Your Mindset Matters More Than You Think

Last week, we covered ergonomics. This week, I'm shifting gears from the physical to the psychological. I won't tell you to go and buy crystals and start praying to the lumbar spine god, but I will be honest. Your mindset matters.

Your Mind and Body are Neighbours

Your body and mind are neighbours, and they both borrow from each other, often. A study of over 500,000 adults in Sweden [1] found that:

• Pain and mental illnesses influence each other simultaneously
  • "Pain causes depression and depression causes pain"
• People with pain are 2x more likely to develop anxiety/depression, and people with anxiety/depression are 2x more likely to develop pain

Your mind and body share the same nervous system and the same biology. To state that pain is 'purely physical' or 'all in your head' would be incorrect. The shared nervous system shapes the experiences of the body and mind.

Understanding this shifts us from helplessness to a practical place where positive thoughts and beliefs help calm the nervous system.

Beliefs Predict Recovery

A logical progression from the last section is to examine research findings on how beliefs shape recovery and subjective experiences of pain. So-called "yellow flags", which are essentially how people feel about their pain, are highly predictive of pain outcomes [2,3]. Some of these yellow flags include:

• Illness beliefs
• Fear of movement
• Low confidence
• Catastrophizing

Self-efficacy and depression levels are strong predictors of rehab outcomes [3]. Well then, why don't we all just sit around and believe that things will get better while taking no action at all? It doesn't quite work like that. Our beliefs and thought patterns do influence our biology, but so do our movements and daily habits. If you think about it, a person who believes that they can't get better is more likely to engage in destructive behaviours and less likely to dedicate themselves to a structured recovery plan.

Fear Avoidance

This is where we get specific to back pain. Some people with back pain avoid movement because they interpret pain as dangerous. Avoiding movement is a one-way ticket to further disability.

Painful movement → Fear of movement → Decreased movement → lost strength & confidence → Decreased capability → Pain

You can see that this is a self-fulfilling process where pain begets greater disability and pain if the cycle is not broken [4]. A study examined the fear avoidance levels of a cohort of people and then tracked them for a year [5]. They found that people with higher levels of fear avoidance were twice as likely to experience an episode of low back pain.

Pain Catastrophizing

I'm sure we all know someone who thinks the sky is falling every time a minor inconvenience pops up. This person is a catastrophizer - they irrationally jump to the worst possible conclusion and let themselves spiral out of control. In relation to pain, catastrophizing thoughts may begin like:

• "This is terrible and getting worse."
• "I can't stop thinking about my pain."
• "Nothing will help."
• And general negative thoughts that reinforce the pain state

A review study of this topic found that catastrophizing thoughts predicted worse pain intensity and disability [6]. The good news is that reductions in catastrophizing behaviours were associated with better pain outcomes!

So, What Should We Do? What Helps?

1. Don't catastrophize
   • Become aware of your negativity towards your pain.
   • Label it.
     • "I'm thinking negative thoughts about my pain."
     • This breaks the loop.
   • Don't indulge in the negativity. Indulging looks like:
     • Ranting about it to a friend or family member
     • Googling things like "will my pain ever get better?"
     • Skipping your walk because your back is a little sore.
2. Stay Active
   • Action is the antidote to anxiety. Keep moving.
   • Flare-ups don't typically require rest, but instead graded returns to full activity. See my previous newsletters on Back Pain Flare-ups and Movement Tweaks and Tips for specific instructions
3. Build confidence
   • Give yourself a stack of undeniable proof that you can manage back pain and keep moving
     • Let the small wins add up. Do this by showing up and sticking to the plan.
4. Have realistic expectations
   • People who expect to recover tend to recover more [7]
   • Believing that improvement is possible encourages behaviours that lead to better outcomes and mental health states
   • You don't have to become a beacon of "toxic positivity", just remind yourself that things can get better and don't assume the worst

This is one of those topics that doesn't get enough airtime. The research is clear. How you think about your pain shapes how you experience it. That doesn't mean it's all in your head. It means your head is part of the equation, and that's actually good news, because it's something you can work on.

As always, have a great weekend.

Best,

Mitch

References

[1] Bondesson et al. (2018) — https://doi.org/10.1002/ejp.1218

[2] Glattacker et al. (2013) — https://doi.org/10.2340/16501977-1104

[3] Glattacker et al. (2018) — https://doi.org/10.1037/rep0000200

[4] Leeuw et al. (2007) — https://doi.org/10.1007/s10865-006-9085-0

[5] Linton et al. (2000) — https://doi.org/10.1080/08870440008407366

[6] Wertli et al. (2014) — https://doi.org/10.1097/BRS.0000000000000110

[7] Cancelliere et al., (2016) — https://pubmed.ncbi.nlm.nih.gov/27610218/