More Difficult than Regular Back Pain
BRLP is a more complex and disabling form of low back pain, often associated with higher pain intensity, greater functional impairment, and reduced quality of life. Although clinical guidelines recommend self-management and exercise as first-line treatments, the study shows that many patients struggle to implement these strategies in their daily lives.
Barriers and facilitators
The study analysed interviews with 40 participants from a previous clinical trial, in which they received chiropractic care combined with home exercise and counselling. Researchers identified several barriers and facilitators to self-management:
Common Barriers:
- Lack of time
- Pain during exercises
- Doubts about the effectiveness of treatment
- Low confidence in one’s ability to manage the pain
Common Facilitators:
- Simple and tailored exercises
- Good relationship with healthcare providers
- Clear information and support
- Desire to reduce pain and improve function
A New Approach: Behaviour Change as the Key
The researchers used the "Behaviour Change Wheel" model to analyse how healthcare professionals can help patients overcome barriers. This includes:
- Education: Providing patients with knowledge about their condition and exercises
- Training: Demonstrating and practicing exercises together with the patient
- Support: Building a safe and trusting relationship
- Goal Setting and Planning: Helping patients set realistic goals and follow up on them
Clinical Relevance
The study emphasizes that self-management is not merely a matter of willpower but requires a targeted effort from both the patient and the clinician. By understanding the psychological and practical barriers, healthcare professionals can better support patients in actively engaging in their own treatment.
Anna-Marie L. Ziegler, Don Thorpe, Douglas Kennedy, Craig Schulz, Stacie A. Salsbury, Gert Bronfort, Roni Evans. Barriers and facilitators to self-management in people with back-related leg pain: a qualitative secondary analysis. Chiropractic & Manual Therapies 2025.