In a qualitative analysis, researchers examine the chiropractor’s central role in supporting patient behaviour change in relation to self-management of low back pain with radiating leg pain. The analysis contributes new insights into the factors that hinder and facilitate self-management, and how clinicians can specifically support behaviour change in clinical practice.
Low back pain with radiating leg pain is often associated with higher pain intensity, greater functional impairment, and a poorer prognosis than uncomplicated low back pain. National and international clinical guidelines recommend exercise, patient education, and self-management as core components of treatment. Nevertheless, both research and clinical practice show that many patients struggle to adhere to these recommendations.
This qualitative analysis provides practice-oriented insights into self-management of low back pain with leg pain and offers a theoretically grounded basis for strengthening the patient’s active role in treatment. For chiropractic practice, the findings highlight the importance of relationship, communication, and individualization as key elements of evidence-based care.
Basis and Methods of the Analysis
The analysis is based on a secondary analysis of qualitative interview data from a randomized clinical trial, in which participants with subacute and chronic low back pain with leg pain received spinal manipulative therapy combined with home exercises and advice. The focus is on participants’ own experiences of working with exercises and self-management during the treatment course.
Data were analysed using the Behavior Change Wheel (a psychological framework guiding the design of effective behaviour change interventions) and the associated COM-B and TDF frameworks, which are used to systematically map behaviour in relation to capability, motivation, and opportunity. The aim was to identify patterns that are of direct relevance to clinical practice.
Barriers to Patient Self-Management
The analysis shows that barriers to self-management are complex and often overlap. The most frequently reported barriers included:
- Lack of time in daily life to perform exercises
- Pain or fear of symptom exacerbation during exercise
- Uncertainty about correct execution and relevance of exercises
- Limited belief in the effectiveness of exercises
- Lack of clear goals for the effort
The barriers varied between patients and over time, highlighting the need for an individualized approach and ongoing adjustment of recommendations.
Factors Facilitating Self-Management
The analysis also identifies several factors that clearly support patient engagement in self-management, including:
- A trusting relationship between patient and clinician
- Clear and simple exercises tailored to the patient’s current level
- Repeated instruction and opportunities for feedback
- Clear, realistic goals linked to function and daily activities
- Experience of symptom relief or functional improvement
In particular, the therapeutic relation was highlighted as consistently important across motivation, confidence, and adherence.
Clinical Perspectives for Chiropractic Practice
The results suggest that chiropractors have a central role in facilitating self-management by systematically integrating elements of behaviour change into treatment, for example by:
- Demonstrating and supervising exercises in the clinic
- Working with progression and adaptation of exercises over time
- Aligning expectations and addressing concerns early in the treatment process
- Using simple and concrete goal setting
- Following up on both effort and outcomes during review visits
Thus, the analysis supports a focus not only on what recommendations are given, but also on how they are communicated and followed up in clinical practice.
Anna-Marie L. Ziegler, Don Thorpe, Douglas Kennedy, Craig Schulz, Stacie A. Salsbury, Gert Bronfort, Ronni Evans. Barriers and facilitators to self-management in people with back-related leg pain. Chiropractic & Manual Therapies, 2025.
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