’s and Moseley’s guidelines.
Another group is given, in addition to words,an aerobic exercise program for the spinal muscles.
Previously, there were some studies that showed the effectiveness of pedagogy on the biology of pain (Moseley), the inefficiency of pedagogy isolated on the biomedical, structural model, and effectiveness of aerobic exercise.
Since exercise and pedagogy on the biology of pain are beneficial, then joining those two virtues, verb and action, knowledge and exercise, optimal results should be obtained.
A + B, A and B beneficial, should be higher than A + 0 (no B).
A (education on biology of pain) + 0 (no exercise) has better results than A + B (exercise)
Adding exercise removes some of the benefits produced by pedagogy.
Just attending one simple class (blah, blah, blah) the student learns basic neurobiology of pain and its sufferer condition gets better significantly: “know pain, no pain”
Knowing that pain is different from damage and getting rid of the fear of movement is necessary and sometimes sufficient to feel relief.
There’s nothing like continuing with the usual activity.
If, after attending these biology of pain lessons, the student attends workout sessions, something changes and he or she goes back to his or her sufferer state. It could be that the exercises reactivate prior expectations of “muscle-skeletal” pain.
Muscle-skeletal pedagogy is ineffective if it does not fit the ritual of exercise.
Muscle-skeletal exercises trim the effectiveness of neurobiological pedagogy.
If we tell the sufferer: ‘your spine is a mess’ and we don’t do anything about it afterwards, it sure gets worse.
If we tell the student that his or her spine is reasonably apt for the struggle, and that what pain indicates is that the brain fears action and not the way the spine is, the situation gets better as long as no one else (more or less intentionally) suggests once again that the spine column needs help (financial).
– So, it’s all about talking? No exercise or anything?
– That’s right. Don’t be afraid to move to achieve your goals. Forget about your spine. No exercise routines to strengthen… forget about the concept that your body cannot hold weight…
We do not need more muscle, but more knowledge… learn to unlearn…