Dr. Peter O'Sullivan - A Paradigm Shift In Understanding and Treating Back Pain

Synopsis: Historically back pain has been thought to be caused by an injury, resulting in damage to the spine. This belief has driven exponential increases in radiological imaging to identify ‘pathological structures’, injections to detect ‘painful structures’ and in some cases surgery directed to the these structures. Physiotherapy practice has responded to this problem with a various manual treatments and exercise interventions with a view to correct ‘biomechanical faults’ presumed to be underlying the problem. These approaches together have not arrested the escalating cost and disability burden of back pain in our community.

In contrast to these beliefs, contemporary research suggests that back pain often develops in adolescence and sets a trajectory for later life. It is rarely caused by injury and findings on MRI scan correlate poorly with the back pain experience. Furthermore biomechanical faults are not strongly causally linked to back pain and people with disabling back pain present with excessive trunk muscle co-contraction rather than a lack of ‘core stability’.

There is growing evidence that disabling back pain is associated with unhelpful beliefs and behaviors that drive fear, distress, sensitization, protective guarding and avoidance. Current clinical practice often reinforces and exacerbates this process.

This evidence challenges current practice to reframe our understanding and management of back pain disorders. A Cognitive functional approach provides a personalized evidence based understanding of low back pain, pain control strategies to enable people to build confidence to return to feared and avoided valued activities and addresses unhelpful lifestyle behaviors. There is growing evidence that this approach results in larger long-term benefits over traditional approaches.



2017 Keynote Peter O'Sullivan, Dip Physio, Post Grad Dip Manip Ther, PhD, FACP, APAM, is Professor of Musculoskeletal Physiotherapy at Curtin University, Perth, Australia. In addition to his teaching and research at Curtin University, he works in clinical practice as a Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists in 2005) in Perth, Australia. He is recognized internationally as a leading clinician, researcher and educator in the management of complex musculoskeletal pain disorders.